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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Lesion Type and Location Identification
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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| colour | Red |
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| title | Issue (CT/Domain) |
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- should TUTEST be: Lesion Location Identification, and TULNKID = Aneurysm 1?
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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 | TUTESTCD | TUTEST | TULOC | TUORRES | TUSTRESC |
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TU Result LOC | TU Result LOC Detail| TURESLOC | TURLODTL | TUMETHOD | VISITNUM | VISIT | TUDTC |
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| 1 | ABC | TU | ABC-123 | 1 | 1 |
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Aneurysm 1Aneurysm | Lesion Indicator | Thoracic region | Y | Y |
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| CT SCAN | 1 | BASELINE | 2020-04-27 | | 2 | ABC | TU | ABC-123 | 2 | 1 | Aneurysm 1 |
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| ABNEXAM | Examination for Abnormality |
Aneurysm Location IdentificationLocated| Aneurysm | Aneurysm | Thoracic Aorta | Aortic Arch to Descending aorta | CT SCAN | 1 | BASELINE | 2020-04-27 | | 3 | ABC | TU | ABC-123 | 3 | 2 | Dissection 1 |
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Dissection Indicator| ABNEXAM | Examination for Abnormality | Thoracic region |
Y | CT SCAN | 1 | BASELINE | 2020-04-27 | 4 | ABC | TU | ABC-123 | 4 | 2 | Dissection 1 | Dissection Location Identification | Thoracic region | Located | | Arterial Dissection | Arterial Dissection | Descending aorta |
| CT SCAN | 1 | BASELINE | 2020-04-27 |
55Aneurysm 2Aneurysm | Lesion Indicator | Abdominal region | Y | Y |
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| CT SCAN | 1 | BASELINE | 2020-04-27 |
66| 5 | 3 | Aneurysm 2 | ABNEXAM | Aneurysm Location Identification | Abdominal region |
Located| Aneurysm | Aneurysm | Infrarenal aorta | proximal to the iliac bifurcation | CT SCAN | 1 | BASELINE | 2020-04-27 |
77| 6 | 4 | Dissection 2 | ABNEXAM | Dissection |
IndicatorLocation Identification | Abdominal region |
Y | CT SCAN | 1 | BASELINE | 2020-04-27 | 8 | ABC | TU | ABC-123 | 8 | 4 | Dissection 2 | Dissection Location Identification | Abdominal region | Located| Arterial Dissection | Arterial Dissection | Infrarenal aorta | proximal to the iliac bifurcation | CT SCAN | 1 | BASELINE | 2020-04-27 |
10 | ABC | TU | ABC-123 | 1 | 1 | Aneurysm 1 | Cardiovascular Lesion Indicator | Thoracic region | Y | CT SCAN | 1 | BASELINE | 2020-04-27 | | 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 | CT SCAN | 1 | BASELINE | 2020-04-27 | 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
Diameters of the identified aneurysms are measured and are mapped to TR. LNKID is used to link TU and TR.
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| Rowcaps |
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| Row 1: | I | examined measured the | image diameter of the thoracic | region (test location) and found an aneurysm, which was identified as "Aneurysm 1"aortic aneurysm where LNKID = Aneurysm 1. |
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| Row 2: | I | examined measured the | image diameter 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..abdominal aortic aneurysm where LNKID = Aneurysm 2. |
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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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| #e3fcef | | hi1 | TRLOC |
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| tableid | TR1 | tableid | tu1 |
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TUSEQTUGRPIDTULNKIDTUTESTTUORRESTULOCTUMETHODTUDTCTU1| 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 |
6ABC | TU | ABC-123 | 5 | Dissection 1 | Dissection Location | Descending aorta | Thoracic regionCT SCAN | 1 | BASELINE | 2020-04-27 | 7 | TU6 | 3Aneurysm IndicatorY | Abdominal region | CT SCAN | BASELINE | 2020-04-27 | 8 | ABC | TU | ABC-123 | 7 | 3 | Aneurysm 2 | Aneurysm Location | Infrarenal aorta | Abdominal region |
| Luminal Diameter | 3 | cm | CT SCAN | 1 | BASELINE | 2020-04-27 |
9 | ABC | TU | ABC-123 | 8 | Aneurysm 2 | Aneurysm Location Detail | Proximal to the iliac bifurcation | Abdominal region | CT SCAN | 1 | BASELINE | 2020-04-2710 | TU8 | Aneurysm Location DetailProximal 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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Diameters of the identified aneurysms are measured and are mapped to TR. LNKID is used to link TU and TR.
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| Status |
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| colour | Red |
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| title | Issue (Domain) |
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Note for Tumor Findings, it is recommended not to populate TRLOC because locations of tumors have been identified in TU. Should this rule be followed for non-tumor lesion?
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| Rowcaps |
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| Row 1: | I measured the diameter of the thoracic aortic aneurysm where LNKID = Aneurysm 1. |
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| Row 2: | I measured the diameter of the abdominal aortic aneurysm where LNKID = Aneurysm 2. |
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| Dataset2 |
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| hi1style | #e3fcef |
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| hi1 | TRLOC |
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| tableid | TR1 |
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| Row | STUDYID | DOMAIN | USUBJID | TRSEQ | TRLNKID | TRTEST | TRLOC | TRORRES | TRORRESU | TRMETHOD | VISITNUM | VISIT | CVDTC |
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| 1 | ABC | TR | ABC-123 | 1 | Aneurysm 1 | Lesion Diameter | Thoracic Aorta | 6 | cm | CT SCAN | 1 | BASELINE | 2020-04-27 |
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2| 4 | ABC | TR | ABC-123 | 24 | Aneurysm 2 | Lesion
| Luminal Diameter | Infrarenal aorta | 74 | cm | CT SCAN | 1 | BASELINE | 2020-04-27 |
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The dissected descending aorta (LNKID =Dissection 1) is classified based on the Stanford Aortic Dissection System as type B.
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| Dataset2 |
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Row | STUDYID | DOMAIN | USUBJID | RSSEQ | RSLNKID | RSTESTCD | RSTEST | RSCAT | RSORRES | RSSTRESC | VISITNUM | VISIT | CVDTC |
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| 1 | ABC | RS(CC) | ABC-123 | 1 | Dissection 1 | STAN0101 | STAN01-Stanford |
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AoD Hiratzka Dissection 2010 | Stanford B | 1 | BASELINE | 2020-04-27 | |
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| Info |
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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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| hi1style | #e3fcef |
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| hi1 | PRLOC |
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| tableid | PR1 |
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Row
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STUDYID
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DOMAIN
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USUBJID
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PRTRT
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VISIT
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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, and an aneurysm in the left renal artery, 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.
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| of Aortic Dissection Type | STANFORD AOD CLASSIFICATION | Stanford B | Stanford B |
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| hi1style | #e3fcef |
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| hi1 | 3,5 |
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| tableid | TU3 |
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Row
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STUDYID
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DOMAIN
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USUBJID
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TUGRPID
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TUTEST
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TUORRES
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TULOC
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TUMETHOD
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VISITNUM
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VISIT
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TUDTC
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ABC
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Located
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Located
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The problem with the way TU is set up now, which is originally designed for tumor identification, and you only care about "already identified tumors", is that it only allows the creation of 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. 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.
The example below models TAA and AAA according to the current TU domain structure. Note i am unable to map the negative identification record.
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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
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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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