PS-2020a / part17

YYY.1.2 Example of exogenous substance administration to encode tumor cell line​

Onlytheexogenoussubstanceinformationisincludedinthisexampleandcontentdescribinganimalhandling,anesthesiainformation,​ etc. is excluded for clarity. Indeed, given the optionality of the other content, it would be possible to create an Acquisition Context SR​ instance that describes only the exogenous substance information and nothing else.​

The content tree structure would resemble:​

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YYY.1.3 Informative References​

YYY.1.3.1 Method Descriptions​

[Stout et al 2013] Molecular Imaging. Stout D, Berr SS, LeBlanc A, Kalen JD, Osborne D, Price J, Schiffer W, Kuntner C, and Wall J.​ 2013. 12. 7. 1-15. “Guidance for Methods Descriptions Used in Preclinical Imaging Papers”. http://journals.sagepub.com/​ doi/pdf/10.2310/7290.2013.00055 .​

[David et al 2013a] Comparative Medicine. David JM, Chatziioannou AF, Taschereau R, Wang H, and Stout DB. 2013. 63. 5. 386–91.​ “The Hidden Cost of Housing Practices: Using Noninvasive Imaging to Quantify the Metabolic Demands of Chronic Cold​ Stress of Laboratory Mice”. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3796748/ .​

[David et al 2013b] Journal of the American Association for Laboratory Animal Science. David JM, Knowles S, Lamkin DM, and Stout​ DB. 2013. 52. 6. 738–44. “Individually Ventilated Cages Impose Cold Stress on Laboratory Mice: A Source of Systemic Ex-​ perimental Variability”. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3838608/ .​

[Rosenbaum et al 2009] Journal of the American Association for Laboratory Animal Science. Rosenbaum MD. 2009. 48. 6. 763–73.​ “EffectsofCage-ChangeFrequencyandBeddingVolumeonMiceandTheirMicroenvironment”. http://www.ncbi.nlm.nih.gov/​ pmc/articles/PMC2786931/ .​

[Fueger et al 2006] Journal of Nuclear Medicine. Fueger BJ. 2006. 47. 6. 999–1006. “Impact of Animal Handling on the Results of​ 18F-FDG PET Studies in Mice”. http://jnm.snmjournals.org/content/47/6/999 .​

[Dandekar et al 2007] Journal of Nuclear Medicine. Dandekar M. 2007. 48. 4. 602–7. “Reproducibility of 18F-FDG microPET Studies​ in Mouse Tumor Xenografts”. 10.2967/jnumed.106.036608. http://jnm.snmjournals.org/content/48/4/602 .​

[Lee et al 2005] Journal of Nuclear Medicine. Lee KH. 2005. 46. 9. 1531–36. “Effects of Anesthetic Agents and Fasting Duration on​ 18F-FDG Biodistribution and Insulin Levels in Tumor-Bearing Mice”. http://jnm.snmjournals.org/content/46/9/1531 .​

[Balcombe et al 2004] Journal of the American Association for Laboratory Animal Science. Balcombe JP. 2004. 43. 6. 42–51.​ “Laboratory Routines Cause Animal Stress”. .​

[Van der Meer et al 2004] Journal of the American Association for Laboratory Animal Science. Van der Meer E. 2004. 38. 4. 376–83.​ “Short-termeffectsofadisturbedlight–darkcycleandenvironmentalenrichmentonaggressionandstress-relatedparameters​ in male mice”. http://www.animalexperiments.info/resources/Studies/Animal-impacts/Stress.-Balcombe-et-al-2004./​ Stress-Balcombe-et-al-2004.pdf .​

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[Tabata et al 1998] Laboratory Animals. Tabata H. 1998. 32. 2. 143–48. “Comparison of Effects of Restraint, Cage Transportation,​ Anaesthesia and Repeated Bleeding on Plasma Glucose Levels between Mice and Rats”. 10.1258/002367798780599983.​ http://lan.sagepub.com/content/32/2/143 .​

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ZZZ Content Assessment (Informative)​

The following use cases exemplify the use of Content Assessment Results IOD.​

ZZZ.1 RT Plan Treatment Assessment Use Case​

ARTPlanSOPInstanceissentfromaTreatmentPlanningSystem(TPS)toaQualityAssurance(QA)ApplicationandtotheTreatment​ Management System (TMS). The TMS de-composes the content for internal storage. At the time of treatment the TMS re-composes​ the Instance and sends it to the operator console of the linear accelerator. However, during re-composition an error occurs and one​ jaw specification is omitted from the recomposed Instance and the Beam Dose in the Fraction Scheme Module is set to 0.0.​

The operator console requests the QA Application to perform an assessment to compare the copy of the Instance received from the​ operator console with the copy of the Instance received earlier from the TPS. The QA Application retrieves the Instance from the op-​ eratorconsole.TheQAApplicationalsoperformsanassessmentbyre-calculationofthedosimetricparametersintheassessedplan.​ Although the Beam Meterset in the assessed plan (from the operator console) is the same as the Beam Meterset in the comparison​ plan(fromtheTPS),theBeamMetersetre-calculatedbytheQAApplicationisdifferentduetothemissingjaw.Furtheronitisdetected,​ that all Beam Dose values have the value 0.0.​

Beam Meterset for the current treatment device in this example is expressed in Monitor Units.​

Table ZZZ.1-1. Content Assessment Results Module Example of a RT Plan Treatment Assessment​

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%item​

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AAAA Protocol Storage Examples and​ Concepts (informative)​

The following examples are provided to illustrate the usage of the CT Defined and Performed Procedure Protocol IODs. They do NOT​ represent recommended scanning practice. In some cases they have been influenced by published protocols, but the examples here​ may not fully encode those published protocols and no attempt has been made to keep them up-to-date.​

AAAA.1 Protocol Storage Concepts​

AAAA.1.1 Use Cases​

Theprimaryapplications(usecases)consideredduringthedevelopmentoftheCTProcedureProtocolStorageIODswerethefollowing:​

•​Managing protocols within a site for consistency and dose management (Using Defined Protocols)​

•​Recording protocol details for a performed study so the same or similar values can be used when performing followup or repeat​ studies, especially for oncology which does comparative measurements (Using Performed Protocols)​

•​Vendor troubleshooting image quality issues that may be due to poor protocol/technique (Using Performed Protocols, Defined​ Protocols)​

•​Distributing departmental, "best practice" or reference protocols (such as AAPM) to modality systems (Using Defined Protocols)​

•​Backing up protocols from a modality to PACS or removable media (e.g., during system upgrades or replacement); most vendors​ have a proprietary method for doing this which would essentially become redundant when Protocol Management is implemented​ (Using Defined Protocols)​

Figure AAAA.1.1-1. Protocol Storage Use Cases​

Additional potential applications include:​

•​Makingmoredetailedprotocolinformationavailabletorenderingorprocessingapplicationsthatwouldallowthemtoselectprocessing​ that corresponds to the acquisition protocol, to select parameters appropriate to the acquisition characteristics, and to select the​ right series to process/display (Using Performed Protocols)​

•​Improving imaging consistency in terms of repeatable technique, performance, quality and image charateristics; would benefit from​ associated image quality metrics and other physics work (Using Defined Protocols and Performed Protocols)​

•​Distributing clinical trial protocols (general purpose or scanner model specific) to participating sites (Using Defined Protocols)​

•​Recording protocol details for a performed study to submit with clinical trial images for technique validation (Using Performed Pro-​ tocols)​

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•​Tracking/extracting details of Performed Protocol such as timestamps, execution sequence and technique for QA, data mining, etc.​ (Using Performed Protocols)​

•​Making more detailed protocol information available to radiologists reviewing a study and priors, or comparing similar studies of​ different patients (Using Performed Protocols)​

AAAA.1.2 Workflow​

Using non-Patient-specific Protocols​

In most cases, the scanner uses any protocol details in the modality worklist item to present to the technologist a list of matching​ Defined Protocols on this scanner.​

Preparing and executing Patient-specific Protocols​

In the simplest form, this process could be driven with a combination of the Modality Worklist and Defined Protocols.​

Radiologist at the RIS:​

•​Selects a patient procedure on the upcoming Modality Worklist​

•​Adds tech notes to the Worklist entry (e.g., "Use Defined Protocol X; Decrease parameter Y…")​

Technologist at the modality:​

•​Selects the patient procedure on the upcoming Modality Worklist​

•​Reads the tech notes​

•​Selects the identified Defined Protocol and adjusts as described​

Modality​

•​Executes procedure​

•​Stores the Performed Protocol to study folder on PACS​

Radiologist​

•​(Optionally) Reviews the Performed Protocols​

In special cases, the radiologist might attend the scan and modify the protocol directly on the console.​

Note that the primary record of adjustments is the Performed Protocol object (which can be compared to the referenced Defined​ Protocol object).​

A new Defined Protocol is not typically saved unless the intent is to have a new Defined Protocol available in the Library.​

AAAA.2 Routine Adult Head Protocol​

The examples in this Annex are intended to illustrate the encoding mechanisms of the DICOM CT Protocol Storage IODs, not to​ suggest particular values for clinical use. Further, these examples do not contain the many detailed Attributes one would expect from​ a fully executable defined protocol generated by a CT scanner, but they do demonstrate the usage of many common Attributes.​

This section includes Defined Protocol examples of a Routine Adult Head Protocol for several different scanner models. The protocol​ is presented as adjusted by a fictitious Mercy Hospital from a reference protocol referenced in the Predecessor Protocol Sequence.​ AlthoughtheexamplesinthissectionwereoriginallyderivedfromprotocoldocumentspreviouslypublishedbytheAAPM,somevalues​ here were modified and are likely out of date. Parties interested in the current AAPM protocols are encouraged to visit ht-​ tp://www.aapm.org/pubs/CTProtocols/​

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