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IHE Cardiology Technical Framework Supplement Cardiac Imaging ...

IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________253035ForewordThis is a supplement to the IHE Cardiology Technical Framework. Each supplement undergoes aprocess of public comment and trial implementation before being incorporated into the volumesof the Technical Frameworks.This supplement is submitted for Public Comment between April 22, 2011 and May 23, 2011.Comments are invited and may be submitted to the IHE forums athttp://forums.rsna.org/forumdisplay.php?f=249. In order to be considered in development of theTrial Implementation version of the supplement comments must be received by May 23, 2011.Please use the Public Comment Template provided in the thread and submit comments byposting the completed template as an attachment to a Reply or New Thread.This supplement describes changes to the existing technical framework documents and whereindicated amends text by addition (bold underline) or removal (bold strikethrough), as well asaddition of large new sections introduced by editor’s instructions to “add new text” or similar,which for readability are not bolded or underlined.“Boxed” instructions like the sample below indicate to the Volume Editor how to integrate therelevant section(s) into the relevant Technical Framework volume:Replace Section X.X by the following:4045General information about IHE can be found at: www.ihe.netInformation about the IHE Cardiology can be found at: http://www.ihe.net/Domains/index.cfmInformation about the structure of IHE Technical Frameworks and Supplements can be found at:http://www.ihe.net/About/process.cfm and http://www.ihe.net/profiles/index.cfmThe current version of the IHE Technical Framework can be found at:http://www.ihe.net/Technical_Framework/index.cfm__________________________________________________________________________2Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________505560657075808590CONTENTSIntroduction ..................................................................................................................................... 6Relationship to Workflow Profiles............................................................................................. 7Open Issues and Questions ........................................................................................................ 7Closed Issues .............................................................................................................................. 8Volume 1 – Integration Profiles ................................................................................................. 101.7 History of Annual Changes ................................................................................................ 102.1 Dependencies among Integration Profiles ......................................................................... 102.2.X Cardiac Imaging Report Content (CIRC).................................................................. 102.3 Actor Descriptions ............................................................................................................. 11X Cardiac Imaging Report Content (CIRC) Integration Profile ................................................... 11X.1 Actors/ Transactions ....................................................................................................... 12X.1.1 Actor Groupings ........................................................................................................ 12X.2 Cardiac Imaging Report Content Profile Options ............................................................. 12X.2.1 Content Consumer Options ....................................................................................... 13X.3 Use Cases ........................................................................................................................ 13X.3.1 Compile and transfer report of cardiac imaging procedure with use of key imagingdata measures ........................................................................................................ 13X.3.2 Perform discrete data-analysis on procedure report content ................................. 14X.3.3 Review Procedure Report .......................................................................................... 14X.4 Security Considerations .................................................................................................. 15X.5 Grouping ........................................................................................................................... 15X.5.1 Content Bindings for Displayable Reports (DRPT) and Image Enabled Office (IEO)Profiles .................................................................................................................. 15X.5.2 Content Bindings for XDS, XDM, XDR, and XDS-I ............................................... 16X.5.3 Content Binding for Portable Data for Imaging (PDI).............................................. 16X.5.4 Content Binding for Retrieve Form for Data Capture (RFD) ................................... 16X.5.5 Relationship to Document Digital Signature (DSG)................................................. 16X.6 Requirements of CIRC Actors .......................................................................................... 17X.6.1 Content Creator ......................................................................................................... 17X.6.2 Content Consumer ..................................................................................................... 17Volume 2 – Transactions and Content Modules ...................................................................... 183 Framework Overview ........................................................................................................... 183.1 Actors and Transactions ................................................................................................. 183.2 Content Modules ............................................................................................................ 185 Namespaces and Vocabularies .............................................................................................. 195.1 IHE Format Codes .......................................................................................................... 196 Content Modules .................................................................................................................... 206.1 Conventions .................................................................................................................... 206.1.1 Data Element Optionality Constraints .................................................................. 206.1.2 Structure of Content Modules ............................................................................... 206.1.2.1 Document Content Modules ............................................................................... 226.1.2.2 Section Content Modules ................................................................................... 22__________________________________________________________________________3Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________951001051101151201251301356.1.2.3 Entry and Header Content Modules ................................................................... 236.1.2.4 Value Sets ........................................................................................................... 236.2 CDA Release 2 Content Modules ................................................................................... 246.2.1 Document Modules ............................................................................................... 246.2.1.1 Cardiac Imaging Report Specification 1.3.6.1.4.1.19376.1.4.1.1.1 ................... 246.2.1.1.1 Format Code ..................................................................................................... 246.2.1.1.2 Parent Template ............................................................................................... 246.2.1.1.3 Clinical Document Code .................................................................................. 246.2.1.1.4 Standards .......................................................................................................... 246.2.1.1.5 Data Element Requirements ............................................................................. 256.2.1.1.6 Specification .................................................................................................... 266.2.1.1.7 Conformance ................................................................................................... 276.2.2 Section Modules.................................................................................................... 296.2.2.1 Medical History (Cardiac) Section ...................................................................... 296.2.2.2 Medications (Cardiac) Section ............................................................................. 296.2.2.3 Allergies and Other Adverse Reactions (Cardiac) Section .................................. 306.2.2.4 Social History (Cardiac) Section ........................................................................ 306.2.2.5 Family History (Cardiac) Section ....................................................................... 316.2.2.6 Prior Results (Cardiac) Section .......................................................................... 316.2.2.7 Cardiac Risk Assessment Section ...................................................................... 326.2.2.8 Procedure Indications (Cardiac) Section ............................................................ 326.2.2.9 Cardiac Procedure Description Section .............................................................. 346.2.2.10 Medications Administered (Cardiac) Section .................................................... 366.2.2.11 Procedure Findings (Cardiac) Section ................................................................ 366.2.2.12 Assessment And Plan (Cardiac) Section ............................................................ 476.2.2.13 Comparison to Prior Study (Cardiac) Section .................................................... 486.2.2.14 Key Images Section ............................................................................................ 496.2.2.15 DICOM Object Catalog Section ......................................................................... 506.2.3 Header Content Modules ...................................................................................... 516.2.3.1 Encompassing Encounter ................................................................................... 516.2.3.1.1 Responsible Party ............................................................................................. 526.2.3.1.2 Health Care Facility ......................................................................................... 526.2.3.1.3 Referring Provider ............................................................................................ 536.2.3.1.4 Physician of Record ......................................................................................... 536.2.3.2 Order .................................................................................................................... 546.2.3.3 Patient Demographics .......................................................................................... 546.2.3.4 Service Event and Performer ............................................................................... 556.2.3.5 Legal Authenticator ............................................................................................. 566.2.4 Entry Content Modules ......................................................................................... 576.2.4.1 Diabetes Problem Concern ................................................................................. 576.2.4.2 Angina Problem Concern ................................................................................... 576.2.4.3 17-Segment Wall Analysis ................................................................................. 576.2.4.4 Projection Angiography Wall Analysis .............................................................. 586.2.4.5 Coronary Angiography Arterial Analysis .......................................................... 59__________________________________________________________________________4Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________1401451501551601651701756.2.4.6 Pericardial Effusion Entry .................................................................................. 596.3 Value Sets ....................................................................................................................... 611.3.6.1.4.1.19376.1.4.1.5.1 Cardiac imaging services ..................................................... 611.3.6.1.4.1.19376.1.4.1.5.2 Cardiac imaging procedures ................................................ 611.3.6.1.4.1.19376.1.4.1.5.3 Referring Physician Specialty ............................................. 611.3.6.1.4.1.19376.1.4.1.5.4 Cardiac problems/concerns .................................................. 621.3.6.1.4.1.19376.1.4.1.5.5 Cardiac interventions ........................................................... 621.3.6.1.4.1.19376.1.4.1.5.7 Angina Type ........................................................................ 621.3.6.1.4.1.19376.1.4.1.5.10 Contrast Agents Classes for Adverse Reactions ................. 631.3.6.1.4.1.19376.1.4.1.5.11 Contrast Agents .................................................................. 631.3.6.1.4.1.19376.1.4.1.5.12 Cardiac MR Acquisition Modes ......................................... 641.3.6.1.4.1.19376.1.4.1.5.13 Cardiac Lab Results ............................................................ 641.3.6.1.4.1.19376.1.4.1.5.14 Cardiac Drug Classes .......................................................... 641.3.6.1.4.1.19376.1.4.1.5.15 Drug Classes Used in Cardiac Procedure ........................... 651.3.6.1.4.1.19376.1.4.1.5.17 Rhythm Findings ................................................................ 651.3.6.1.4.1.19376.1.4.1.5.18 ECG Findings ..................................................................... 661.3.6.1.4.1.19376.1.4.1.5.19 Myocardium Assessments .................................................. 661.3.6.1.4.1.19376.1.4.1.5.20 Wall motion ........................................................................ 661.3.6.1.4.1.19376.1.4.1.5.21 LVEF Assessments ............................................................. 661.3.6.1.4.1.19376.1.4.1.5.22 Cardiac Chamber Size Assessments ................................... 671.3.6.1.4.1.19376.1.4.1.5.23 Pulmonary Veins Assessments ........................................... 671.3.6.1.4.1.19376.1.4.1.5.24 Imaging Findings ................................................................ 671.2.840.10008.6.1.57 DICOM CID 3261 - Stress Protocols ............................................ 671.2.840.10008.6.1.211 DICOM CID 3710 - Coronary Dominance ................................. 681.2.840.10008.6.1.218 DICOM CID 3717 - Myocardial Wall Segments ........................ 681.2.840.10008.6.1.223 DICOM CID 3722 - Diabetic Therapy ........................................ 691.2.840.10008.6.1.225 DICOM CID 3724 - Smoking History ........................................ 691.2.840.10008.6.1.253 DICOM CID 3758 - Cardiovascular Family History .................. 701.2.840.10008.6.1.616 DICOM CID 12224 - Ultrasound Image Modes ......................... 701.2.840.10008.6.1.744 DICOM CID 3112 - Attenuation Correction ............................... 701.2.840.10008.6.1.755 DICOM CID 3200 - Stress Test Procedure ................................. 711.2.840.10008.6.1.756 DICOM CID 3201 – Indications for Stress Test ......................... 711.2.840.10008.6.1.759 DICOM CID 3204 - Stress Agents .............................................. 721.2.840.10008.6.1.781 DICOM CID 3235 - Perfusion Comparison Findings ................. 721.2.840.10008.6.1.782 DICOM CID 3236 - Tolerance Comparison Findings ................ 721.2.840.10008.6.1.783 DICOM CID 3237 - Wall Motion Comparison Findings ............ 722.16.840.1.113883.3.88.12.3221.5.2 HITSP Health Insurance Type ............................... 73Appendix U – US Realm Requirements ....................................................................................... 75ACC Key Data Elements ................................................................................................................ 0__________________________________________________________________________5Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________180185190195200205210IntroductionThis Supplement introduces a new Profile to the IHE Cardiology Technical Framework, with theoverall design in Volume 1 and specific content in Volume 2. This Profile relies heavily onContent Profile concepts specified in the IHE Patient Care Coordination Technical Framework.This content profile is motivated by cardiologists, who face an increasing demand from patientcare,data-quality and legislative perspectives to increase the usefullness and actionability of(discrete) clinical data across the various care-settings and stakeholders.A solution for such interoperability is, however, not a simple undertaking. Unstructured textualdata forms remains the predominate mechanism for information exchange among health careproviders, and a good majority of data needed by physicians and other health care providers tomake good clinical decisions is embedded in this free text. Efficient and effective interoperabilitytherefore begins by identifying the most relevant clinical data.Clinically-relevant cardiac imaging data is the key value proposition of this profile. Theapproach is to:1. reuse the distribution and structuring work from the XDS ( ITI domain), Medicalsummaries (PCC domain), and exchangable procedure notes (HL7)2. extend it through adding and codifying the Key Data Elements for Cardiac Imaging 1content identified by the ACC/AHA task-force on clinical data standardsThe aim is to enable collection and distribution of the most clinically-relevant discrete data onthe diagnostic imaging procedures common in cardiology. The usage of the discrete data is twofold:1. to enable individual test data to be more easily shared and used between care givers andsystems2. to enable population-based outcomes-based research on test effectivenessThese imaging procedures are used as key constituents of the patient’s treatment during cardiacencounters and disease management. Allowing a means to extract and exchange key cardiacmeasures across providers and their systems will be a huge advantage to providing a complete,accessible and actionable cardiac data set in front of cardiologists.There are very successful quality-improvement programs in place by the professional bodiessuch as the ACC, AHA, and state registries concentrating on the most invasive, and expensivecardiac procedures. However, the vast majority of cardiology imaging usage is in the area ofnon-interventional diagnostic procedures. The aggregate volume and reimbursement level of1 ACC/AHA/ACR/ASE/ASNC/HRS/NASCI/RSNA/SAIP/SCAI/SCCT/SCMR/SIR 2008 Key Data Elementsand Definitions for Cardiac Imaging. JACC Vol. 53, No. 1, 2009.__________________________________________________________________________6Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________215220225230235these procedures mean that there must be significant automated collection/processing of keydiscrete data to make it economical to evaluate effectiveness of these procedures.This supplement provides a framework to make progress on both these goals. This profilecodifies extensive areas of diagnostic imaging indications, procedures, medications,observations, complications and findings and specifies how this discrete data can be exchangedto be used by both care-providers and automated data processing systems.Future work is expected to extend the types of cardiac procedures that can be reported in astructured format to support existing population-based registries e.g. NCDR-PCI forinterventional procedures. Another key target of this future work includes electrophysiology,based on the forthcoming EP key data elements recommendations from the Heart RhythmSociety (HRS).Relationship to Workflow ProfilesCardiac Imaging Report Content (CIRC) is a content profile – it is agnostic with respect to theworkflow or data exchange mechanism in which the data is produced and handled.Content Profiles define how the content used in a transaction is structured. The binding of theContent to an IHE transaction, which is part of an IHE Workflow Profile, specifies how thispayload may influence the metadata or the behavior of the transaction. Content modules withinthe Content Profile then define the payloads. Content modules are transaction neutral, in thatwhat they describe is independent of the transaction in which they are used, whereas contentbindings explain how the payload influences the transaction metadata and/ or behavior.The CIRC content is intended to be deployed, for example, in the Image Enabled Office (IEO)workflow profile for ambulatory care environments, the Displayable Reports (DRPT) workflowprofile for in-patient environments, or the Cross-Enterprise Document Sharing (XDS) profile topropagate the content across organizational boundaries.It is important to note that that key report-generation/distribution workflow aspects such asphysician identification, insurance preauthorization, report routing and acknowledgement, andpatient consent, are out of scope for this Content Profile.Open Issues and Questions# Open Issue Description1 The Supplement uses the convention that a content module cannot have more than oneparent (section 6.1.2), yet in section 6.2.1.1.2 the Cardiac Imaging Report Template isdescribed as being a specialization (descendant) of both the Medical Document templateand the Procedure Note template. This inconsistency needs to be resolved prior to thisprofile being published for Trial Implementation.2 There are a number of instances where codes are missing (or unaccounted for) in someof the value sets listed in the 6.3.x subsections. These gaps need to somehow be resolvedprior to this profile being published for Trial Implementation. Examples of missingcodes include:__________________________________________________________________________7Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________# Open Issue Descriptiona. Missing code for pharma echo Stress tests (just exercise stress)b. Missing codes for some Echo and Cardiac MR procedure acquisitiontypesc. Missing codes for a couple of contrast agentsd. Missing codes for LVEF Assessment conceptse. Missing codes for Cardiac Risk Assessment scores (e.g., Framinghamrisk assessment score). List of concepts has been submitted for inclusionin LOINC.3 How should non-DICOM "images" (such as Bull’s eye diagrams and coronary treediagrams) be included in the Cardiac Imaging Report?5 The current profile supplement does not describe how to identify profile conformance,especially as the template evolves. Is this something that should be covered in thisContent Profile, and if so, how should that be done?6 The supplement currently does not describe how to reference the prior study referencedin the observation(s) within Comparison section. Assuming this referencing should berequired if a comparison section exists, should that reference be done based on someDICOM identifier (e.g., study UID), or some human identifiable item (e.g., study date)?7 Does this supplement need to describe how the content data gets mapped into XDSmeta-data (to see a similar situation, refer to medical summary)? Examples are formatcodes/code-lists that differentiate medical summary from cardiac report. It is believedthat this is "covered" by the reference made to the PCC TF specification for XDSmetadata mapping (specific reference is to XDS-MS). The Cardiology TechnicalCommittee solicits feedback from the PCC Technical Committee on this approach.8 There are some missing details for describing Cardiac Findings in section 6.2.2.11.These gaps in detailed data modeling need to be resolved prior to this profile beingpublished for Trial Implementation. Such missing information is highlighted in yellow.9 A local extension has been specified to allow physician orfacility accreditation to be described. It there a more standard way to handle this?240Closed Issues# Closed Issue Description/ Resolutoin9 Should this Cardiac Imaging Report Template inherit its defintion from both theProcedure Report Implementation Guide and the Basic Diagnostic Imaging ReportImplementation Guide?Answer: This document is not a specialization of the HL7 Basic Diagnostic Imaging__________________________________________________________________________8Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________# Closed Issue Description/ ResolutoinReport template due to conflicts with two Procedure Note requirements (format ofserviceEvent/effeciveTime, and title on DICOM Catalogue section). When and if theseare resolved, an instance may also comply to the Diagnostic Imaging Report.8 The supplement does not aim to be comprehensive for all downstream uses of discretedata - from next-level analysis, discrete data warehousing of clinical record, to registrysubmission.Answer: The Cardiology Technical Committee believes this is acceptable for thefollowing reasons:a. The intent of this content profile is to capture structure and codify the keydiscrete data that is today conveyed in cardiology imaging reports.b. There is no widely accepted standard for report composition across the broadrange of imaging procedures in cardiology.c. Furthermore, registry-submission and clinical records have broader data scopethan individual cardiac procedure reports. The work here is an initial attempt tosupport the communication of discrete cardiac data throughout and betweenenterprises, it will require extension and extensive collaboration in futureupdates to the IHE-TF.4 There are currently no specific requirements for Content Consumers with respect tohaving to handle multiple coding schemes. Should there be?Answer: The use of specific coding schemes to codify the wide variety of conceptincluded in the CIRC Content Profile is frequently a national, regional or even localdecision based on regulation or legislation. Thus the Cardiology Technical Committeedocumented the most common, internationally applicable codes in the value sets defined,but stopped short of mandating specific coding scheme in this specificatin.__________________________________________________________________________9Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________Volume 1 – Integration Profiles245Add the following bullet to the end of the bullet list in section 1.71.7 History of Annual Changes• Added the Cardiac Imaging Report Content which describes the content and format of theclinical report created for a cardiac imaging procedure.250Add the following to Table 2-12.1 Dependencies among Integration ProfilesTable 2-1. Cardiology Integration Profiles DependenciesIntegration Profile Depends on Dependency Type Comments…Cardiac Imaging ReportContentConsistent TimeContent Creator is required to begrouped with Time Client actor255Add the following section to section 2.22602652.2.X Cardiac Imaging Report Content (CIRC)The Cardiac Imaging Report Content (CIRC) Profile specifies the content structure for a clinicalreport of a cardiology imaging exam, recorded in a DICOM Study. Such exams include:• Echocardiography (transthoracic - TTE, transesophageal - TEE, and TTE stress)• Cardiac computed tomography (angiography - CTA, and coronary artery calcium scoring -CACS)• Cardiac magnetic resonance (angiography - MRA, and MR stress)• Cardiovascular nuclear medicine (SPECT myocardial perfusion, positron emissiontomography - PET)• Diagnostic coronary catheter based fluoroscopy (interventional coronary angiography - ICA,and left ventriculography - LVG)The CIRC Profile specifies the use of an HL7 Clinical Document Architecture (CDA) format forthe report.__________________________________________________________________________10Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________270Not included in the scope of this profile are non-imaging studies (e.g., ECG), electrophysiologyprocedures, and non-cardiology procedures (e.g., peripheral angiography). Such use cases maybe supported by other similar content profiles.Add the following section to section 2.32752802.3 Actor Descriptions…Content Creator – a system that creates documents in accordance with a content profileContent Consumer – a system that receives documents in accordance with a content profile…Table 2.3-1. Integration Profile ActorsIntegration Profile … CIRCActor…Content CreatorContent ConsumerXXAdd Section X285290295X Cardiac Imaging Report Content (CIRC) Integration ProfileThe Cardiac Imaging Report Content (CIRC) Profile specifies the content structure for a clinicalreport of a cardiology imaging exam, recorded in a DICOM Study. Such exams include:• Echocardiography (transthoracic - TTE, transesophageal - TEE, and TTE stress)• Cardiac computed tomography (angiography - CTA, and coronary artery calcium scoring -CACS)• Cardiac magnetic resonance (angiography - MRA, and MR stress)• Cardiovascular nuclear medicine (SPECT myocardial perfusion, and positron emissiontomography - PET)• Diagnostic coronary catheter based fluoroscopy (interventional coronary angiography - ICA,and left ventriculography - LVG)The CIRC Profile specifies the use of an HL7 Clinical Document Architecture (CDA) format forthe report.Not included in the scope of this profile are non-imaging studies (e.g., ECG), electrophysiologyprocedures, interventional therapeutic procedures (e.g., angioplasty), and non-cardiologyprocedures (e.g., peripheral angiography). Such use cases may be supported by other similarcontent profiles.__________________________________________________________________________11Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________300305310315It is presumed that there is a DICOM Study associated with the exam. If there is not a DICOMStudy, this report content may not be appropriate.The CIRC Profile does not presume to describe the complete content of an imaging report. Itdoes provide the framework of high level section titles and a set of discrete data elements.Within that framework reports can be created with the clinical content desired by their authors,including additional discrete data elements. In general, there are no constraints on the narrativetext and figures that the cardiologist could include in the report document, although there arerequirements on minimum data elements reflecting expert consensus (ACC/AHA/et al. 2008 KeyData Elements for Cardiac Imaging).This profile also does not provide all of the details necessary to construct a CDA compliantdocument. Please refer to the HL7 CDA Release 2 Standard.X.1 Actors/ TransactionsThere are two actors in this profile, the Content Creator and the Content Consumer. Content iscreated by a Content Creator and is to be consumed by a Content Consumer. The sharing ortransmission of content from one actor to the other is addressed by the appropriate use of otherIHE profiles, and is out of scope of this profile; hence there is no transaction per se defined forthis profile.Figure X.1-1 Cardiac Imaging Report Template Actor Diagram320Note:The primary intended transmission mechanism in the intra-institutional context is the IHE Displayable ReportsProfile (DRPT), and in the inter-institutional context the IHE Cross Enterprise Document Sharing Profiles (XDS,XDM and XDR). A Report Creator, Document Source or a Portable Media Creator of those profiles mayembody the Content Creator Actor. A Document Consumer, a Document Recipient or a Portable Media Importermay embody the Content Consumer Actor.325330X.1.1 Actor GroupingsThe Content Creator shall be grouped with Time Client actor of the IHE IT InfrastructureConsistent Time Profile, as specified in ITI TF-1:7. This allows the Legal Authenticationtimestamp to be accurate.X.2 Cardiac Imaging Report Content Profile OptionsOptions that may be selected for this Content Profile are listed in Table X.2-1 along with theActors to which they apply. Dependencies between options when applicable are specified innotes.__________________________________________________________________________12Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________Table X.2-1 CIRC Profile OptionsActor Option Name Optionality SectionView Option O (see X.2.1) PCC TF-2 :3.1.1Content ConsumerDocument Import Option O (see X.2.1) PCC TF-2 :3.1.2Section Import Option O (see X.2.1) PCC TF-2 :3.1.3Discrete Data Import Option O (see X.2.1) PCC TF-2 :3.1.4Content CreatorNo options defined335340X.2.1 Content Consumer OptionsThe Content Consumer actor is required to support at least one of the View or Discrete DataImport options. The Document Import and Section Import options, if implemented, also requirethe View option. These options as specified in the PCC Technical Framework assume use ofXDS or related profiles for transport; this Profile specifies bindings to other workflow profiles(see Section X.5), and these options should be interpreted as applicable with any binding. Seealso Section X.6.2.X.3 Use Cases345350355360X.3.1 Compile and transfer report of cardiac imaging procedure with use of keyimaging data measuresThis use case addresses the generation and transfer of a cardiac imaging report based on theACC/AHA Key data Elements for Cardiac Imaging 1 . The initial content, structure and coding ofthe report to support this use case are detailed as part of this profile (see IHE CARD TF-2: 6Content Modules). However various reporting system implementations, institute reportingguidelines and individual Reporting Physician usage may result in some variability in thespecific report content provided.Pre conditionsThe systems underlying the data collection and management for the various elements of theprocedure report has all the mandatory data elements identified using codes, and are expected tobe the source for the information used in creating the majority of the structured imaging reportdocument.Main Flow• Cardiologist reviews and/or records the codifiedo procedures and protocols used in the procedureo image and related data generated from the various modalities and monitoring equipmentused during the procedure so that they key physiological measures, acquired and derivedare present in line with the ACC/AHA guidelines.__________________________________________________________________________13Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________365370375380385o Other relevant patient characteristicso medications documented for the patient both pre and during procedure.o Indications and observations/complications noticed during the procedure.o Findings, assessment and plan• Cardiologist approves the procedure report and this marks it ready for distribution• The content creator system will format the report appropriately (this profile) and send it viaone of the IHE mechanisms to a content consumer system (an appropriate workflow profile).Post conditionsThe subsequent clinical stakeholder (system) receives the Document for import, procesing andoptionally viewing of the data.X.3.2 Perform discrete data-analysis on procedure report contentThe goal of this use case is to assist data collection for comparative and research purposes. Basedon a report generated in the previouse use cases an advanced medical data analysis sytemcollects discrete data from multiple patients and their procedure, e.g. for cardiac ClinicalDecision Support or for advance lifetime patient records.Pre conditionsThe content consumer (e.g. an advanced medical data analysis system) received a CardiacImaging Report with coded/structured content as defined in IHE CARD TF-2: 6.2 CDA Release2 Content Modules.Main FlowThe consuming system collects and processes the data from the various reports it receives andextracts those relevant data for either:• a specific clinical concern for a population e.g. pre-populating a procedure-specific registry;extracting a data subset for a specific research question..• A more comprehensive longitudional patient record ( e.g. an EMR) which can providetrending over time on an individual patient’s key cardiac measures.390395Post conditionsThe content consumer generated new (derived) data for use by others. The type of data generatedis out of the scope of this profile.X.3.3 Review Procedure ReportA secondary use-case addressed by this profile involves the direct human use of the procedurereport. In most practical cases this will be• the referring physician who instigated/ordered the procedure, and other healthcare providerswho manage subsequent patient care activities__________________________________________________________________________14Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________400405410• another person involved in downstream clinical or administrative data processing e.g.,someone validating/source-checking for QA the original report as part of JCAHO audits, orpre-submission checking on the original reporting data against the case-data imported in theNCDR-PCI registry-submission applicationPre conditions• the Reviewing Physician consumer has a system (EMR or other) capable of importing anddisplaying the received report in a clinically useful format• the Cardiac Imaging Report has been received at this systemNote: This profile does not assume any explicitly specified relationship between the creator and consumer.Main Flow• the reviewing physician selects the report of his patient and opens it for review• the system displays the human readable content for the reviewing physician to reviewPost conditionsThe Reviewer has extracted (visually) the necessary information from the report.X.4 Security ConsiderationsSecurity considerations are dealt with by the transport mechanism (e.g., XDS, DRPT) and areoutside the scope of this content profile. See PCC TF-1: 3.8415420425X.5 GroupingContent modules describe the content of a payload found in an IHE transaction. Content profilesare transaction neutral. They do not have dependencies upon the transaction that they appear in.A Content Creator or Content Consumer must be grouped with appropriate actors from workflowprofiles that manage interchange of clinical data. Such groupings are described in this section.Content profiles may impose additional requirements on the transactions used when groupedwith actors from other IHE Profiles. The metadata sent in the document sharing or interchangemessages has specific relationships to the content of the clinical document described in thecontent profile. These mappings between the workflow metadata and the content attributes aredescribed in Volume 2 of the Technical Framework.X.5.1 Content Bindings for Displayable Reports (DRPT) and Image Enabled Office(IEO) ProfilesCDA documents using the CIRC content may be exchanged between a Report Creator and aReport Manager, as defined in the Displayable Reports (DRPT) and Image Enabled Office (IEO)Profiles using the Encapsulated Report Submission [CARD-7] transaction.__________________________________________________________________________15Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________430435440445450455460X.5.2 Content Bindings for XDS, XDM, XDR, and XDS-IIt is expected that the transfers of care will occur in an environment where the physician officesand hospitals have a coordinated infrastructure that serves the information sharing needs of thiscommunity of care. Several mechanisms are supported by IHE profiles:• A registry/repository-based infrastructure is defined by the IHE Cross Enterprise DocumentSharing (XDS) and other IHE Integration Profiles such as patient identification (PIX & PDQ)and notification of availability of documents (NAV). An extension for imaging studyexchange is Cross Enterprise Document Sharing for Imaging (XDS-I).• A media-based infrastructure is defined by the IHE Cross Enterprise Document MediaInterchange (XDM) profile.• A reliable messaging-based infrastructure is defined by the IHE Cross Enterprise DocumentReliable Interchange (XDR) profile.• All of these infrastructures support Security and privacy through the use of the ConsistentTime (CT) and Audit Trail and Node Authentication (ATNA) profiles.For more details on these profiles, see the IHE IT Infrastructure Technical Framework, and theIHE Radiology Technical Framework for XDS-I.Actors from the ITI XDS, XDM and XDR profiles may embody the Content Creator and ContentConsumer sharing function of this profile.X.5.3 Content Binding for Portable Data for Imaging (PDI)CDA documents using the CIRC content may be exchanged on interchange media in accordancewith the Portable Data for Imaging (PDI) profile. Such documents may be encapsulated withinDICOM SOP Instances, or may be native CDA documents, as described in the IHE RadiologyTechnical Framework.X.5.4 Content Binding for Retrieve Form for Data Capture (RFD)A CDA document may be used for prepoulation of a data entry form managed by actors of theRetrieve Form for Data Capture (RFD) Profile. In particular, the CIRC content, as a carrier ofdiscrete encoded data, may be used to prepopulate data entry forms for cardiovascular dataregistries. The CIRC profile has been developed with key data elements that support commonresearch related data fields. This profile, however, does not provide mapping between CIRCfield content and any specific registry field content.X.5.5 Relationship to Document Digital Signature (DSG)When a Content Creator Actor needs to digitally sign a document in a submission set, it maysupport the Digital Signature (DSG) Content Profile as a Document Source. When a ContentConsumer Actor needs to verify a Digital Signature, it may retrieve the digital signaturedocument and may perform the verification against the signed document content.__________________________________________________________________________16Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________465470475480485490X.6 Requirements of CIRC ActorsThis section describes the specific requirements for each Actor defined within this profile.Specific details can be found in Volume 1 and Volume 2 of the technical framework.X.6.1 Content Creator1. A Content Creator shall be able to create a Cardiac Imaging Report Document accordingto the specifications for that content profile found in CARD TF-2.2. A Content Creator shall be grouped with the Time Client Actor, and shall synchronize itsclock with a Time Server.X.6.2 Content Consumer1. A Content Consumer shall be able to consume a Cardiac Imaging Report document.2. A Content Consumer shall implement the View Option or Discrete Data Import option, orboth.3. A Content Consumer that implements the Document Import or Section Import Optionshall implement the View Option as well.4. A Content Consumer that implements the View option shall be able to:a. Demonstrate rendering of the document for display.b. Print the document.c. Display the document with its original style sheet.d. Support traversal of any links contained within the document.5. A Content Consumer that implements the Document Import Option shall:a. Store the document.b. Demonstrate the ability to access the document again from local storage.6. A Content Consumer that implements the Section Import Option shall offer a means toimport one or more document sections into the patient record as free text.7. A Content Consumer that implements the Discrete Data Import Option shall offer ameans to import structured data from one or more sections of the document.__________________________________________________________________________17Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________Volume 2 – Transactions and ContentModulesUpdate section 34955005053 Framework OverviewThe IHE Technical Framework is based on actors that interact through transactions; thosetransactions may be further qualified with respect to their content.3.1 Actors and TransactionsActors are information systems or components of information systems that produce, manage, oract on information associated with operational activities in the enterprise.Transactions are interactions between actors that transfer the required information throughstandards-based messages.Specific sets of actors and transactions are specified in the Integration Profiles (see CARD TF-1). While transactions are described in this volume (CARD TF-2), the role andimplementation of these transactions require the understanding of the Integration profilethey support.Add new section 3.25105155203.2 Content ModulesThere is often a very clear distinction between the transactions in a messaging framework used topackage and transmit information, and the information content actually transmitted in thosemessages. This is especially true when the messaging framework begins to move towardsmainstream computing infrastructures being adopted by the healthcare industry.In these cases, the same transactions may be used to support a wide variety of use cases inhealthcare, and so more and more the content and use of the message also needs to be profiled,sometimes separately from the transaction itself. Towards this end IHE has developed theconcept of a Content Integration Profile.Content Integration Profiles specify how the payload of a transaction fits into a specific use ofthat transaction. A content integration profile has three main parts. The first part describes theuse case (this is found in Volume 1 in the definition of each Profile). The second part is aContent Module (found in this Volume 2), which describes the payload of the transaction; acontent module is specified so as to be independent of the transaction in which it appears. Thethird part is binding to a specific IHE transaction, which describes how the content affects the__________________________________________________________________________18Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________525transaction. The binding of CDA-based medical documents to workflow transactions isdescribed in the Profile definition in Volume 1 (e.g., see IHE CARD TF-1:X.5).Add new section 55305 Namespaces and VocabulariesThis section lists the namespaces and identifiers defined or referenced by the IHE CardiologyTechnical Framework, and the vocabularies defined or referenced herein.codeSystem codeSystemName Description1.3.6.1.4.1.19376.1.5.3.11.3.6.1.4.1.19376.1.4.1IHE PCC TemplateIdentifiersIHE CardiologyTemplate IdentifiersThis is the root OID for all IHE PCC Templates. A list of PCCtemplates can be found in IHE PCC TF-2:6.2 (CDA Release 2.0Content Modules).2.16.840.1.113883.5.112 RouteOfAdministration See the HL7 RouteOfAdministration Vocabulary2.16.840.1.113883.6.1 LOINC Logical Observation Identifier Names and Codes2.16.840.1.113883.6.96 SNOMED-CT SNOMED Controlled Terminology2.16.840.1.113883.6.88 RxNorm RxNorm1.2.840.10008.2.16.4 DCMDICOM Controlled Terminology; PS 3.16 Content MappingResource, Annex D2.16.840.1.113883.6.24 MDC ISO/IEEE 11073 Medical Device Nomenclature2.16.840.1.113883.3.26.1.5 NDF-RT National Drug File Reference Terminology (NCI version)2.16.840.1.113883.11.19465 nuccProviderCodesNational Uniform Codes Council Healthcare ProviderTerminology2.16.840.1.113883.6.255.1336 X12DE1336 Insurance Type Code (ASC X12 Data Element 1336)5355.1 IHE Format CodesThe table below lists the format codes, root template identifiers and media types used by the IHEProfiles specified in the Cardiology Technical Framework.Note that the code system for these codes is 1.3.6.1.4.1.19376.1.2.3 as assigned by the ITIDomain for codes used for the purposes of cross-enterprise document sharing (XDS).__________________________________________________________________________19Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________Profile Format Code Media Type Template IDCardiac Imaging Report urn:ihe:card:imaging:2011 text/xml 1.3.6.1.4.1.19376.1.4.1.1.1540Add new section 66 Content Modules6.1 Conventions5456.1.1 Data Element Optionality ConstraintsWithin Section 6, the following conventions are used in data element content constraint.550RA "Required" data element is one that SHALL always be provided. If there is informationavailable, the data element must be present. If there is no information available, or it cannotbe transmitted, the data element must contain a value indicating the reason for omission ofthe data.R2 A "Required if data present" data element is one that shall be provided when a value exists.If the information cannot be transmitted, the data element shall contain a value indicatingthe reason for omission of the data. If no such information is available to the creator or ifsuch information is not available in a well identified manner (e.g. buried in a free formnarrative that contains additional information relevant to other sections) or if the creatorrequires that information be absent, the R2 section shall be entirely absent. This isequivalent to a SHOULD requirement.OCAn optional data element is one that MAY be provided, whether the information isavailable or not. If the implementation elects to support this optional section, then itssupport shall meet the requirement set forth for the "Required if data present" or R2.A conditional data element is one that is required, required if known, or optional, dependingupon other conditions. These will have further notes explaining when the data element isrequired.Note:The definitions of R, R2, and O are consistent with other IHE Content profiles, but differ slightly from IHEWorkflow profiles. This is due in part to the fact that local regulations and policies may in fact prohibit thetransmission of certain information, and that a human decision to transmit the information may be required inmany cases.6.1.2 Structure of Content ModulesFor CDA Release 2 the Content Modules are organized by document, section, entry, and headerelements.__________________________________________________________________________20Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________555EntriesDocumentSectionsFigure 6.1.2-1 CDA R2 R-MIM with location of Document, Sections, and Entries560565570575580Each content module is defined in terms of constraints that must be obeyed by instances of thatcontent module, in effect a contract between the creator and the reciver. Each content module hasa name, also known as its template identifier. The template identifiers are used to identify thecontract agreed to by the content module.Content modules may inherit features of other content modules of the same type (Document,Section, or Entry) by defining the parent content module that they inherit from. They may notinherit features from a different type. Although information in the CDA Header is in a differentlocation than information in a CDA Entry, these two content modules are considered to be of thesame type, and so may inherit from each other when necessary.Each content module has a list of data elements that are required (R), required if known (R2),optional (O), and conditional (C). The presentation of this information varies with the type ofcontent module, and is described in more detail below. Additional data elements may beprovided by the sender that are not defined by a specific content module, but the receiver is notrequired to interpret them. Thus, it is not an error to include more than is asked for, but it is anerror to reject a content module because it contains more than is defined by the framework. Thisallows values to be added to the content modules delivered in this framework, throughextensions to it that are not defined or profiled by IHE. It further allows content modules to bedefined later by IHE that are refinements or improvements over previous content modules.In order to retain this capability, constraints that apply to any content module will always applyto any content modules that inherit from it. Thus, the "contracts" are always valid down theinheritance hierarchy. Second, data elements of a content module will rarely be deprecated. Thiswill usually occur only in the cases where they have been deprecated by the base standard. Whileany specific content module has a limited scope and set of use cases, deprecating the dataelement prevents any future content module from taking advantage of what has already been__________________________________________________________________________21Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________defined when a particular data element has been deprecated simply because it was not necessaryin the original use case.5855905956006056106156.1.2.1 Document Content ModulesEach document content module will define the appropriate codes used to classify the document,and will also describe the specific section and header data elements that are included. The codeused to classify it is specified using an external vocabulary, typically LOINC in the case of CDARelease 2 documents. The set of data elements that make up the document are defined, includingthe whether these data elements must, should or may be included in the document. Each dataelement is mapped to a lower level content module via a template identifier, and the documentcontent module will further indicate whether these data elements are required, required if knownor optional. Thus, a document content module contains as constraints:• The template identifier of the parent content module when there is one.• The LOINC code or codes that are used to classify the document.• A possibly empty set of required, required if known, and optional header content modules,and their template identifiers.• A possibly empty set of required, required if known, and optional section content modules,and their template identifiers.• Other constraints as necessary.6.1.2.2 Section Content ModulesSection content modules will define the content of a section of a clinical document. Sections willusually contain narrative text, and so this definition will often describe the information present inthe narrative, although sections may be wholly comprised of subsections.Sections may contain various subsections, and these may be required, required if known oroptional. Sections may also contain various entries, and again, these may be required, required ifknown, or optional. A section may not contain just entries; it must have at least some narrativetext or subsections to be considered to be valid content.Sections can inherit constraints from another parent section content module. Sections areclassified using an external vocabulary (again typically this would be LOINC, although in somecases DICOM), and so the list of possible section codes is also specified. Sections that inheritfrom another section module will specify the same section code(s) as its parent, unless it furtherrestricts the type of section to smaller set of codes.Thus, a section content module will contain as constraints:• The template identifier of the parent content module when there is one.• The code or codes that shall be used to classify the section.• A possibly empty set of required, required if known, and optional section content modules,and their template identifiers for the subsections of this section.__________________________________________________________________________22Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________620• A possibly empty set of required, required if known, and optional entry content modules, andtheir template identifiers.• Other constraints as necessary.6256306356406456506556.1.2.3 Entry and Header Content ModulesEntry and Header content modules are the lowest level of content for which content modulesare defined. These content modules are associated with classes from the HL7 ReferenceInformation Model (RIM). These "RIM" content modules will constrain a single RIM class.Entry content modules typically constrain an "Act" class or one of its subtypes, while headercontent modules will normally constrain "Participation", "Role" or "Entity" classes, but may alsoconstrain an "Act" class.Entry and Header content modules describe the required, required if known, and optional XMLelements and attributes that are present in the CDA Release 2 instance. Header and Entry contentmodules may also be built up using other Header and Entry content modules. An entry or headercontent module may also specify constraints on the vocabularies used for codes found in theentry, or data types for the values found in the entry. Thus, an entry or header content modulewill contain as constraints:• The template identifier of the parent content module when there is one.• A description of the XML elements and attributes used in the entry, along with explanationsof their meaning.• An indication of those XML elements or attributes that are required, required if known, oroptional.• Vocabulary domains to use when coding the entry.• Data types used to specify the value of the entry.• Other constraints as necessary.6.1.2.4 Value SetsValue sets, which are potentially reusable in a variety of contexts, are described separately fromthe content modules. Each value set is identified by name and OID, and its constituent conceptvalues are listed in a table.Value sets concepts may be drawn from multiple coding systems and some concepts may berepresented in more than one coding system. When there is a choice of coding system, thecontent module that invokes the value set may establish constraints on when to use a particularsystem (e.g., based on local policy or national regulation). The content module that invokes thevalue set may also establish constraints on whether concepts not in the defined value set can beused (e.g., using the HL7 CWE [coded with exceptions] and CNE [coded no exceptions] datatypes). The HL7 v3 CD data type allows the representation of a concept by a code together witha translation code in a different coding system; when multiple codes are provided for a concept,use of such translation codes is recommended.__________________________________________________________________________23Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________6.2 CDA Release 2 Content Modules6.2.1 Document Modules6606656706756.2.1.1 Cardiac Imaging Report Specification 1.3.6.1.4.1.19376.1.4.1.1.1This is the template for Cardiac Imaging Reports with discrete data elements as described in theACC/AHA/et al. 2008 Key Data Elements and Definitions for Cardiac Imaging. The Template ID forconformance to this template is OID = 1.3.6.1.4.1.19376.1.4.1.1.1.6.2.1.1.1 Format CodeThe XDSDocumentEntry format code for this content is urn:ihe:card:imaging:2011The mapping of CDA header attributes to XDS metadata shall be identical to the XDS-MSmapping specified in PCC TF-2: 4.1.1.6.2.1.1.2 Parent TemplateThis document is a specialization of the IHE PCC Medical Document template (OID =1.3.6.1.4.1.19376.1.5.3.1.1.1).Note:The Medical Document includes requirements for various header elements; name, addr and telecom elements foridentified persons and organizations; and basic participations record target, author, and legal authenticator.This document is a specialization of the HL7 Procedure Note template (OID =2.16.840.1.113883.10.20.18.1).Note:This document is not a specialization of the HL7 Basic Diagnostic Imaging Report template due to conflicts withtwo Procedure Note requirements (format of serviceEvent/effeciveTime, and title on DICOM Catalogue section).When and if these are resolved, an instance may also comply to the Diagnostic Imaging Report.6806856.2.1.1.3 Clinical Document CodeThe ClinicalDocument/code for this document MAY be 18748-4 Diagnostic Imaging Studyreport 2.16.840.1.113883.6.1 LOINC STATIC.Note:Procedure Note specifies a list of alternate document codes. The selection of an appropriate document type codewill depend on the intended access workflow, and may vary by local policy. As a query key, the code shouldallow efficient access to all relevant reports, while minimizing the number of query key values from which a usermust choose. The LOINC code identified here was selected under the assumption that a clinical user looking fora cardiac imaging report would typically be interested in seeing all diagnostic imaging reports for the patient.6.2.1.1.4 StandardsKDECI ACC/AHA/et al. 2008 Key Data Elements and Definitions for Cardiac ImagingCDAR2 HL7 CDA Release 2.0CDTPN HL7 Implementation Guide for CDA Release 2: Procedure Note (Universal Realm)__________________________________________________________________________24Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________CDTDIRCCDPCCMDDICOM(DSTU)Implementation Guide for CDA Release 2: Imaging Integration: Basic ImagingReports in CDA and DICOM Diagnostic Imaging Reports (DIR) – Universal Realm(Informative)ASTM/HL7 Continuity of Care Document Implementation Guide for CDAr2IHE PCC Medical Documents SpecificationDICOM PS3.16 - Part 16: Content Mapping Resource6906.2.1.1.5 Data Element RequirementsTable 6.2.1.1.5-1 presents the a summary of the data element requirements of KDECI, and theirgeneral mapping to sections in referenced CDA Implementation Guides. The data elements aresummarized by category, and the number of discrete data elements in each category is listed.Implementation Guide sections listed in boldface are required in their respective standards.Table 6.2.1.1.5-1 Summary of Data Element RequirementsKDECI CDTDIR CDTPN CCD PCCMDDICOM ObjectCatalog (5)AdministrativeCDA HeaderCDA Header CDA Header CDA HeaderFacility (5)Data Source (1)Priority (1)Accreditation (2)Insurance (1)Demographics (5)General (10)Document (19)Participants (20)Order (1)Service Event (12)Encounter (10)PayersStudy Referral Data (2) RequestHistory and Risk FactorsVital Signs (4)Labs (2)Problems (14)Chest Pain (5)Family History (1)Tobacco Use (1)Risk Estimates (6)Functional assessment (2)Prior Tests (2)Prior Procedures (4)Medications (2)Contrast Reaction (1)History Medical History ProblemsHistory ofPresent IllnessSocial History Social HistoryFamily History Family HistoryProcedure ProceduresHistoryPatient Presentation PhysicalExaminationVital Signs Vital SignsFunctional statusPrevious FindingsResultsMedicationHistoryMedications__________________________________________________________________________25Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________Study DescriptionIdentification (2)Indication (2)Physician (3)Procedure (1)Acquisition Parameters (14)Stress Method (4)Study Findings—IschemicHeart Disease (25)Study Findings—LV Function(6)Study Findings—CardiacMorphologyChambers (6)Myocardium (5)Pulmonary Veins (1)Intracardiac Mass (1)Intracardiac Shunt (1)Pericardium (4)Valves (15)Aorta (3)Study Findings—Summary(6)Current ProcedureDescriptionsIndications forProcedureComplicationsFindingsSummaryConclusionsRecommendationsKey ImagesAllergiesPlannedProcedureProcedureDescriptionProcedureIndicationsMedicationsAdministeredComplicationsProcedureFindingsPostprocedureDiagnosisAssessmentand/or PlanAlerts695700705The data elements in KDECI are specified only as named concepts, with value sets as lists ofterms. This document template (including its subsidiary section and entry templates) maps thoseconcepts to appropriate coded concepts from SNOMED CT, LOINC, DICOM, or NDF-RT,using existing value sets from DICOM where applicable.Note:In DICOM, value sets are known as Context Groups, and are identified by a Context Group ID (CID) as well asan OID.6.2.1.1.6 SpecificationThis section specifies lower level content modules comprising the Cardiac Imaging Report, usingTemplate ID as the key identifier.Sections that are used according to the definitions in other specifications, without additionalconstraints, are identified with the relevant specification document.__________________________________________________________________________26Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________Table 6.2.1.1.6-1 Cardiac Imaging Report Content SpecificationData Element Name Opt Template ID DocumentHeader ElementsEncompassing Encounter R 1.3.6.1.4.1.19376.1.4.1.3.1 CARD TF-2 6.2.3.1Physician of Record R2 2.16.840.1.113883.10.20.6.2.2 CDTDIROrder R 1.3.6.1.4.1.19376.1.4.1.3.2 CARD TF-2 6.2.3.2Patient Demographics R 1.3.6.1.4.1.19376.1.4.1.3.3 CARD TF-2 6.2.3.3Service Event and Performer R 1.3.6.1.4.1.19376.1.4.1.3.4 CARD TF-2 6.2.3.4SectionsMedical History (Cardiac) R 1.3.6.1.4.1.19376.1.4.1.2.1 CARD TF-2 6.2.2.1Problems O 1.3.6.1.4.1.19376.1.4.1.2.1 PCC-TF-2History of Present Illness O 1.3.6.1.4.1.19376.1.5.3.1.3.4 PCC-TF-2History of Past Illness O 2.16.840.1.113883.10.20.2.9 CDTPNMedications (Cardiac) R 1.3.6.1.4.1.19376.1.4.1.2.2 CARD TF-2 6.2.2.2Allergies and Other Adverse Reactions (Cardiac) R 1.3.6.1.4.1.19376.1.4.1.2.3 CARD TF-2 6.2.2.3Social History (Cardiac) R 1.3.6.1.4.1.19376.1.4.1.2.4 CARD TF-2 6.2.2.4Family History (Cardiac) R2 1.3.6.1.4.1.19376.1.4.1.2.5 CARD TF-2 6.2.2.5Physical Examination O 2.16.840.1.113883.10.20.2.10 CDTPNVital Signs R 1.3.6.1.4.1.19376.1.5.3.1.3.25 PCC-TF-2Prior Results (Cardiac) R 1.3.6.1.4.1.19376.1.4.1.2.6 CARD TF-2 6.2.2.6Cardiac Risk Assessment O 1.3.6.1.4.1.19376.1.4.1.2.7 CARD TF-2 6.2.2.7Procedure Indications (Cardiac) R 1.3.6.1.4.1.19376.1.4.1.2.8 CARD TF-2 6.2.2.8Planned Procedure O 2.16.840.1.113883.10.20.18.2.6 CDTPNProcedure Description (Cardiac) R 1.3.6.1.4.1.19376.1.4.1.2.9 CARD TF-2 6.2.2.9Medications Administered (Cardiac) O 1.3.6.1.4.1.19376.1.4.1.2.10 CARD TF-2 6.2.2.10Procedure Findings (Cardiac) R 1.3.6.1.4.1.19376.1.4.1.2.11 CARD TF-2 6.2.2.11Complications / Adverse Events R 2.16.840.1.113883.10.20.18.2.4 CDTPNPostprocedure Diagnosis R 2.16.840.1.113883.10.20.18.2.3 CDTPNAssessment And Plan (Cardiac) R 1.3.6.1.4.1.19376.1.4.1.2.12 CARD TF-2 6.2.2.12Key Images O 1.3.6.1.4.1.19376.1.4.1.2.14 CARD TF-2 6.2.2.14DICOM Object Catalog R2 1.3.6.1.4.1.19376.1.4.1.2.15 CARD TF-2 6.2.2.15Payer O 1.3.6.1.4.1.19376.1.5.3.1.1.5.3.7 PCC-TF-27106.2.1.1.7 ConformanceCDA Release 2.0 documents that conform to the requirements of this document content moduleshall indicate their conformance by the inclusion of the XML elements in the__________________________________________________________________________27Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________715header of the document. A CDA Document may conform to more than one template. Thiscontent module inherits from the CDTPN and the PCCMD content modules, and so mustconform to the requirements of those templates as well the Cardiac Imaging Report templates.This is shown in the sample document below, which includes elements for theOIDs of all three templates.720725730735740Cardiac Imaging Report::Figure 6.2.1.1.7-1 Cardiac Imaging Report Example Extract__________________________________________________________________________28Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________6.2.2 Section Modules6.2.2.1 Medical History (Cardiac) SectionTemplate ID 1.3.6.1.4.1.19376.1.4.1.2.1Parent Template 2.16.840.1.113883.10.20.18.2.5General DescriptionLOINC Code11329-0 Medical HistoryThe Medical History Section records past and current problems relevant to thepatient’s cardiac presentation. Other non-cardiac medical history may also berecorded.DescriptionSubsections Opt Description1.3.6.1.4.1.19376.1.4.1.2.1 O Problems (PCC TF-2)1.3.6.1.4.1.19376.1.5.3.1.3.4 O History of Present Illness (PCC TF-2)2.16.840.1.113883.10.20.2.9 O History of Past Illness (CDTPN)Entries Opt Description1.3.6.1.4.1.19376.1.5.3.1.4.5.2 R2 Problem Concern Entry (PCC TF-2)1.3.6.1.4.1.19376.1.4.1.4.1 R2 Diabetes Problem Concern Entry (Card TF-2: 6.2.4.1)1.3.6.1.4.1.19376.1.4.1.4.2 R2 Angina Problem Concern Entry (Card TF-2: 6.2.4.2)1.3.6.1.4.1.19376.1.5.3.1.4.13 O Simple Observation (PCC TF-2)745750755A Content Creator SHALL be able to include a Problem Concern Entry for each of theconditions identified in Value Set 1.3.6.1.4.1.19376.1.4.1.5.4 Cardiac Problems/Concerns.A Problem Concern Entry for diabetes (SNOMED-CT code 73211009) SHALL use thespecialization of Problem Concern (OID = 1.3.6.1.4.1.19376.1.4.1.4.1) to indicate whethertreatment with insulin is required.A Problem Concern Entry for angina (SNOMED-CT code 194828000) SHALL use thespecialization of Problem Concern (OID = 1.3.6.1.4.1.19376.1.4.1.4.2) to indicate angina type.The Medical History section MAY contain a Simple Observation entry for each of the conditionslisted in value set 1.3.6.1.4.1.19376.1.4.1.5.4 Cardiac Problems/Concerns indicating absence ofthe condition for the patient, represented with a compositional SNOMED CT code with qualifier[ 408729009 | finding context | = 410516002 | known absent ].6.2.2.2 Medications (Cardiac) SectionTemplate ID 1.3.6.1.4.1.19376.1.4.1.2.2Parent Template 1.3.6.1.4.1.19376.1.5.3.1.3.19__________________________________________________________________________29Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________General DescriptionThe medications section shall contain a description of the relevant medications for thepatient, including specifically identification of cardiac relevant medications.LOINC CodeDescription10160-0 HISTORY OF MEDICATION USEEntries Opt Description1.3.6.1.4.1.19376.1.5.3.1.4.7 R Medications (PCC TF-2)Medication Entries SHOULD use the cardiac relevant medications identified in Value Set1.3.6.1.4.1.19376.1.4.1.5.14 Cardiac Drug Classes.7606.2.2.3 Allergies and Other Adverse Reactions (Cardiac) SectionTemplate ID 1.3.6.1.4.1.19376.1.4.1.2.3Parent Template 1.3.6.1.4.1.19376.1.5.3.1.3.13The adverse and other adverse reactions section shall contain a narrative description ofGeneral Description the substance intolerances and the associated adverse reactions suffered by the patient,including specifically identification of reaction to imaging agent classes.LOINC CodeDescription48765-2 Allergies, adverse reactions, alertsEntries Opt Description1.3.6.1.4.1.19376.1.5.3.1.4.5.3 R Allergies and Intolerances Concern (PCC-TF-2)Allergies and Intolerances Concern Entries SHOULD use the imaging agent classes identified inValue Set 1.3.6.1.4.1.19376.1.4.1.5.10 Contrast Agents Classes for Adverse Reactions.6.2.2.4 Social History (Cardiac) SectionTemplate ID 1.3.6.1.4.1.19376.1.4.1.2.4Parent Template 1.3.6.1.4.1.19376.1.5.3.1.3.16General DescriptionThe Social History (Cardiac) section shall contain a narrative description of the person’sbeliefs, home life, community life, work life, hobbies, and risky habits.LOINC CodeDescription29762-2 SOCIAL HISTORYEntries Opt Description1.3.6.1.4.1.19376.1.5.3.1.4.13 R Simple Observations (PCC TF-2) (For use, see requirements below)765The Social History (Cardiac) Section SHALL include Simple Observation Entries in accordancewith Table 6.2.2.4-1. For each row in Table 6.2.2.4-1, an entry SHALL (R), SHOULD (R2), orMAY (O) be present in accordance with the condition (column 1), using the specifiedobservation/code (column 2), data type (column 3), and Unit of Measure code (column 4). ForCD data types, a value from the specified value set (column 5) SHOULD be used.__________________________________________________________________________30Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________770Additional observation Entries MAY be present.ROR2Table 6.2.2.4-1 Social History (Cardiac) ObservationsCondition observation/code DataType229819007 SNOMED-CT Tobaccouse and exposure230056004 SNOMED-CT cigaretteconsumption363908000 SNOMED-CT Details ofdrug misuse behaviorUnit ofMeasureValue SetCD n/a 1.2.840.10008.6.1.225(DICOM CID 3784)PQ {pack}/d n/aCD n/a 78267003 SNOMED-CTcocaine abuse6.2.2.5 Family History (Cardiac) SectionTemplate ID 1.3.6.1.4.1.19376.1.4.1.2.5Parent Template 1.3.6.1.4.1.19376.1.5.3.1.3.14General DescriptionThe Family History - Cardiac section shall include narrative and entries for familyhistory of cardiac diseases.LOINC CodeDescription10157-6 HISTORY OF FAMILY MEMBER DISEASESEntries Opt Description1.3.6.1.4.1.19376.1.5.3.1.4.13 O Simple Observations(PCC TF-2) (For use, see requirements below)775The Family History (Cardiac) section MAY contain a Simple Observation Entry for each of theconditions listed in value set 1.2.840.10008.6.1.253 (DICOM CID 3758 Cardiovascular FamilyHistory).Note:These observations are organized by disease, not by family member; hence, this section template is not a child ofCoded Family Medical History Section 1.3.6.1.4.1.19376.1.5.3.1.3.15, which requires a person-based history7806.2.2.6 Prior Results (Cardiac) SectionTemplate ID 1.3.6.1.4.1.19376.1.4.1.2.6Parent Template 1.3.6.1.4.1.19376.1.5.3.1.3.28General DescriptionLOINC Code__________________________________________________________________________31Rev. 1.0 – 2011-04-22The results section shall contain a narrative description of the relevant diagnosticprocedures the patient received in the past, including procedures (studies) used forcomparison. It shall include entries for procedures and references to procedure reportswhen known as described in the Entry Content Modules.Description30954-2 RELEVANT DIAGNOSTIC TESTS AND/OR LABORATORY DATAEntries Opt Description1.3.6.1.4.1.19376.1.5.3.1.4.19 R2 Procedure Entry (PCC-TF-2)Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________1.3.6.1.4.1.19376.1.5.3.1.4.4 R2 External References Entry (PCC-TF-2)1.3.6.1.4.1.19376.1.5.3.1.4.13 R2 Simple Observation (PCC-TF-2)785790Procedure Entries SHOULD use codes for cardiac related imaging procedures from Value Set1.3.6.1.4.1.19376.1.4.1.5.2 Cardiac Imaging Procedures in the procedure/code element. Theentry MAY include an actRelationship to an ExternalDocument act that is the report of theprocedure.The Procedure Entry of a study used for comparison (see Assessment and Plan (Cardiac)Section) SHALL include an ID attribute as a target for cross-reference.The External References Entry allows reference to other documents, not necessarily linked to aspecific identified procedure in a Procedure Entry.Simple Observation Entries MAY use codes for cardiac related lab results from Value Set1.3.6.1.4.1.19376.1.4.1.5.13 Cardiac Lab Results in the observation/code element. However, notethat depending on the method used for the lab test, a different LOINC code may be applicable,even though the test name is identical.6.2.2.7 Cardiac Risk Assessment SectionTemplate ID 1.3.6.1.4.1.19376.1.4.1.2.7Parent TemplateGeneral DescriptionX-CARDRISKLOINC CodenoneThe Cardiac Risk Assessment Section records risk calculations made prior to theprocedure.Descriptionassessment for risk of cardiovascular diseaseEntries Opt Description1.3.6.1.4.1.19376.1.5.3.1.4.13 R Simple Observation (PCC TF-2)795The section SHALL contain a Simple Observation Entry for each cardiac risk estimate or scorereported. Example risk assesment codes are listed in value set TBD.Note: the list of various risk assesment scores has been submitted to LOINC for assignment ofcodes, and will be included in the Trial Implementation version.8006.2.2.8 Procedure Indications (Cardiac) SectionTemplate ID 1.3.6.1.4.1.19376.1.4.1.2.8Parent Template 2.16.840.1.113883.10.20.18.2.1The Procedure Indications section records details about the reason for the procedure.General Description This section may include the pre-procedure diagnosis or diagnoses as well as one ormore symptoms that contribute to the reason the procedure is being performed.LOINC Code59768-2 PROCEDURE INDICATIONSDescription__________________________________________________________________________32Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________Entries Opt Description1.3.6.1.4.1.19376.1.5.3.1.4.13 C Simple Observation (PCC TF-2) (For use, see requirements below)805The Procedure Indications (Cardiac) Section SHALL include one or more Simple ObservationEntries describing the indications for the procedure in accordance with Table 6.2.2.8-1. For eachrow in Table 6.2.2.8-1, one or more entries SHALL (R), SHOULD (R2), or MAY (O) be presentin accordance with the condition (column 1). For CD data types, a value from the specified valueset (column 5) SHOULD be used.Table 6.2.2.8-1 Procedure Indications (Cardiac) ObservationsCondition observation/code DataTypeUnit ofMeasureValue SetR – Stress testO - otherR – Cath432678004 SNOMED-CTIndication for Procedure432678004 SNOMED-CTIndication for ProcedureCD n/a 1.2.840.10008.6.1.756DICOM CID 3201 –Indications for Stress TestCD n/a 1.2.840.10008.6.1.227DICOM CID 3727 -Indications forCatheterization810The following is the list of concepts from KDECI, which needs to be reconciled with the DICOMvalue sets prior to Trial Implementation. Note: need to clarify procedure indication fromprocedure intent.Detection of CADRisk assessment of CADR-413C5 Pre-operative assessmentR-00357 Post-revascularization assessmentDetermination of viability—candidacy for revascularizationCongenital heart diseasePericardial diseasePulmonary vein assessmentCardiac morphology (including cardiac mass)Assessment of ventricular functionEvaluation for cardiomyopathyEvaluation for valvular heart diseaseEvaluation for great vesselsSymptom/signs evaluation not related to above categories__________________________________________________________________________33Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________6.2.2.9 Cardiac Procedure Description SectionTemplate ID 1.3.6.1.4.1.19376.1.4.1.2.9Parent Template 2.16.840.1.113883.10.20.18.2.2General DescriptionLOINC CodeThe Cardiac Procedure Description section shall include narrative and entries identifyingthe procedure performed and the details of the procedure such as contrast agent(s) used,imaging procedure protocol used, characteristics of the imaging equipment used, .29554-3 PROCEDURE DESCRIPTIONDescriptionSubsections Opt DescriptionOConstituent procedure (for combined procedure, see requirement below)2.16.840.1.113883.10.20.18.2.8 O Medications administered (CDTPN) (May be separate top level section)Entries Opt Description1.3.6.1.4.1.19376.1.5.3.1.4.19 R2.16.840.1.113883.10.20.1.24 R22.16.840.1.113883.10.20.1.24 CProcedures Entry (PCC TF-2. (For allowed values, see requirementbelow)Medication activity (medications administered) (PCC TF-2) (Forallowed values, see requirement below)Medication activity (contrast/imaging agents) (PCC TF-2) (For allowedvalues, see requirement below).1.3.6.1.4.1.19376.1.5.3.1.4.13 C Simple Observations (PCC TF-2) (For use, see requirements below)815820825830For combined procedures (e.g., CACS and CCTA), each constituent procedure MAY bedescribed in a subsection of Procedure Description. The section/title of each subsectionSHOULD identify the constituent procedure; the section/code MAY be absent. The narrative andentries of the subsection SHALL describe the parameters of the constituent procedure.The allowed codes for the procedure/code element of the Procedures Entry template(1.3.6.1.4.1.19376.1.5.3.1.4.19) SHALL be taken from the value set 1.3.6.1.4.1.19376.1.4.1.5.2(Cardiac imaging procedures).If medications other than contrast were administered, and a Medications Administered section isnot present, Medication Activity Entry SHOULD use the values of Value Set1.3.6.1.4.1.19376.1.4.1.5.15 (Drug Classes Used in Cardiac Procedure).If contrast/imaging agents were used, a Medication Activity Entry SHALL be present, andSHOULD use the values of Value Set 1.3.6.1.4.1.19376.1.4.1.5.11 Contrast Agents. Inaccordance with the Medication Activity Entry template, administered contrast agent volume ordose SHOULD be included in the entry in substanceAdministration /doseQuantity.The Procedure Description Section SHALL include Simple Observation Entries dependent onthe type of procedure performed. For each row in Table 6.2.2.9-1, one entry SHALL (R),SHOULD (R2), or MAY (O) be present in accordance with the condition (column 1), using thespecified observation/code (column 2), data type (column 3), and Unit of Measure code (column4). For CD data types, a value from the specified value set (column 5) SHOULD be used.__________________________________________________________________________34Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________835The following is the list of concepts from KDECI, some of which need observation codes to bedetermined prior to Trial Implementation.Table 6.2.2.9-1 Cardiac Procedure Description ObservationsCondition observation/code DataTypeUnit ofMeasureValue SetR - Cardiac CTO - othersR - nuclear cardiology,cardiac CT, or cardiac MRR - nuclear cardiologyR - EchocardiographyR - Cardiac MRR - Cardiac CT8867-4, LOINC, Heart Rate PQ {HB}/min n/aCardiac SynchronizationTechnique122713, DCM, “Attenuationcorrection”125203, DCM, “AcquisitionProtocol”125203, DCM, “AcquisitionProtocol”Number of concurrently acquiredslicesR - Cardiac CT Gantry rotation speed PQ msR - Cardiac CTR – XA FluoroscopyR – XA FluoroscopyR – stress CMR, stressTTE, stress SPECT, stressPETR – stress CMR, stressTTE, stress SPECT, stressPETR – stress CMR, stressTTE, stress SPECT, stressPETR – stress CMR, stressTTE, stress SPECT, stressPET113813, DCM, “CT Dose LengthProduct Total”113722, DCM, “Dose AreaProduct Total”113730, DCM, “Total FluoroTime”121058, DCM, “Procedurereported”CD n/a TbdCD n/a 1.2.840.10008.6.1.744DICOM CID 3112 -Attenuation CorrectionCD n/a 1.2.840.10008.6.1.616DICOM CID 12224 -Ultrasound Image ModesCD n/a1.3.6.1.4.1.19376.1.4.1.5.12Cardiac MR AcquisitionModes● Morphology and function● Delayed enhancement● Flow/velocityquantification● MR angiography● Perfusion● OtherPQPQPQPQ{slices}mGy.cmGy.m2sCD 1.2.840.10008.6.1.755DICOM CID 3200 - StressTest Procedure109056, DCM, “Stress Protocol” CD 1.2.840.10008.6.1.57DICOM CID 3261 - StressProtocols252130009, SNOMED-CT, “TotalExercise duration”246489000, SNOMED-CT,“Pharmacological Stress Agent”PQminCD 1.2.840.10008.6.1.759DICOM CID 3204 - StressAgents__________________________________________________________________________35Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________8406.2.2.10 Medications Administered (Cardiac) SectionTemplate ID 1.3.6.1.4.1.19376.1.4.1.2.10Parent Template 2.16.840.1.113883.10.20.18.2.8General DescriptionThe Medications Administered (Cardiac) section defines medications and fluidsadministered during a cardiac imaging procedure, excluding anesthetic medications.LOINC CodeDescription29549-3 MEDICATIONS ADMINISTEREDEntries Opt Description2.16.840.1.113883.10.20.1.24 R2 Medication activity (CCD)If medications were administered, Medication Activity Entry SHOULD use the values of ValueSet 1.3.6.1.4.1.19376.1.4.1.5.15 Drug Classes Used in Cardiac Procedure.6.2.2.11 Procedure Findings (Cardiac) SectionTemplate ID 1.3.6.1.4.1.19376.1.4.1.2.11Parent Template 2.16.840.1.113883.10.20.18.2.15General DescriptionThe Cardiac Procedure Findings section records clinically significant observationsconfirmed or discovered during the procedure.LOINC CodeDescription59776-5 PROCEDURE FINDINGSSubsections Opt DescriptionO Constituent procedure or technique (see requirement below)1.3.6.1.4.1.19376.1.4.1.2.13 O Comparison to prior study (Cardiac) (Card TF-2: 6.2.2.13)Entries Opt Description1.3.6.1.4.1.19376.1.5.3.1.4.13 C Simple Observations (PCC TF-2) (For use, see requirements below)1.3.6.1.4.1.19376.1.4.1.4.3 C 17-Segment Wall Analysis1.3.6.1.4.1.19376.1.4.1.4.4 C Projection Angiography Wall Analysis1.3.6.1.4.1.19376.1.4.1.4.5 C Coronary Angiography Arterial Analysis1.3.6.1.4.1.19376.1.4.1.4.6 C Pericardial Effusion845850For combined procedures (e.g., CACS and CCTA), findings for each constituent procedureMAY be described in a subsection of Procedure Findings. For stress tests that use ECG andimaging techniques, findings for each technique MAY be described in a subsection of ProcedureFindings. The section/title of each subsection SHOULD identify the constituent procedureor technique; the section/code MAY be absent. The narrative and entries of the subsectionSHALL describe the findings of the constituent procedure or technique.__________________________________________________________________________36Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________855860865The Procedure Findings (Cardiac) Section and its sub-sections SHALL include SimpleObservation Entries dependent on the type of procedure performed. For each row in Table6.2.2.11-1 one entry SHALL (R), SHOULD (R2), or MAY (O) be present in accordance with thecondition (column 1), using the specified observation/code (column 2), data type (column 3), andUnit of Measure code (column 4). For CD data types, a value from the specified value set(column 5) SHOULD be used.Observation concepts in Table 6.2.2.11-1 for which the observation was not performed (or notassessed) MAY be represented in a Simple Observation Entry with a value using an HL7 NullFlavor. Explicit observations of conditions known to not be present SHALL be represented witha compositional SNOMED CT code with qualifier [ 408729009 | finding context | = 410516002 |known absent ].The 17-Segment Wall Analysis Entry SHALL be present if the procedure was a stress SPECT,stress PET, stress TTE, or stress CMR.The Projection Angiography Wall Analysis Entry SHOULD be present if the procedure includeda left ventriculogram.The Coronary Angiography Arterial Analysis Entry SHALL be present if the procedure was aCCTA or ICA.870Note: many of the following concepts still need to be modeled before Trial ImplementationTable 6.2.2.11-1 Procedure Findings (Cardiac) ObservationsOCondition observation/code DataTypeBaseline ECG: Q-wavepathology(Optional)ASSERTION HL7ActCode(2.16.840.1.113883.5.4)Unit ofMeasureValue SetIndicate if pathologic Qwaves were present on thebaseline electrocardiogram(leads).Choose 1 of the following:● Yes● No● N/AR2 - CCTA, SPECT,CMR251149006: 246090004=128974000 SNOMED CTBaseline ECG Rhythm164918000:246090004=1289740001.3.6.1.4.1.19376.1.4.1.5.17Rhythm FindingsOBaseline ECG: ST-segmentdepression(Optional)Indicate if there wasnegative deflection belowthe isoelectric line greaterthan or equal to 0.1 mV onthe electrocardiogram (inmm).Choose 1 of the following:__________________________________________________________________________37Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________Condition observation/code DataTypeUnit ofMeasure● Yes● No● N/AValue Set(Recommended—stress TTE, stressSPECT, stress PET,CCTA, stress CMR)Baseline ECG readingsIndicate whether anyadditional ECG findingswere present.Choose any of thefollowing:● Left bundle branch block● Right bundle branch block● Ventricular paced rhythm● Pre-excitation● Other(Optional)Exercise capacity: METS(122717, DCM, ”Peakactivity workload”)PQ [MET] If exercise stress testing wasperformed during the study,indicate the number ofMETS achieved (based ontime completed for aspecific protocol, usingstandardized tables)(Recommended—stress TTE, stressSPECT)HR response: Baselineheart ratePQ {HB}/min If stress testing wasperformed during the study,indicate the baseline heartrate.HR response: % Predictedheart rate responseachieved(Derived)If stress testing wasperformed during the study,indicate the % predictedheart rate response achieved.R - stress TTE, stressSPECT428630002, SNOMED CT,Maximum HR AchievedPQ{HB}/min(Optional) exercisestress testingHR response: Heart raterecoveryIf exercise stress testing wasperformed during the study,indicate the heart raterecovery, defined as thereduction in the heart ratefrom the rate at peakexercise to the rate 1 minuteafter the cessation ofexercise.Choose 1 of the following:● Adequate (greater than 12bpm)● Inadequate (less than orequal to 12 bpm)● Unknown__________________________________________________________________________38Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________Condition observation/code DataTypeUnit ofMeasureValue Set(Recommended—stress echo, stressSPECT)BP response: Baselinesystolic blood pressureIf stress testing wasperformed during the study,indicate the firstmeasurement or earliestrecord of systolic bloodpressure (in mm Hg) for thisepisode of care.(Recommended—stress echo, stressSPECT)BP response: Baselinediastolic blood pressureIf stress testing wasperformed during the study,indicate the baselinediastolic blood pressure (inmm Hg).(Recommended—stress TTE, stressSPECT)BP response: Max systolicblood pressureIf stress testing wasperformed during the study,indicate the maximumsystolic pressure (in mmHg).(Optional) exercisestress testingBP response: Max diastolicblood pressure(Optional)If stress testing wasperformed during the study,indicate the maximumdiastolic pressure (in mmHg).O - exercise stresstesting122718, DCM, ”PeakDouble Product”PQmm[Hg].{HB}/min(Recommended—exercise SPECT,exercise TTE, stressPET)Stress testing: Chest painduring exerciseIf exercise stress testing wasperformed during the study,indicate the type of chestpain.Choose 1 of the following:● Limiting chest pain● Nonlimiting chest pain● Anginal equivalent● NoneSufficient heart rate forexercise testing(Derived)If exercise stress testing wasperformed during the study,indicate whether the patientis able to achieve 85% orgreater of maximumpredicted heart rate [(220 age in years) 0.85].Choose 1 of the following:● Yes● No● N/A__________________________________________________________________________39Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________Condition observation/code DataTypeUnit ofMeasureValue SetECG: ST-segmentdepression(Optional)Indicate additional STsegmentdepression beyondbaseline. If baseline STsegmentdepression isgreater than 1 mm, thenuninterpretable.Choose 1 of the following:● None● Less than 1 mm● 1 mm● 1.5 mm● 3 mmResults: Abnormality extent(Derived)Extent of abnormality basedon number of segmentswithin 17-segment model:● None● Small: 1 to 2 segments● Moderate: 3 to 4 segments● Large: greater than 5segmentsReport conclusions: ECGfindings(Recommended)271921002 SNOMED CT"ECG Finding")Indicate the conclusionderived from the ECGfindings. Choose 1 of thefollowing:● Ischemia 164861001● Equivocal 370359005● Normal 164854000● Nondiagnostic● N/A(Optional)Evidence of viability in theinfarct zoneIf perfusion defects or wallmotion abnormalities arepresent, indicate the degreeof viability.Choose 1 of the following:● Small● Moderate● Large● NoneR2 - CACS112058, DCM, "CalciumScore"observation/methodCode=112055, DCM, AgatstonScoring MethodPQIf coronary CT calciumscore is performed, provideAgatston score.__________________________________________________________________________40Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________Condition observation/code DataType(Recommended—CCTA or ICA)Coronary angiographyarterial segments Stenosis.(ICA and CCTA): ArterialsegmentsTarget: Choose any of thefollowing:● Left main● Proximal LAD and 1stdiagonal branches● Mid/Distal LAD, D2 andD3 branches● LCX, OMs, LPDA andLPL branches● RCA, RPDA, RPL, AMbranches● Ramus● Saphaneous vein grafts orfree arterial grafts, ifrelevant● Internal mammary artery(LIMA, RIMA), if relevantUnit ofMeasureValue SetIf coronary angiography wasperformed, indicate thearterial segments visualized.For each segment visualized,indicate the percent stenosis:● Normal● Less than 50%● 50% to 70%● Greater than 70%● OccludedAn example of how thisinformation could becollected is included inAppendix C.(Recommended—CCTA or ICA)Coronary angiography(invasive and CCTA):DominanceDICOM CID 3710Coronary angiography(ICA and CCTA):Coronary anomalies(Optional)If coronary angiography wasperformed, indicate whethercoronary anomalies, such asabnormal origin or location,are present.● Yes● NoLV diastolic function(Recommended)Indicate the overallassessment of LV diastolicfunction.Choose 1 of the following:● Normal for age● Abnormal for age● N/AO10230-1 LOINC LVEFPQ %observation/methodCode=● Visual estimation258083009● Quantitative (calculated__________________________________________________________________________41Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________Condition observation/code DataType258090004)Unit ofMeasureValue SetR2 LV Ejection fraction -categoricalCD● Hyperdynamic: greaterthan 70%● Normal: 50% to 70%(midpoint 60%)● Mild dysfunction: 40% to49% (midpoint 45%)● Moderate dysfunction:30% to 39% (midpoint 35%)● Severe dysfunction: lessthan 30%ROO(Recommended—TTE, TEE, CMR)(Optional—CCT)(Recommended—TTE, TEE, CMR)(Optional—CCT)(Recommended—TTE, TEE, CMR)(Optional—CCT)O – TTE, TEEO – TTE, TEEO – TTE, TEE250932006 SNOMED-CTleft ventricular cavity sizeend-diastolic8823-7 LOINC leftventricle systolic volume8821-1 LOINC Leftventricle diastolic volume250966002 SNOMED-CTright ventricular cavity sizeend-diastolic399121005 SNOMED-CTLeft atrium cavity sizeCD 1.3.6.1.4.1.19376.1.4.1.5.22Cardiac Chamber SizeAssessmentsPQmlPQmlCD 1.3.6.1.4.1.19376.1.4.1.5.22Cardiac Chamber SizeAssessmentsCD 1.3.6.1.4.1.19376.1.4.1.5.22Cardiac Chamber SizeAssessmentsRight atrium cavity size 1.3.6.1.4.1.19376.1.4.1.5.22Cardiac Chamber SizeAssessments18154-5, LOINC,Interventricular septumThickness diastole by USWall thickness: Leftventricle: Inferolateral wall:end-diastolic thicknessWall thickness: Rightventricle: Free wall: enddiastolicthicknessPQPQmmmmIndicate the end-diastolicthickness of the mid-freewall.Choose 1 of the following:● Normal● Increased● Not reportedOLeft ventricular myocardialmass(Optional)Indicate assessment of leftventricular myocardial mass.Choose 1 of the following:● Normal● Increased__________________________________________________________________________42Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________Condition observation/code DataTypeUnit ofMeasureValue Set● Not reportedLeft ventricular myocardialmass:By body surface area(Derived)Indicate the left ventricularmyocardial mass indexed bybody surface area.Choose 1 of the following:● Normal● Increased● Not reportedOptional—CMR,CCT)304522008 SNOMED CTPulmonary vein findingIntracardiac (nonvalvular)mass: Type(Optional)CD 1.3.6.1.4.1.19376.1.4.1.5.23Pulmonary VeinsAssessmentsIf an intracardiac mass ispresent, indicate the type ofintracardiac mass.Choose 1 of the following:● None● Vegetation 363564008● Thrombus 396339007● Neoplasm 108369006● UnknownRecommended—TTE,TEE, CCT, CMR)Intracardiac shunt(Optional)Valvular: Aortic: StructureIndicate if the patient hasevidence for an intracardiacshunt and etiology.Choose 1 of the following:● None● PFO 204317008● ASD 70142008● VSD 30288003● PDA 83330001● Cardiac shunt 442119001Indicate if the structure ofthe aortic valve is abnormal.Choose 1 of the following:● Normal● Abnormal● Prosthetic● Not assessedO__________________________________________________________________________43Rev. 1.0 – 2011-04-22Valvular: Aortic: Structure:Cause of abnormality(Optional)If the aortic valve isabnormal, indicate the causeof abnormality in the aorticvalve.Choose any of thefollowing:● Congenital leafletCopyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________Condition observation/code DataTypeUnit ofMeasureValue Setabnormality● Leafletthickening/calcification● Vegetation/mass● Other● None● N/ARecommended—TTE,TEE, CMR, cardiaccath)Recommended—TTE,TEE, CMR, cardiaccath)Valvular: Aortic: StenosisValvular: Aortic:RegurgitationIndicate the severity ofstenosis in the aortic valve.Choose 1 of the following:● Mild● Moderate● Severe● None● Not assessedIndicate the severity ofregurgitation in the aorticvalve.Choose 1 of the following:● Mild● Moderate● Severe● None● Not assessedRecommended—TTE,TEE, CMR)Valvular: Mitral: StructureIndicate if the structure ofthe mitral valve is abnormal.Choose 1 of the following:● Normal● Abnormal● Prosthetic● Annuloplasty ring● Not assessedRecommended—TTE,TEE, CMR)Valvular: Mitral: Structure:AbnormalIf the mitral valve isabnormal, indicate thelocation of the abnormalityof the mitral valve.Choose 1 or more of thefollowing:● Congenital leafletabnormality● Leafletthickening/calcification● Vegetation/mass● Flail● Prolapse__________________________________________________________________________44Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________Condition observation/code DataTypeUnit ofMeasureValue Set● None● Not assessedRecommended—TTE,TEE, CCT, CMR,cardiac cath)Valvular: Mitral: AnnularcalcificationIndicate if there is annularcalcification in the mitralvalve.Choose 1 of the following:● Present● Absent● Not assessedRecommended—TTE,TEE, CMR, cardiaccath)Valvular: Mitral: StenosisIndicate the severity ofstenosis in the mitral valve.Choose 1 of the following:● Mild● Moderate● Severe● None● Not assessedRecommended—TTE,TEE, CMR, cardiaccath)Valvular: Mitral:RegurgitationIndicate the severity ofregurgitation in the mitralvalve.Choose 1 of the following:● Mild● Moderate● Severe● None● Not assessedRecommended—TTE,TEE, CMR)Valvular: Tricuspid:StructureIndicate if the structure ofthe tricuspid valve isabnormal.Choose 1 of the following:● Normal● Abnormal● Prosthetic● Annuloplasty ring● None● Not assessedRecommended—TTE,TEE, CMR)Valvular: Tricuspid:StenosisIndicate the severity ofstenosis in the tricuspidvalve.Choose 1 of the following:● Mild● Moderate__________________________________________________________________________45Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________Condition observation/code DataTypeUnit ofMeasureValue Set● Severe● None● Not assessedRecommended—TTE,TEE, CMR)Valvular: Tricuspid:RegurgitationIndicate the severity ofregurgitation in the tricuspidvalve.Choose 1 of the following:● Mild● Moderate● Severe● None● Not assessedRecommended—TTE,TEE, CMR)Valvular: Pulmonic:StructureIndicate if the structure ofthe pulmonic valve isabnormal.Choose 1 of the following:● Normal● Abnormal● Prosthetic● None● Not assessedRecommended—TTE,TEE, CMR)Valvular: Pulmonic:StenosisIndicate the severity ofstenosis in the pulmonicvalve.Choose 1 of the following:● Mild● Moderate● Severe● None● Not assessedOValvular: Pulmonic:RegurgitationIndicate the severity ofregurgitation in thepulmonic valve.Choose 1 of the following:● Mild● Moderate● Severe● None● Not assessedRecommended—TTE,TEE, CMR, CCTA,cardiac cath)Aorta: DissectionIndicate if the aorta isdissected.Choose 1 of the following:__________________________________________________________________________46Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________Condition observation/code DataTypeUnit ofMeasureValue Set● Present● Absent● Not assessedRecommended—TTE,TEE, CMR, CCTA,cardiac cath)Aorta: Dissection: Present:Stanford ClassificationIf the aorta is dissected,indicate the type ofdissection that is present inthe aorta.Choose 1 of the following:● Stanford type A—alldissections involving theascending aorta regardless ofsite of origin● Stanford type B—alldissections not involving theascending aortaAortic Root: Dilation:EnlargedIndicate if the aortic root isdilated.Choose 1 of the following:● Present● Absent● Not assessedThe Procedure Findings (Cardiac) Section MAY include a subsection Comparison to Prior Study(Cardiac).8756.2.2.12 Assessment And Plan (Cardiac) SectionTemplate ID 1.3.6.1.4.1.19376.1.4.1.2.12Parent Template 2.16.840.1.113883.10.20.18.2.14The assessment and plan section shall contain a narrative description of the assessment ofGeneral Description the patient condition and expectations for care including proposals, goals, and orderrequests for monitoring, tracking, or improving the condition of the patient.LOINC CodeDescription51847-2 ASSESSMENT AND PLANSubsections Opt Description1.3.6.1.4.1.19376.1.4.1.2.13 O Comparison to prior study (Cardiac) (Card TF-2: 6.2.2.13)Entries Opt Description1.3.6.1.4.1.19376.1.5.3.1.4.13 O Simple Observation (PCC TF-2)2.16.840.1.113883.10.20.1.25 O Plan of Care Activities (CCD)__________________________________________________________________________47Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________880The Assessment And Plan (Cardiac) Section SHOULD include Simple Observation Entriesdependent on the type of procedure performed. For each row in Table 6.2.2.12-1, an entry shallor may be present in accordance with the condition (column 1), using the specifiedobservation/code (column 2), data type (column 3), and Unit of Measure code (column 4). ForCD data types, a value from the specified value set (column 5) SHOULD be used.Table 6.2.2.12-1 Assessment And Plan (Cardiac) ObservationsCondition observation/code DataTypeR - cathischemic heart diseaseassessmentR - CCTA, cath, stressSPECT, stress echoischemiaUnit ofMeasureValue Set1.3.6.1.4.1.19376.1.4.1.5.24Imaging Findings● Yes● No● Equivocal 408379005● N/AR2250907009, SNOMED CT,left ventricular function1.3.6.1.4.1.19376.1.4.1.5.24Imaging Findings885The Assessment and Plan (Cardiac) Section MAY include a subsection Comparison to PriorStudy (Cardiac).6.2.2.13 Comparison to Prior Study (Cardiac) SectionTemplate ID 1.3.6.1.4.1.19376.1.4.1.2.13Parent Template noneGeneral DescriptionDICOM CodeDescription111424 (note this is a DICOM code,not LOINC)Comparison to Previous ExamsEntries Opt Description1.3.6.1.4.1.19376.1.5.3.1.4.13 O Simple Observation (PCC TF-2)890The Comparison to Prior Study (Cardiac) Section SHALL reference a prior study identified inthe Prior Results (Cardiac) Section using the ID attribute in a element.The Comparison to Prior Study Section SHOULD include Simple Observation Entriescomparing the current with a prior study. For each row in Table 6.2.2.13-1, an entry shall ormay be present in accordance with the condition (column 1), using the specified__________________________________________________________________________48Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________895observation/code (column 2), data type (column 3), and Unit of Measure code (column 4). ForCD data types, a value from the specified value set (column 5) SHOULD be used.Note: Concept “Significant changes from prior study” needs to be modeled prior to TrialImplementationTable 6.2.2.13-1 Comparison to Prior Study (Cardiac) ObservationsROCondition observation/code DataTypeSignificant changes fromprior study248243004, SNOMED CT,“Exercise tolerance”Unit ofMeasureValue SetCD n/a ● Yes—Describe changes fromprior study● No● N/ACD n/a CID (3236) ToleranceComparison FindingsOO251053005, SNOMED CT,“Myocardial Perfusion”250909007, SNOMED CT,“LV Wall motion”CD n/a CID (3235) PerfusionComparison FindingsCD n/a CID (3237) Wall MotionComparison Findings9006.2.2.14 Key Images SectionTemplate ID 1.3.6.1.4.1.19376.1.4.1.2.14Parent TemplateGeneral DescriptionLOINC CodeCDTDIR 3.1.1 (no Template OID)55113-5 KEY IMAGESThe Key Images section contains narrative description of and references to DICOMImage Information Objects that illustrate the findings of the procedure reported.DescriptionEntries Opt Description2.16.840.1.113883.10.20.6.2.8 O SOP Instance Observation (defined in CDTDIR)905The Key Images section text SHALL contain image references using linkHtml elements,where @href is a valid Web Access to DICOM Persistent Object (WADO) URL and the textcontent of linkHtml is the either visible text of the hyperlink or a descriptor or identifier of theimage.The Key Images section MAY contain Entries corresponding to the image references, inaccordance with the CDTDIR SOP Instance Observation Template (OID =2.16.840.1.113883.10.20.6.2.8).__________________________________________________________________________49Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________9106.2.2.15 DICOM Object Catalog SectionTemplate ID 1.3.6.1.4.1.19376.1.4.1.2.15Parent TemplateGeneral DescriptionDICOM Code121181 (note this is a DICOMcode, not LOINC)noneDICOM Object Catalog lists all referenced objects and their parent Series and Studies,plus other DICOM attributes required for retrieving the objects.DICOM OBJECT CATALOGDescriptionEntries Opt Description2.16.840.1.113883.10.20.6.2.6 R Study Act (CDTDIR)915A DICOM Object Catalog Section SHALL be present if other document sections containreferences to DICOM SOP Instances (images or other information objects), and otherwise MAYbe present with references to some or all SOP Instances of the associated DICOM Study.The DICOM Object Catalog Section SHALL provide Study Act Entries, including subsidiarySeries and SOPInstance Acts, that identify all SOP Instances referenced in other documentsections.Note:CIRC and its parent Procedure Note require a section/title attribute for all document sections.920__________________________________________________________________________50Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________6.2.3 Header Content Modules9256.2.3.1 Encompassing EncounterThe CDA Header SHALL include exactly one encompassingEncounter Act. The TemplateID for conformance to this template is OID = 1.3.6.1.4.1.19376.1.4.1.3.1.The encompassingEncounter / effectiveTime value SHALL be accurate to the day, andMAY be accurate to the second.930935940945950955960965970975responsible physician namereferring physician addressreferring physician phonereferring physician nameorganization nameorganization addressorganization phone, web, other telecom accessservice location nameservice location address...Figure 6.2.3.1-1 Encompassing Encounter Example__________________________________________________________________________51Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________980985990995100010056.2.3.1.1 Responsible PartyThe responsible party element represents only the party responsible for the encounter, notnecessarily the entire episode of care.The responsibleParty element MAY be present. If present, responsibleParty/assignedEntity SHALL have at least one assignedPerson orrepresentedOrganization element present.Note:This is identical to CDTDIR CONF-DIR-67responsibleParty assignedEntity id SHALL be present with the responsiblephysician’s identifier.assignedEntity code SHOULD be present with the responsible physician’s specialty.assignedEntity MAY include an accreditation element from the urn:ihe:cardnamespace to provide physician accreditation status.The accreditation element SHALL use the character string (ST) data type.The accreditation element SHALL appear after the defined elements of the Role class, andbefore any scoper or player entity elements.assignedEntity assignedPerson name SHALL be present with the responsiblephysician’s name.6.2.3.1.2 Health Care FacilityConformance requirements for encoding of information about the Health Care Facility areprovided in the Procedure Note Implementation Guide, and are reproduced here for reference:CONF-PN-18: A Procedure Note SHOULD contain information about where the procedurewas performed.CONF-PN-19: If present, the physical location of the procedure SHALL be represented withcomponentOf/encompassingEncounter/location/ healthCareFacility/idelement.CONF-PN-20: If present, the location/healthCareFacility element SHALL contain acode element representing the type of location.location/ healthCareFacility/ serviceProviderOrganization SHOULD bepresent with name, addr and telecom elements.location/ healthCareFacility/ location (Place Entity) MAY be present with nameand/or addr elements identifying the place of the encounter.healthCareFacility MAY include an accreditation element from the urn:ihe:cardnamespace to provide facility accreditation status.The accreditation element SHALL use the character string (ST) data type.__________________________________________________________________________52Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________1010101510201025103010351040The accreditation element SHALL appear after the defined elements of the Role class, andbefore any scoper or player entity elements.6.2.3.1.3 Referring ProviderConformance requirements for encoding of information about the referring provider are providedin the Procedure Note Implementation Guide, and are reproduced here for reference:CONF-PN-21: A Procedure Note MAY contain information about the referring provider.CONF-PN-22: If present, the referring provider SHALL be represented with acomponentOf/encompassingEncounter/encounterParticipant element.CONF-PN-23: When an encompassingEncounter/encounterParticipantrepresenting the referring provider is present, the encounterParticipant/@typeCodeSHALL be REF (referrer) and an assignedEntity SHALL be present.CONF-PN-24: If elements required in componentOf/encompassingEncounter/encounterParticipant are unknown, these elements SHALL be represented with theappropriate HL7 null value.If present, the referring provider assignedEntity id SHALL be present with one value of theset being the Performer’s National Provider Identifier (root OID = 2.16.840.1.113883.4.6) (in theUS) or the equivalent.The referring provider assignedEntity code SHOULD be present with the referringprovider’s specialty.6.2.3.1.4 Physician of RecordFor procedures performed in an in-patient context, conformance requirements for encoding ofinformation about the Physician of Record are taken from the Diagnostic Imaging ReportImplementation Guide.CONF-DIR-68: A Physician of Record Participant (templateId2.16.840.1.113883.10.20.6.2.2) SHOULD be present.CONF-DIR-69: The templateId for a Physician of Record Participant SHALL be2.16.840.1.113883.10.20.6.2.2.CONF-DIR-70: A Physician of Record Participant SHALL be represented with anencounterParticipant element where @typeCode is ATND.CONF-DIR-71: An encounterParticipant/assignedEntity/id element SHALL bepresent containing the ID of the physician of record.CONF-DIR-72: A encounterParticipant/assignedEntity/code element SHALLbe present and SHALL contain … an appropriate national health care provider coding system(e.g., NUCC in the U.S., where @codeSystem is 2.16.840.1.113883.11.19465).__________________________________________________________________________53Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________1045CONF-DIR-73: An assignedPerson/name element SHOULD be present containing thename of the physician of record.Copied from Diagnostic Imaging Report Implementation Guide105010556.2.3.2 OrderThe CDA Header SHOULD include an inFulfillmentOf Act Relationship to an order Act.Conformance to the requirements of this section SHALL be indicated by a templateID OID =1.3.6.1.4.1.19376.1.4.1.3.2.order / priorityCode SHALL be present, with values from coding system HL7 ActPriority(OID = 2.16.840.1.113883.5.7).One value within the set of order / id values SHALL be the Accession Number used in theDICOM imaging data, with the root representing the Assigning Authority (Issuer of AccessionNumber).10601065< inFulfillmentOf>Figure 6.2.3.2-1 Order107010756.2.3.3 Patient DemographicsThe CDA Header Patient Entity SHOULD include the elements birthTime,administrativeGenderCode, raceCode and ethnicGroupCode. For the US, raceCodevalue SHALL be drawn from level 0 codes of the HL7 Race coding system (OID =2.16.840.1.113883.5.104), and ethnicGroupCode value SHALL be drawn from level 0 codesof the HL7 Ethnicity coding system (OID = 2.16.840.1.113883.5.50). Note that these elementsmay be encoded with a “flavor of null” if the information is unknown or collection is prohibitedby local regulation.__________________________________________________________________________54Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________1080108510901095Charles David Anderson IIMaui HealthcarePukalani, Maui, HIFigure 6.2.3.3-1 Demographics110011051110111511206.2.3.4 Service Event and PerformerConformance requirements for encoding of information about the Service Event and Performerare provided in the Procedure Note Implementation Guide, and are reproduced here forreference:CONF-PN-31: A Procedure Note SHALL contain one or more documentationOf/serviceEvent elements.CONF-PN-32: The value for serviceEvent/code SHOULD be selected from code system2.16.840.1.113883.6.96 SNOMED CT and MAY be selected from a localized procedurecoding system for a given country such as 2.16.840.1.113883.6.104 ICD9 CM Procedures or2.16.840.1.113883.6.12 CPT-4 in the U.S.CONF-PN-21: A Procedure Note MAY containinformation about the referring provider.CONF-PN-33: The serviceEvent/effectiveTime SHALL be present witheffectiveTime/low and SHALL include effectiveTime/high ifeffectiveTime/width is not present. The serviceEvent/effectiveTime SHALLbe accurate to the day, and MAY be accurate to the second.CONF-PN-34: If the date and only the general length of the procedure are known, theserviceEvent/effectiveTime/low SHALL be present with aneffectiveTime/width element. The serviceEvent/effectiveTime/low SHALLbe accurate to the day, and MAY be accurate to the second.CONF-PN-35: If only the date is known and the duration of the procedure is unknown, theserviceEvent/effectiveTime/width element SHALL contain the appropriate HL7 nullvalue.CONF-PN-36: The primary performers (PPRF) SHALL be identified.__________________________________________________________________________55Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________CONF-PN-37: For all performers, serviceEvent/performer/assignedEntity/codeSHALL be present.112511301135114011451150CONF-PN-38: The value for serviceEvent/performer/assignedEntity/codeSHOULD be selected from a localized assignedEntity coding system for a given countryand MAY be selected from code system 2.16.840.1.113883.11.19465 Healthcare ProviderTaxonomy Code (NUCC).CONF-PN-39: Any assistants SHALL be identified and SHALL be identified as secondaryperformers (SPRF).The value for serviceEvent code MAY be drawn from value set 1.3.6.1.4.1.19376.1.4.1.5.1.The set of serviceEvent id values SHALL include the Study Instance UID used in theDICOM imaging data, with the UID value in the root attribute.If the performer is a physician, assignedEntity id SHALL be present with the Performer’sNational Provider Identifier (root OID = 2.16.840.1.113883.4.6) (in the US) or the equivalent.assignedEntity MAY include an accreditation element from the urn:ihe:cardnamespace to provide physician accreditation status.The accreditation element SHALL use the character string (ST) data type.The accreditation element SHALL appear after the defined elements of the Role class, andbefore any scoper or player entity elements.performer nameFigure 6.2.3.4-1 Performer115511606.2.3.5 Legal AuthenticatorThe CDA Header SHALL include a Legal Authenticator participation, identifying the personsigning the report.assignedEntity id SHALL be present with the Legal Authenticator’s National ProviderIdentifier (root OID = 2.16.840.1.113883.4.6) (in the US) or the equivalent.assignedEntity code SHOULD be present with the Legal Authenticator’s specialty, withvalues from coding system NUCC Health Care Provider Taxonomy (OID =2.16.840.1.113883.6.101) (in the US) or the equivalent.__________________________________________________________________________56Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________6.2.4 Entry Content Modules116511706.2.4.1 Diabetes Problem ConcernThis is a specialization of the Problem Concern entry template (OID =1.3.6.1.4.1.19376.1.5.3.1.4.5.2), where the specific problem is Diabetes (SNOMED CT =73211009). Conformance to this specialization shall be identified by templateID OID =1.3.6.1.4.1.19376.1.4.1.4.1.The Problem SHALL include a component actRelationship to an act representing treatmenttherapy, with therapy codes drawn from value set 1.3.6.1.4.1.19376.1.4.1.5.6.117511801185119011956.2.4.2 Angina Problem ConcernThis is a specialization of the Problem Concern entry template (OID =1.3.6.1.4.1.19376.1.5.3.1.4.5.2), where the specific problem is Angina (SNOMED CT =194828000). Conformance to this specialization shall be identified by templateID OID =1.3.6.1.4.1.19376.1.4.1.4.2.The negationInd attribute SHALL be used to specifies that the problem indicated was observedto not have occurred.Note the following concepts still need to be modeled before Trial ImplementationPresence of angina (Y/N/U)Stability drawn from value set 1.3.6.1.4.1.19376.1.4.1.5.7Angina type with supporting descriptive characteristics6.2.4.3 17-Segment Wall AnalysisThe 17-Segment Wall Analysis Entry SHALL consist of an Organizer Act, subsidiaryObservations, and optionally a subsidiary ObservationMedia. Conformance to this specificationshall be identified by templateID OID = 1.3.6.1.4.1.19376.1.4.1.4.3 in the Organizer Act.The Organizer Act/code shall be BATTERY. The Organizer Act/statusCode shall be tbdThere SHALL be one or two ActRelationships with typeCode COMP with a target of anobservation for each of the values in Value Set 1.2.840.10008.6.1.218 DICOM CID 3717Myocardial Wall Segments. The value from the Value Set shall be encoded inobservation/targetSiteCode.The observation/value shall be a morphological assessment from Value Set x and/or a wallmotion categorical assessment from Value Set y, or a null flavor.If the observation/value is a morphological assessment or a null flavor, the observation/codeshall be (72724002, SNOMED CT, “morphology findings”). If the observation/value is a__________________________________________________________________________57Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________1200wall motion categorical assessment, the observation/code shall be (60797005, SNOMED CT,“Cardiac Wall Motion”).A morphological assessment observation MAY have a subsidiary Severity observation inaccordance with template 1.3.6.1.4.1.19376.1.5.3.1.4.1 (IHE PCC TF-2).There SHOULD be one ActRelationship from the Organizer with typeCode COMP with a targetof an ObservationMedia, whose value of type ED shall contain an in-line encoding of agraphic depiction of the wall analysis. The ObservationMedia shall include an XML IDREFS IDattribute as a target of a element in the section/text narrative block.1205Note the following concepts still need to be modeled before Trial Implementation(Recommended—SPECT, echo, CMR)(Optional—CCTA)LV wall motionabnormalities—17segment60797005 SNOMEDCardiac Wall Motionobservation/targetSiteCodefrom CID 3717CD CID 370312101215122012256.2.4.4 Projection Angiography Wall AnalysisThe Projection Angiography Wall Analysis Entry shall consist of an Organizer Act, subsidiaryObservations, and optionally a subsidiary ObservationMedia. Conformance to this specificationshall be identified by templateID OID = 1.3.6.1.4.1.19376.1.4.1.4.4 in the Organizer Act.The Organizer Act/code shall be BATTERY.There SHALL be one ActRelationship with typeCode COMP with a target of an observation foreach of the values in Value Set 1.2.840.10008.6.1.219 DICOM CID 3718 Myocardial WallSegments in Projection. The value from the Value Set shall be encoded inobservation/targetSiteCode.The observation/value shall be a morphological assessment from Value Set x, a wall motioncategorical assessment from Value Set y, or a null flavor.If the observation/value is a morphological assessment or a null flavor, the observation/codeshall be (72724002, SNOMED CT, “morphology findings”). If the observation/value is a wallmotion categorical assessment, the observation/code shall be (60797005, SNOMED CT,“Cardiac Wall Motion”).A morphological assessment observation MAY have a subsidiary Severity observation inaccordance with template 1.3.6.1.4.1.19376.1.5.3.1.4.1 (IHE PCC TF-2).There SHOULD be one ActRelationship from the Organizer with typeCode COMP with a targetof an ObservationMedia, whose value of type ED shall contain an in-line encoding of a graphic__________________________________________________________________________58Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________depiction of the wall analysis. The ObservationMedia shall include an XML IDREFS IDattribute as a target of a element in the section.text narrative block.Note the following concepts still need to be modeled before Trial Implementation1230(Optional—LVG)LV wall motionabnormalities—10segmentCD CID 370360797005 SNOMEDCardiac Wall Motionobservation/targetSiteCodefrom CID 371812351240124512506.2.4.5 Coronary Angiography Arterial AnalysisThe Coronary Angiography Arterial Analysis Entry shall consist of an Organizer Act, subsidiaryObservations, and optionally a subsidiary ObservationMedia. Conformance to this specificationshall be identified by templateID OID = 1.3.6.1.4.1.19376.1.4.1.4.5 in the Organizer Act.The Organizer Act/code shall be BATTERY.There SHALL be one ActRelationship with typeCode COMP with a target of an observation foreach arterial segment visualized. The observation/targetSiteCode of the observation SHALLcontain one or more values from Value Set 1.2.840.10008.6.1.218 DICOM CID 3715 CoronaryArteries.The observation/code shall be (408715008, SNOMED CT, “Lumen Diameter Stenosis”).The observation/value shall be a numerical value (data type PQ), a categorical assessment fromValue Set z (data type CD), or a null flavor.There SHOULD be one ActRelationship from the Organizer with typeCode COMP with a targetof an ObservationMedia, whose value of type ED shall contain an in-line encoding of a graphicdepiction of the coronary analysis. The ObservationMedia shall include an XML IDREFS IDattribute as a target of a element in the section.text narrative block.6.2.4.6 Pericardial Effusion EntryThe Pericardial Effusion Entry shall consist of an Observation Act and subsidiary Observations.Conformance to this specification shall be identified by templateID OID =1.3.6.1.4.1.19376.1.4.1.4.6.Note the following concepts still need to be modeled before Trial ImplementationRecommended—TTE, TEE,CCT, CMR)Pericardial: Effusion(pericardial effusion 373945007373945007:408729009= 410516002__________________________________________________________________________59Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________Optional interpretationCode● Trivial● Small● Moderate● LargeOOPericardial effusion: Evidence ofincreased intrapericardial pressure(Optional)Pericardial: Thickness(Optional)35304003 tamponade is present.Choose 1 of the following:● Present● Absent● Equivocal 42425007● Not assessedIndicate the thickness of thepericardium.Choose 1 or more of the following:● Normal● Thickened● Calcified● Not assessed__________________________________________________________________________60Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________12556.3 Value Sets1.3.6.1.4.1.19376.1.4.1.5.1 Cardiac imaging servicesCoding Scheme SNOMED CTConceptEchocardiography 40701008CCT (cardiac computed tomography) 241547009CMR (cardiac magnetic resonance) 241620005Cardiovascular NM 108294005Cardiac PET (positron emission tomography) 241439007coronary angiography and left ventriculography 4189030081.3.6.1.4.1.19376.1.4.1.5.2 Cardiac imaging proceduresCoding Scheme SNOMED CTConceptNuclear: SPECT MPI 252432008Nuclear: PET 241439007Nuclear: RNA 426940008Echocardiography: exercise stress TTE 433233004Echocardiography: TTE 433236007Echocardiography: TEE 105376000CCT: CACS 426005005CCT: CCTA 419545005CMR: CMR 241620005CMR: stress CMR 431609005Cardiac catheterization: ICA 419416005Cardiac catheterization: ICA and LVG 41890300812601.3.6.1.4.1.19376.1.4.1.5.3 Referring Physician SpecialtyCoding Scheme nuccProviderCodes SNOMED CTConceptCardiologist 207RC0000X 17561000Family practice 207Q00000X 62247001Internal medicine 207R00000X 39677007OB/GYN 207V00000X 309367003Hospitalist 208M00000X 309395003Surgeon 208600000X 304292004Anesthesiologist 207L00000X 88189002Radiologist 2085R0202X 66862007__________________________________________________________________________61Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________Emergency department physician 207P00000X 309294001Physician extenderNote:As described in Section 6.1.2.4, the selection of the appropriate coding system for use may be based on localpolicy or national regulation.12651.3.6.1.4.1.19376.1.4.1.5.4 Cardiac problems/concernsCoding Scheme SNOMED CTConceptHypertension 38341003Dyslipidemia 370992007Diabetes 73211009Acute renal failure 14669001Chronic kidney disease 236425005Peripheral arterial disease 399957001Cerebrovascular disease 62914000Erectile dysfunction 398175007Cardiac arrhythmia 44808001Asthma 195967001Bronchospasm 4386001Implanted pacemaker 371821000Heart failure 84114007Myocardial infarction 22298006Angina 1948280001.3.6.1.4.1.19376.1.4.1.5.5 Cardiac interventionsCoding Scheme SNOMED CTConceptPercutaneous coronary intervention 415070008Coronary artery bypass graft 232717009Implantation of cardiac pacemaker 3072800051.3.6.1.4.1.19376.1.4.1.5.7 Angina TypeCoding Scheme SNOMED CTConceptStable angina 233819005Unstable angina 4557003Atypical chest pain 371807002Myocardial infarction 22298006__________________________________________________________________________62Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________12701.3.6.1.4.1.19376.1.4.1.5.10 Contrast Agents Classes for Adverse ReactionsCoding Scheme SNOMED CTConceptIodinated contrast agent 426722004Gadolinium compound 105879004Echocardiography agent 409290009radiopharmaceutical 3493580001.3.6.1.4.1.19376.1.4.1.5.11 Contrast Agents__________________________________________________________________________63Rev. 1.0 – 2011-04-22Concept Code Value Coding SchemeRadionuclide: F-18 FDG for viability 422975006 SNOMED CTRadionuclide: Rubidium-82 perfusion 79197006 SNOMED CTRadionuclide: Nitrogen-13 ammonia perfusion 21576001 SNOMED CTRadionuclide: Tc-99m tetrofosmin (Myoview) 404707004 SNOMED CTRadionuclide: Tc-99m sestamibi (Cardiolite) 404706008 SNOMED CTRadionuclide: Tl-201 353842007 SNOMED CTEcho Contrast: Optison (Perflutren) 409291008 SNOMED CT00019-2707-03 NDCEcho Contrast: Definity (Perflutren Lipid Microsphere) 11994-*011-04 NDCEcho Contrast: Agitated saline ???????? ???????Echo Contrast: Iodinated contrast 426722004 SNOMED CTHigh Osmolar Ionic Contrast: Diatrizoate meglumine anddiatrizoate sodium (Renografin, etc.)412372002(meglumine),24891006 (sodium)SNOMED CTHigh Osmolar Ionic Contrast: Ioxithalamate (Telebrix) ???????? ???????High Osmolar Ionic Contrast: Iothalamate dimeglumine 109221002 SNOMED CT(Conray)Low osmolar non-ionic contrast: Iopamidol (Isovue) 109219007 SNOMED CTLow osmolar non-ionic contrast: Iohexol (Omnipaque) 109218004 SNOMED CTLow osmolar non-ionic contrast: Ioversol (Optiray) 109222009 SNOMED CTLow osmolar non-ionic contrast: Ioxaglate (Hexabrix) 353924001 SNOMED CTLow osmolar non-ionic contrast: Iomeprol (Iomeron) 356671000 SNOMED CTLow osmolar non-ionic contrast: Iopromide (Ultravist) 353903006 SNOMED CTIso-osmolar nonionic contrast: Iodixanol (VisiPaque) 353962003 SNOMED CTParamagnetic agent: Gadopentetate dimeglumine 404846007 SNOMED CT(Magnevist)Paramagnetic agent: Gadodiamide (Omniscan) 354088005 SNOMED CTParamagnetic agent: Gadoversetamide (Optimark) 409477004 SNOMED CTParamagnetic agent: Gadobenate dimeglumine414307008 SNOMED CT(MultiHance)Contrast Media: None 260413007 is this SNOMED CTCopyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________right??1.3.6.1.4.1.19376.1.4.1.5.12 Cardiac MR Acquisition ModesCoding Scheme SNOMED CTConceptMorphology and Function ????????Delayed Enhancement ????????Flow/ velocity quantification ????????MR Angiography 419997008MR Cardiac Perfusion 419535008Other ????????(MR for myocardial viability) 43194000012751.3.6.1.4.1.19376.1.4.1.5.13 Cardiac Lab ResultsCoding Scheme LOINCConceptCholesterol.in HDL 2085-9Cholesterol.in LDL 2089-1Cholesterol 2093-3Triglyceride 2571-8High sensitivity C reactive protein 30522-7Creatine kinase.MB 13969-1Natriuretic peptide.B 30934-4Natriuretic peptide.B prohormone 33762-6Troponin T.cardiac 6598-7Creatinine 2160-0Hemoglobin A1c 41995-2Urea nitrogen 3094-0Fasting glucose 1557-81.3.6.1.4.1.19376.1.4.1.5.14 Cardiac Drug ClassesCoding Scheme SNOMED CTNDF-RTConceptACE inhibitor 69306018 N0000029130Angiotensin receptor blocker 96308008 N0000175561Aspirin, other antiplatelet agents 7947003 N0000145918Calcium channel blockers 48698004 N0000029119Beta-blockers 33252009 N0000029118Erectile dysfunction medication 407315009(genital NEED CODE__________________________________________________________________________64Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________1280system agent, couldcode finer if we hadexact ED drugs)Nitrates 31970009 N0000007647Warfarin 48603004 N0000148057Antiarrhythmics 67507000 N0000029121Digitalis 65774009 N0000147198Metformin 109081006 N0000021984Lipid-lowering medication (niacin, statins, 57952007 N0000029122fibrates, etc.)Other antihypertensivesHypotensive Agent1182007(NOT69306018, 96308008,33252009)N0000029427Aminophylline 55867006 N0000146397Theophylline 66493003 N0000146467Dipyridamole 66859009 N0000146237Inhaler (NEED SPECIFIC TYPE) N0000177906Diabetic medications 384953001 NEED CODENote:As described in Section 6.1.2.4, the selection of the appropriate coding system for use may be based on localpolicy or national regulation.12851.3.6.1.4.1.19376.1.4.1.5.15 Drug Classes Used in Cardiac ProcedureCoding Scheme SNOMED CTNDF-RTConceptCalcium channel blockers 48698004 N0000029119Beta-blockers 33252009 N0000029118Nitrates 31970009 N0000007647Aminophylline 55867006 N0000146397Note:As described in Section 6.1.2.4, the selection of the appropriate coding system for use may be based on localpolicy or national regulation.1.3.6.1.4.1.19376.1.4.1.5.17 Rhythm FindingsCoding Scheme SNOMED MDC MDC RefConceptCodeNormal sinus rhythm 64730000 10:9232 MDC_ECG_RHY_SINUS_NORMAL_RHYAtrial fibrillation 49436004 10:9472 MDC_ECG_RHY_ATR_FIBPremature atrial contractions 425880007 10:8272 MDC_ECG_BEAT_ATR_P_CPremature ventricular contractions 427172004 10:8336 MDC_ECG_BEAT_V_P_CPaced rhythm 426453001 10:8704 MDC_ECG_BEAT_PACED__________________________________________________________________________65Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________Atrial flutter 164890007 10:9456 MDC_ECG_RHY_ATR_FLUTSinus tachycardia 427084000 10:9264 MDC_ECG_RHY_SINUS_TACHYSinus bradycardia 426177001 10:9248 MDC_ECG_RHY_SINUS_BRADYNote:As described in Section 6.1.2.4, the selection of the appropriate coding system for use may be based on localpolicy or national regulation.12901.3.6.1.4.1.19376.1.4.1.5.18 ECG FindingsCoding Scheme SNOMED MDC MDC RefConceptCodeLeft bundle branch block 64730000 10:9232 MDC_ECG_BEAT_LBB_BLK_COMPRight bundle branch block 49436004 10:9472 MDC_ECG_BEAT_RBB_BLK_COMPVentricular paced rhythm 10:5120 MDC_ECG_WAVP_PACE_VPre-excitation 10:10096 MDC_ECG_RHY_PREXNote:As described in Section 6.1.2.4, the selection of the appropriate coding system for use may be based on localpolicy or national regulation.12951.3.6.1.4.1.19376.1.4.1.5.19 Myocardium AssessmentsCoding Scheme SNOMED CTConceptnormal cardiovascular function 61618002Scar 12402003Myocardial ischemia 414795007Mixed scar and ischemia 12402003+4147950071.3.6.1.4.1.19376.1.4.1.5.20 Wall motionCoding Scheme SNOMED CTConceptNormal wall motion 373122000Hyperkinetic region 373123005Hypokinesis 37706002Akinesis 195675009Dyskinesis 2543700513001.3.6.1.4.1.19376.1.4.1.5.21 LVEF AssessmentsCoding SchemeConcept__________________________________________________________________________66Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________Hyperdynamic: greater than 70%Normal: 50% to 70%Mild dysfunction: 40% to 49%Moderate dysfunction: 30% to 39%Severe dysfunction: less than 30%Coding scheme for this value set has not been established1.3.6.1.4.1.19376.1.4.1.5.22 Cardiac Chamber Size AssessmentsCoding Scheme SNOMED CTConceptnormal size cardiac chamber 373124004abnormally small cardiac chamber 373125003mildly enlarged cardiac chamber 373126002moderately enlarged cardiac chamber 373127006markedly enlarged cardiac chamber 37312800113051.3.6.1.4.1.19376.1.4.1.5.23 Pulmonary Veins AssessmentsCoding Scheme SNOMED CTConceptpulmonary venous connections normal 446158009variant number of pulmonary veins (usually 3 or 5), butwith normal pulmonary venous drainage into left atriumanomalous pulmonary venous drainage 5963100713101.3.6.1.4.1.19376.1.4.1.5.24 Imaging FindingsCoding Scheme SNOMED CTConceptImaging result normal 408573005Imaging result abnormal 408574004Imaging result equivocal 4083790051.2.840.10008.6.1.57 DICOM CID 3261 - Stress ProtocolsCoding Scheme SNOMED-CTConcept__________________________________________________________________________67Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________Balke protocol 129097005Bruce protocol 129095002Ellestad protocol 129098000Modified Bruce protocol 129096001Modified Naughton protocol 129102008Naughton protocol 129101001Pepper protocol 129100000Ramp protocol 129099008Exercise stress ECG test 46136006Stress test using Bicycle Ergometer 26046004Pharmacologic Stress protocol 424064009Dipyridamole Stress protocol 422685009Adenosine Stress protocol 424444005Dobutamine Stress protocol 424225000Pharmacologic and exercise stress test 428813002Stress test using cardiac pacing 428685003Adapted from DICOM PS3.16-200913151.2.840.10008.6.1.211 DICOM CID 3710 - Coronary DominanceCoding Scheme SNOMED CTConceptLeft Coronary Dominance 253729004Right Coronary Dominance 253728007Balanced Coronary Dominance 253730009Adapted from DICOM PS3.16-20091.2.840.10008.6.1.218 DICOM CID 3717 - Myocardial Wall SegmentsCoding Scheme SNOMED CTConceptleft ventricle basal anterior segment 264850008left ventricle basal anteroseptal segment 396482007left ventricle basal inferoseptal segment 396646008left ventricle basal inferior segment 264846001left ventricle basal inferolateral segment 396652009left ventricle basal anterolateral segment 396654005__________________________________________________________________________68Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________1320left ventricle mid anterior segment 264848000left ventricle mid anteroseptal segment 396647004left ventricle mid inferoseptal segment 396649001left ventricle mid inferior segment 264847005left ventricle mid inferolateral segment 396655006left ventricle mid anterolateral segment 396656007left ventricle apical anterior segment 264844003left ventricle apical septal segment 264845002left ventricle apical inferior segment 264849008left ventricle apical lateral segment 264853005apex of left ventricle 128564006Adapted from DICOM PS3.16-200913251.2.840.10008.6.1.223 DICOM CID 3722 - Diabetic TherapyCoding Scheme SNOMED CTConceptDietary Treatment 284071006Oral Treatment 170746002Insulin 225302006Adapted from DICOM PS3.16-20091.2.840.10008.6.1.225 DICOM CID 3724 - Smoking HistoryCoding Scheme SNOMED CTConceptNo History of Smoking 266919005Current Smoker 77176002Former Smoker 8517006Adapted from DICOM PS3.16-20091.2.840.10008.6.1.227 DICOM CID 3727 - Indications for CatheterizationCoding Scheme SNOMED CTConceptcardiogenic shock 89138009valvular heart disease 368009Arrhythmia 44808001ischemic heart disease 414545008cardiac function test abnormal 165076002__________________________________________________________________________69Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________1330heart transplant 32413006heart disease - congenital 13213009cardiomyopathy 85898001heart disease 56265001Adapted from DICOM PS3.16-20091.2.840.10008.6.1.253 DICOM CID 3758 - Cardiovascular Family HistoryCoding Scheme SNOMED CTConceptFamily history of coronary artery disease 430091005Family history: Diabetes mellitus 160303001Family history of myocardial infarction 266897007Adapted from DICOM PS3.16-200913351.2.840.10008.6.1.616 DICOM CID 12224 - Ultrasound Image ModesCoding Scheme SNOMED CTConcept2D mode 399064001Doppler Color Flow 261197005M mode 399155008Doppler Pulsed 261199008Doppler Continuous Wave 261198000Power Doppler 4257040083D mode 426865009Concepts from KDECI to be harmonizedM-mode and 2-D3-DSpectral DopplerDoppler – ColorPerfusionTissue DopplerAdapted from DICOM PS3.16-20091.2.840.10008.6.1.744 DICOM CID 3112 - Attenuation CorrectionCoding Scheme DCMConceptAlgorithmic Attenuation Correction 122726NM Transmission Attenuation Correction 122727__________________________________________________________________________70Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________1340CT–based Attenuation Correction 122728No Attenuation Correction 122729Adapted from DICOM PS3.16-20091.2.840.10008.6.1.755 DICOM CID 3200 - Stress Test ProcedureCoding Scheme SNOMED-CTConceptExercise stress test 165079009Pharmacologic stress test 424064009Pharmacologic and exercise stress test 428813002Paced stress test 428685003Adapted from DICOM PS3.16-20091.2.840.10008.6.1.756 DICOM CID 3201 – Indications for Stress TestCoding Scheme SNOMED-CTConceptChest Pain 29857009Pre-operative 262068006Coronary Artery Disease 53741008Heart failure 84114007Heart disease risk factors 171224000Dyspnea 267036007Post PTCA 373108000History of CABG 399261000Abnormal exercise tolerance test 165084003Abnormal ECG 102594003Arrhythmia 44808001Angina pectoris 194828000Hypertension 38341003Palpitations 80313002Supraventricular tachycardia 6456007Syncope 271594007History of Myocardial Infarction 399211009Left bundle branch block 63467002Valvular heart disease 368009Occupational requirement 429060002__________________________________________________________________________71Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________1345Adapted from DICOM PS3.16-20091.2.840.10008.6.1.759 DICOM CID 3204 - Stress AgentsCoding Scheme SNOMED-CTConceptDipyridamole 66859009Dobutamine 26523005Adenosine 108502004Atropine 73949004Adenosine A2 receptor agonist 432062000Adapted from DICOM PS3.16-200913501.2.840.10008.6.1.781 DICOM CID 3235 - Perfusion Comparison FindingsCoding Scheme SNOMED-CTConceptNo change 260388006New ischemia 428927006Less ischemia 429232006Resolution of ischemia 428824000More ischemia 429477006New infarction 429391004Adapted from DICOM PS3.16-200913551.2.840.10008.6.1.782 DICOM CID 3236 - Tolerance Comparison FindingsCoding Scheme SNOMED-CTConceptNo change 260388006Decreased tolerance 102460003Increased tolerance 102459008Adapted from DICOM PS3.16-20091.2.840.10008.6.1.783 DICOM CID 3237 - Wall Motion Comparison FindingsCoding Scheme SNOMED-CTConceptNo change 260388006New wall motion abnormality 429058004__________________________________________________________________________72Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________Improvement of wall motion 428825004Adapted from DICOM PS3.16-200913602.16.840.1.113883.3.88.12.3221.5.2 HITSP Health Insurance TypeThis value set uses the ASC X12 vocabulary for Insurance Type Code (ASC X12 Data Element1336) and identifies the type of health plan covering the individual, e.g., an HMO, PPO, POS,etc. The use of this value set is limited to the United States.Coding Scheme X12DE1336ConceptMedicare Secondary Working Aged Beneficiary or Spouse with Employer Group 12Health PlanMedicare Secondary End-Stage Renal Disease Beneficiary in the 12 month13coordination period with an employer’s group health planMedicare Secondary, No-fault Insurance including Auto is Primary 14Medicare Secondary Worker’s Compensation 15Medicare Secondary Public Health Service (PHS)or Other Federal Agency 16Medicare Secondary Black Lung 41Medicare Secondary Veteran’s Administration 42Medicare Secondary Disabled Beneficiary Under Age 65 with Large Group Health 43Plan (LGHP)Medicare Secondary, Other Liability Insurance is Primary 47Auto Insurance PolicyAPCommercialC1Consolidated Omnibus Budget Reconciliation Act (COBRA)COMedicare Conditionally PrimaryCPDisabilityDDisability BenefitsDBExclusive Provider OrganizationEPFamily or FriendsFFGroup PolicyGPHealth Maintenance Organization (HMO)HMHealth Maintenance Organization (HMO) - Medicare RiskHNSpecial Low Income Medicare BeneficiaryHSIndemnityINIndividual PolicyIPLong Term CareLCLong Term PolicyLD__________________________________________________________________________73Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________1365Coding Scheme X12DE1336ConceptLife InsuranceLILitigationLTMedicare Part AMAMedicare Part BMBMedicaidMCMedigap Part AMHMedigap Part BMIMedicare PrimaryMPOtherOTProperty Insurance – PersonalPEPersonalPLPersonal Payment (Cash - No Insurance)PPPreferred Provider Organization (PPO)PRPoint of Service (POS)PSQualified Medicare BeneficiaryQMProperty Insurance – RealRPSupplemental PolicySPTax Equity Fiscal Responsibility Act (TEFRA)TFWorkers CompensationWCWrap Up PolicyWUAdapted from HITSP C80 Clinical Document and Message Terminology Component V2.0.1__________________________________________________________________________74Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________13701375Appendix U – US Realm RequirementsPhysicians identified in an assignedEntity or assignedAuthor SHALL include in id thephysician’s National Provider Identifier (root OID = 2.16.840.1.113883.4.6).Note:This includes, e.g., clinicalDocument.legalAuthenticator, clinicalDocument.author, andclinicalDocument.componentOf.encompassingEncounter.responsibleParty.Physicians identified in an assignedEntity or assignedAuthor SHALL include in code, ifpresent, a value from coding system NUCC Health Care Provider Taxonomy (OID =2.16.840.1.113883.6.101)Insurance Type identified in the Payer section shall use a value from value set2.16.840.1.113883.3.88.12.3221.5.2 HITSP Health Insurance Type.__________________________________________________________________________75Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


ACC Key Data ElementsThe following extract from KEDCI has been used for IHE Cardiology Technical Committee workon this Supplement, and is provided as an aid for Public Comment.Site ID(Recommended)Site of service(Optional)Cardiac imagingservices(Recommended)Imaging facility:address(Recommended)Site ID is a unique number assigned to eachdatabase site. A database site is defined as 1entity that signs a site agreement, submits 1data submission file to the harvest, and getsback 1 report on their data.Each site’s data if submitted to be analyzedmust be in 1 data submission file. If 1 sitekeeps their data in more than 1 file (e.g., at2 sites), then the data must be combinedinto a single data submission file for theharvest.If 2 or more sites share a single purchasedsoftware, and enter cases into 1 database,then the data must be exported intodifferent data submission files, 1 for eachSite ID.Indicate the type of facility submitting thereporting data.Choose 1 of the following:● Hospital—inpatient● Hospital—outpatient● Nonhospital—inpatient● Nonhospital—outpatient● Mobile-based—inpatient● Mobile-based—outpatientIndicate the cardiac imaging servicesprovided by the site.Choose any of the following:● Echocardiography● CCT● CMR● SPECT MPI● PET● ICA/LVGIndicate the physical location of the facilitywhich may be described using streetaddress, city, state or province, postal code,and country.ClinicalDocument /documentationOf /encompassingEncounter /location / HealthCareFacility /idClinicalDocument /documentationOf /encompassingEncounter /location / HealthCareFacility /codeSection “Site”ClinicalDocument /documentationOf /encompassingEncounter /location / HealthCareFacility /addrCopyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________Imaging facility:telephone(Recommended)Source(s) ofinformation(Recommended)Priority of study(Recommended)Accreditation status(Recommended)Accreditation entity(Recommended)Insurance payer(Recommended)Indicate the number that uniquely identifiesa telecommunications connection of thefacility.May select more than 1:● Patient● Referring clinician● Laboratory● Medical record● OtherDesignate the study as 1 of the following:● Routine● STATFor each imaging service provided by thesite, indicate the accreditation status of thesite performing the study.Choose 1 of the following for each imagingservice:● Yes● Application submitted, pending approval● NoIf the site is accredited, indicate the entityproviding the accreditation for each imagingmodality.Choose any of the following:● American College of Radiology● ICAEL● ICANL● ICACTL● ICAMRL● Other● N/AIndicate the appropriate description of thepatient’s insurance carrier(s) for thisadmission. If the patient has more than 1,choose all that apply:● Medicare—A federal health care plan thatreimburses hospitals and physicians formedical care provided to qualifying peopleage 65 years or older, people under age 65ClinicalDocument /documentationOf /encompassingEncounter /location / HealthCareFacility /telecomMapping not determinedClinicalDocument /inFulfillmentOf /Order /priorityCodeSection “Site”Section “Site”Payers Section1.3.6.1.4.1.19376.1.5.3.1.1.5.3.7Parent Template CCD 3.1(2.16.840.1.113883.10.20.1.9)__________________________________________________________________________1Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________years with certain disabilities, and people ofall ages with end-stage renal disease.● Medicaid—Any state and federal healthcare program that reimburses hospitals andphysicians for providing care to qualifyingpeople who cannot finance their ownmedical expenses.● Commercial—Any health insuranceprovided by a commercial plan, regardlessof the type of restrictions or paymentarrangements. This includes managed careplans, such as HMOs, PPOs, POSs, and IPAs.● Military/VAMC—Refers to any military orVeteran’s Administration Health Plans, andPHS.● Non-U.S. Insurance—Refers to individualswith no or limited health insurance; thus,the individual is the payer regardless ofability to pay.● Self/None—Refers to situations when theindividual is the sole payer regardless ofhis/her ability to pay. Check this choice onlywhen “self” or “none” is listed as the firstinsurance in the medical record.Unique patient ID(Recommended)Patient DOB(Recommended)Participant ID is a unique number thatpermanently identifies each patient. Onceassigned to a patient, this can never bechanged or reassigned to a differentpatient. If a patient returns to the site, theyMUST receive this same unique patientidentifier.Indicate the patient’s date of birthClinicalDocument > recordTarget>patientRole >id = unique idproviderOrganization >name = hospital nameClinicalDocument > recordTarget>patientRole >Patient / birthTimeorClinicalDocument >component >__________________________________________________________________________2Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________Gender(Recommended)Race(Recommended)Ethnicity(Recommended)Indicate the patient’s gender at birth aseither male or female.Choose 1 of the following:● Male● FemaleIndicate the patient’s race as determined bythe patient/family.Choose 1 of the following:● Caucasian● Black● Asian● Native American or Alaska Native● Native Hawaiian or other Pacific Islander● Other race not listedIndicate if the patient is of Hispanic ethnicityas determined by the patient/family.Hispanic ethnicity includes patient reportsof Cuban, Mexican, Puerto Rican, South orCentral American, or other Spanish cultureor origin, regardless of race.Choose 1 of the following:● Yes● NostructuredBody >component >section >title = “Patient Demographics”code = (LOINC, 22048-3)entry >observation >code = date of birthClinicalDocument > recordTarget> patientRole > Patient /administrativeGenderCodeClinicalDocument > recordTarget> patientRole > Patient /raceCodeorsection “social history”2.16.840.1.113883.10.20.1.15observation >code = (LOINC, 32624-9, “race”)ClinicalDocument > recordTarget> patientRole > Patient /ethnicGroupCodeorsection “social history”2.16.840.1.113883.10.20.1.15Physician NPI—Referral physician(Recommended)Indicate the participant’s National ProviderIdentifier (NPI). This number, assigned bythe Centers for Medicare & MedicaidServices (CMS), is used to uniquely identifyphysicians for Medicare billing purposes.ClinicalDocument /documentationOf /encompassingEncounter /encounterParticipant@typeCode=REF (referrer) /assignedEntity / id @root=2.16.840.1.113883.4.8__________________________________________________________________________3Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________@extensionReferral physicianspecialty(Recommended)Indicate the primary specialty of thephysician referring the patient.● Cardiologist● Family practice● Internal medicine● OB/GYN● Hospitalist● Surgeon● Physician extender● Anesthesiologist● Radiologist● Emergency department physician● OtherClinicalDocument /documentationOf /encompassingEncounter /encounterParticipant@typeCode=REF (referrer) /assignedEntity / codeHeight (cm)(Recommended)Weight (kg)(Recommended)Indicate the patient’s first recordedheight in centimeters at the time of thestudy. If not in cm, list units. To beconverted from English units if needed.Indicate the patient’s first recordedweight in kilograms at the time of thestudy. If not in kg, list units. To beconverted from English units if needed.section “vital signs”1.3.6.1.4.1.19376.1.5.3.1.3.252.16.840.1.113883.10.20.1.16section “vital signs”1.3.6.1.4.1.19376.1.5.3.1.3.252.16.840.1.113883.10.20.1.16Estimated ability toexercise (prior to test),described in METS(Recommended—stressSPECT, stress TTE,stress CMR, stress PET)Indicate the ability of the patient to meetestimated energy requirements forvarious activities expressed as a numberof metabolic equivalents.Choose 1 of the following:● Less than 4 METS—defined as ability todo 1 or more of the following activities(can take care of oneself, eat, dress, oruse the toilet, walk indoors around thehouse, or walk a block or 2 on levelground at 2 to 3 mph or 3.2 to 4.8 km/h)● 4 METS or greater—defined as theability to do 1 or more of the followingactivities (climb a flight of stairs or walkuphill, walk on level ground at 4 mph or6.4 km/h, run a short distance, do heavywork around the house such as scrubbing__________________________________________________________________________4Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________floors or lifting or moving heavyfurniture, participate in moderaterecreational activities like golf, bowling,dancing, doubles tennis, or throwing abaseball or football, or participate instrenuous sports like swimming, singlestennis, football, basketball or skiing)Hypertension(Recommended)Systolic blood pressure(Recommended)Diastolic blood pressure(Recommended)Dyslipidemia(Recommended)Indicate if the patient has a currentdiagnosis of hypertension defined by any1 of the following:● History of hypertension diagnosed andtreated with medication, diet, and/orexercise● Prior documentation of blood pressuregreater than 140 mm Hg systolic and/or90 mm Hg diastolic for patients withoutdiabetes or chronic kidney disease, orprior documentation of blood pressuregreater than 130 mm Hg systolic or 80mm Hg diastolic on at least 2 occasionsfor patients with diabetes or chronickidney disease● Currently on pharmacological therapyfor the treatment of hypertension.Choose 1 of the following:● Yes● No● UnknownIndicate most recent systolic bloodpressure (mm Hg) reading during visit forthe imaging study.Indicate most recent diastolic bloodpressure (mm Hg) reading during visit forthe imaging study.Indicate if the patient has a history ofdyslipidemia diagnosed and/or treatedby a physician. National CholesterolEducation Program (12) criteria includedocumentation of the following:● Total cholesterol greater than 200mg/dl (5.18 mmol/l)Active Problems Section1.3.6.1.4.1.19376.1.5.3.1.3.6Parent Template CCD 3.5(2.16.840.1.113883.10.20.1.11)161501007 SNOMED history ofhypertensionor38341003 SNOMEDhypertensionsection “vital signs”1.3.6.1.4.1.19376.1.5.3.1.3.252.16.840.1.113883.10.20.1.16section “vital signs”1.3.6.1.4.1.19376.1.5.3.1.3.252.16.840.1.113883.10.20.1.16Active Problems Section1.3.6.1.4.1.19376.1.5.3.1.3.6Parent Template CCD 3.5(2.16.840.1.113883.10.20.1.11)414416008 History ofhypercholesterolemia__________________________________________________________________________5Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________● Low-density lipoprotein (LDL) greaterthan or equal to 130 mg/dl (3.37 mmol/l)● High-density lipoprotein (HDL) lessthan 40 mg/dl (1.04 mmol/l) in men andless than 50 mg/dl (1.30 mmol/l) inwomen● Currently on antilipidemic treatmentChoose 1 of the following:● Yes● No● Unknown370992007 DyslipidemiaLDL(Optional)HDL(Optional)Family history ofcoronary artery disease(Recommended)History of tobacco use(Recommended)Indicate most recent LDL measurement(mg/dl) in medical record prior toimaging study.Indicate most recent HDL measurement(mg/dl) in medical record prior toimaging study.Any first-degree relatives (parents,siblings, children) who have had any ofthe following at age less than 55 years:1. Angina,2. Myocardial infarction (MI),3. Coronary artery bypass graft (CABG),4. Percutaneous coronary intervention(PCI), or5. Sudden cardiac death without obviouscause.Choose 1 of the following:● Yes● No● UnknownIndicate if the patient has a historyconfirming any form of tobacco use inthe past. This includes cigarettes, cigar,tobacco chew, etc.Choose 1 of the following:● Yes, Current: Use of tobacco within 1month of this study.● Yes, Former: Use of tobacco greaterthan 3 months prior to this study.● NeverFamily Medical History Section1.3.6.1.4.1.19376.1.5.3.1.3.14Parent Template CCD 3.6(2.16.840.1.113883.10.20.1.4)Social History Section1.3.6.1.4.1.19376.1.5.3.1.3.16Parent Template CCD 3.72.16.840.1.113883.10.20.1.15History of Tobacco Use Section1.3.6.1.4.1.19376.1.5.3.1.1.9.8110483000 SNOMED History oftobacco use__________________________________________________________________________6Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________● UnknownDiabetes(Recommended)History of acute renalfailure(Recommended)History of chronickidney disease(Recommended)Indicate if the patient has a history ofdiabetes mellitus, regardless of durationof disease or need for antidiabeticagents; or a fasting blood sugar greaterthan 7 mmol/l or 126 mg/dl. Thisincludes diagnosis at any time prior tothe study. It does not include gestationaldiabetes.Choose 1 of the following:● Yes—insulin requiring● Yes—noninsulin requiring● No● UnknownIndicate if the patient has a history ofacute renal failure, which is defined ashistory of reduced renal function (GFRgreater than 30) for less than 3 months.Year of occurrence and precipitant foracute renal insufficiency may bespecified.Indicate if the patient has a history ofchronic kidney disease, which is definedas either kidney damage or GFR less than60 ml/min/1.73 m2 for greater than orequal to 3 months. Kidney damage isdefined as pathologic abnormalities ormarkers of damage, includingabnormalities in blood or urine tests orimaging studies.Indicate the patient’s stage of disease(13):● Stage 0—No known kidney disease● Stage 1—Kidney damage with normalor high—GFR greater than or equal to 90ml/min/1.73 m2● Stage 2—Kidney damage with mildlyActive Problems Section1.3.6.1.4.1.19376.1.5.3.1.3.6Parent Template CCD 3.5(2.16.840.1.113883.10.20.1.11)orHistory of Past Illness Section1.3.6.1.4.1.19376.1.5.3.1.3.8161445009 SNOMED history ofdiabetes mellitusActive Problems Section1.3.6.1.4.1.19376.1.5.3.1.3.6Parent Template CCD 3.5(2.16.840.1.113883.10.20.1.11)orHistory of Past Illness Section1.3.6.1.4.1.19376.1.5.3.1.3.814669001 History of acute renalfailureActive Problems Section1.3.6.1.4.1.19376.1.5.3.1.3.6Parent Template CCD 3.5(2.16.840.1.113883.10.20.1.11)orHistory of Past Illness Section1.3.6.1.4.1.19376.1.5.3.1.3.8236425005 History of chronickidney disease__________________________________________________________________________7Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________decreased—GFR 60 to 89 ml/min/1.73m2● Stage 3—Moderately decreased—GFR30 to 59 ml/min/1.73 m2● Stage 4—Severely decreased—GFR 15to 29 ml/min/1.73 m2● Stage 5—Kidney failure—GFR less than15 ml/min/1.73 m2 or on dialysis● UnknownPeripheral arterialdisease(Recommended)Cerebrovasculardisease(Recommended)Indicate if the patient has a history ofperipheral arterial disease (includesupper and lower extremity, renal,mesenteric, and abdominal aorticsystems).This can include:● Claudication, either with exertion or atrest● Amputation for arterial vascularinsufficiency● Vascular reconstruction, bypasssurgery, or percutaneous intervention tothe extremities (excluding dialysis fistulasand vein stripping)● Documented aortic aneurysm with orwithout repair● Positive invasive angiogram● Positive noninvasive test (e.g., anklebrachial index less than or equal to 0.9,ultrasound, magnetic resonance orcomputed tomography imaging ofgreater than 50% diameter stenosis inany peripheral artery, i.e., renal,subclavian, femoral, iliac).Choose 1 of the following:● Yes● No● UnknownIndicate if the patient has a history ofcerebrovascular disease, including any 1of the following:● Cerebrovascular accident (CVA):Patient has a history of stroke, i.e., loss ofneurological function with residualActive Problems Section1.3.6.1.4.1.19376.1.5.3.1.3.6Parent Template CCD 3.5(2.16.840.1.113883.10.20.1.11)orHistory of Past Illness Section1.3.6.1.4.1.19376.1.5.3.1.3.8399957001 Peripheral arterialdiseaseActive Problems Section1.3.6.1.4.1.19376.1.5.3.1.3.6Parent Template CCD 3.5(2.16.840.1.113883.10.20.1.11)or__________________________________________________________________________8Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________Erectile dysfunction(Optional)Estimated cardiac eventrisk(Recommended—stressSPECT, stress PET,stress TTE, CCTA, CACS,stress CMR)symptoms at least 24 h after onset,presumed to be from vascular etiology.● Transient ischemic attack (TIA): Patienthas a history of loss of neurologicalfunction that was abrupt in onset butwith complete return of function within24 h, presumed to be due to vascularetiology.● Noninvasive/invasive carotid test withgreater than greater than or equal to80% occlusion.● Previous carotid arterysurgery/intervention for carotid arterystenosis.This does not include neurologicaldisease processes such as metabolicand/or anoxic ischemic encephalopathy.Choose 1 of the following:● Yes● No● UnknownIndicate if the patient has a history oferectile dysfunction.Choose 1 of the following:● Yes● NoIndicate the coronary (Framingham) risk(calculated based on published criteria atthe NHLBI Web site [14]) of myocardialinfarction or cardiac death based onclinical history of the patient asestimated at the study site.Choose 1 of the following:● Low (less than 10% 10-year risk)● Intermediate (10% to 20% 10-year risk)● High (greater than 20% 10-year risk ora coronary risk equivalent as defined byHistory of Past Illness Section1.3.6.1.4.1.19376.1.5.3.1.3.862914000 CerebrovasculardiseaseActive Problems Section1.3.6.1.4.1.19376.1.5.3.1.3.6Parent Template CCD 3.5(2.16.840.1.113883.10.20.1.11)orHistory of Past Illness Section1.3.6.1.4.1.19376.1.5.3.1.3.8398175007 Erectile dysfunction__________________________________________________________________________9Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________ATPII/NCEP (diabetes, PAD, etc.)● N/ACalculated cardiacevent risk(Derived)History of arrhythmias(Recommended)History of asthma orbronchospasm(Recommended—stressTTE, stress SPECT,stress PET, CCTA, stressCMR)Previous pacemaker orimplantablecardioverterdefibrillator(ICD) insertion(Recommended)History of heart failure(Recommended)Indicate the patient’s calculated cardiac(Framingham) risk (calculated based onpublished criteria at the NHLBI Web site[14]):● Low (less than 10% 10-year risk)● Intermediate (10% to 20% 10-year risk)● High (greater than 20% 10-year risk ora coronary risk equivalent as defined byATPII/NCEP (diabetes, PAD, etc.)● N/AIndicate whether the patient has ahistory of the following arrhythmias.Choose any of the following:● Frequent PVCs● Sinus tachycardia● Ventricular tachycardia● Atrial fibrillation● Atrial flutter● Other● NoneIndicate if the patient has a history ofasthma or bronchospasm:● Yes● No● UnknownPacemaker or ICD implantation prior tothe current encounter. Device type(pacemaker, ICD, combination), cardiacchamber(s) involved, and year ofimplantation may be helpful.Choose 1 of the following:● Yes● NoHistory of heart failure, per medicalrecord, physician, or patient historyActive Problems Section1.3.6.1.4.1.19376.1.5.3.1.3.6Parent Template CCD 3.5(2.16.840.1.113883.10.20.1.11)orHistory of Past Illness Section1.3.6.1.4.1.19376.1.5.3.1.3.844808001 History of arrhythmiasActive Problems Section1.3.6.1.4.1.19376.1.5.3.1.3.6Parent Template CCD 3.5(2.16.840.1.113883.10.20.1.11)orHistory of Past Illness Section1.3.6.1.4.1.19376.1.5.3.1.3.8Active Problems Section1.3.6.1.4.1.19376.1.5.3.1.3.6__________________________________________________________________________10Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________● Yes● NoParent Template CCD 3.5(2.16.840.1.113883.10.20.1.11)New York HeartAssociation (NYHA)functional class(Optional)CanadianCardiovascular AnginaClass(Optional)If heart failure, indicate NYHA functionalclass (15)Choose 1 of the following:● Class I: patients with cardiac diseasebut without resulting limitations ofphysical activity. Ordinary physicalactivity does not cause undue fatigue,palpitation, or dyspnea.● Class II: patients with cardiac diseaseresulting in slight limitation of physicalactivity. They are comfortable at rest.Ordinary physical activity results infatigue, palpitation, or dyspnea.● Class III: patients with cardiac diseaseresulting in marked limitation of physicalactivity. They are comfortable at rest.Less than ordinary activity causes fatigue,palpitation, or dyspnea.● Class IV: patients with cardiac diseaseresulting in inability to carry on anyphysical activity without discomfort.Symptoms are present even at rest orminimal exertion).If angina, indicate the CanadianCardiovascular Angina class.Choose 1 of the following:● 0. Asymptomatic. No angina.● 1. Ordinary physical activity (e.g.,walking or climbing stairs) does not causeangina; angina occurs with strenuous orrapid or prolonged exertion at work orrecreation● 2. Slight limitation of ordinary activity(e.g., angina occurs walking or stairorHistory of Past Illness Section1.3.6.1.4.1.19376.1.5.3.1.3.884114007 History of heart failurefunctional status section2.16.840.1.113883.10.20.1.5Coded Functional StatusAssessment Section1.3.6.1.4.1.19376.1.5.3.1.1.12.2.1functional status section2.16.840.1.113883.10.20.1.5Coded Functional StatusAssessment Section1.3.6.1.4.1.19376.1.5.3.1.1.12.2.1__________________________________________________________________________11Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________climbing after meals, in cold, in wind,under emotional stress, or only duringthe few hours after awakening; walkingmore than 2 blocks on the level orclimbing more than 1 flight of ordinarystairs at a normal pace; and in normalconditions)● 3. Marked limitation of ordinaryactivity (e.g., angina occurs with walking1 or 2 blocks on the level or climbing 1flight of stairs in normal conditions and ata normal pace)● 4. Inability to perform any physicalactivity without discomfort; anginasyndrome may be present at rest● 5. N/AChest pain symptoms orsuspected anginaequivalent(Recommended—stressTTE, stress SPECT,stress PET, CCTA, stressCMR)Stability of chest painsymptoms(Recommended—stressTTE, stress SPECT,stress PET, CCTA, stressCMR)Characteristics of chestpain/discomfort orsuspected anginaequivalent(Recommended—stressTTE, stress SPECT,stress PET, CCTA, stressCMR)Indicate whether chest pain ordiscomfort, dyspnea/shortness of breathsuspected to be anginal equivalent, orother suspected anginal equivalent hasbeen documented within the pastmonth.Choose 1 of the following:● Yes● No● UnknownIndicate the patient’s angina type:● Atypical chest pain● Stable angina● Unstable angina● Myocardial infarctionIf chest pain or discomfort has beendocumented, indicate all characteristicsof the chest pain or discomfort.Choose 1 or more of the following:● Substernal chest pain or discomfort● Provoked by exertion 427341007 oremotional distress● Relieved by rest 427935006 and/ornitroglycerinhistory of present illness?__________________________________________________________________________12Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________Angina type(Derived from previouselement)Pre-test probability ofcoronary artery disease(Derived)ECG interpretable forischemia(Recommended—stressTTE, stress SPECT,stress PET, CCTA, stressCMR)Previous diagnostic testand dateIndicate the angina type based on thecharacteristics of chest pain/discomfortor suspected angina equivalent.● Typical angina (definite)—the chestpain or discomfort has all threecharacteristics recorded in the previouselement.● Atypical angina (probable)—the chestpain or discomfort recorded in theprevious element lacks one of the threecharacteristics.● Nonanginal chest pain—the chest painor discomfort recorded in the previouselement meets one or none of the typicalangina characteristics.● N/A due to absence of chest painIf chest pain or discomfort has beendocumented, calculate the pre-testprobability of obstructive CAD. Choose 1of the following:● Low (less than 10%)● Intermediate (10% to 90%)● High (greater than 90%)● Known CAD● N/A, no chest pain or anginalequivalentIndicate whether the ECG is interpretablefor ischemia if used as part of a stresstest.Choose 1 of the following:● Yes● No [resting ST-segment depression(greater than or equal to .10 mV),complete left bundle-branch block(LBBB), pre-excitation (Wolf-Parkinson-White Syndrome), left ventricularhypertrophy, digoxin use, or pacedrhythm]● Equivocal● N/AIndicate diagnostic imaging test withinthe last 24 months.__________________________________________________________________________13Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________(Recommended)Previous diagnosticimaging test result(Optional)Previous MI(Recommended)Date of previous MI(Optional)Select all applicable from the following:● Stress SPECT MPI● Stress TTE● TTE● TEE● CACS● CCTA● CMR● Invasive coronary angiography● ECG—only stress test● Unknown● NoneInclude the date of the test. If the monthand day are unknown, the year issufficient.Indicate documented and verifiedfindings of previous diagnostic imagingstudy.Select all that apply:● Coronary artery stenosis greater thanor equal to 50%● Coronary artery stenosis less than 50%stenosis● Myocardial ischemia● Scar/MI● Cardiac mass/thrombus/vegetation● Significant LV systolic dysfunction● Pericardial disease● Valvular heart disease● Congenital heart disease● Nondiagnostic● Not applicableHistory of MI by patient history, medicalrecords, or physicianChoose 1 of the following:● Yes● NoIf the patient had a previous MI, indicatethe date of most recent MI. If the monthand day are unknown, the year issufficient.__________________________________________________________________________14Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________Previous PCI(Recommended)Previous PCI—date(Recommended—stressTTE, stress SPECT,stress PET, CCTA, stressCMR)Previous CABG(Recommended)Previous CABG—date(Recommended—stressTTE, stress SPECT,stress PET, CCTA, stressCMR)Noncardiac surgery—risk of procedure(Recommended if preoperative)Indicate if the patient had a previouspercutaneous intervention (PCI) (even ifunsuccessful) of any type (balloonangioplasty, stent or other), performedprior to the study.Choose 1 of the following:● Yes● NoIf the patient had a previous PCI of anytype (balloon angioplasty, stent or other),performed prior to the current study,indicate the date of the most recent PCI.If the month and day are unknown, theyear is sufficient.Indicate if the patient had a previouscoronary artery bypass graft surgery(CABG) by any approach.Choose 1 of the following:● Yes● NoIf the patient had a previous CABG priorto the current admission, indicate thedate of the most recent CABG. If themonth and day are unknown, the year issufficient.If the patient is scheduled for surgery,indicate the cardiac risk (incidence ofcardiac death and nonfatal myocardialinfarction) from the surgery itself.Choose 1 of the following:● Low-risk surgery (less than 1%; e.g.,endoscopic procedures, superficialprocedures, cataract surgery, breastsurgery)● Intermediate-risk surgery (less than5%; e.g. intraperitoneal and intrathoracicsurgery, carotid endarterectomy, headand neck surgery, orthopedic surgery,prostate surgery)● High-risk surgery (greater than or equalto 5%, e.g., emergent major operations,__________________________________________________________________________15Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________aortic or other major vascular surgery,peripheral vascular surgery, anticipatedprolonged surgical procedure associatedwith large fluid shifts and/or blood loss)● N/ANoncardiac surgery—patient activeconditions(Recommended if preoperative)Noncardiac surgery—patient risk factors(Recommended if preoperative)Medication ID—medications(Recommended)(Optional—TEE, TTE)For a patient scheduled to undergononcardiac surgery, does the patienthave any active cardiac conditions;defined as any of the following:● Unstable coronary syndrome● Decompensated heart failure (NYHAfunctional class IV, worsening or newheart failure)● Significant arrhythmias (e.g., highgradeAV block, ventricular arrhythmias,symptomatic bradycardia,supraventricular arrhythmias with anuncontrolled rate)● Severe valvular heart diseaseChoose 1 of the following:● Yes● NoFor a patient scheduled to undergononcardiac surgery, how many of thefollowing clinical risk factors are present:● Ischemic heart disease● Compensated or prior heart failure● Diabetes mellitus● Renal insufficiency● Cerebrovascular diseaseChoose 1 of the following:● 3 or more● 1 to 2● NoneIndicate which of the followingcategories of medications are routinelytaken by the patient. Choose allapplicable of the following:● ACE inhibitor/angiotensin receptorblocker● Aspirin, other antiplatelet agents● Calcium channel blockersMedications Section1.3.6.1.4.1.19376.1.5.3.1.3.19Parent Template CCD 3.9(2.16.840.1.113883.10.20.1.8)__________________________________________________________________________16Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________● Beta-blockers● Erectile dysfunction medication● Nitrates● Warfarin● Antiarrhythmics● Digitalis● Metformin● Lipid-lowering medication (niacin,statins, fibrates, etc.)● Other antihypertensives● Aminophylline or theophylline● Dipyridamole● Inhaler● Diabetic medications● NoneMedications—normallyused but held prior totesting(Recommended)(Optional—TEE, TTE)History of reaction tocontrast agent(Recommended)Indicate if any medications normally usedby the patient that were notadministered per routine schedule priorto test:● ACE inhibitor/angiotensin receptorblocker● Aspirin, other antiplatelet agents● Calcium-channel blockers● Beta-blockers● Erectile dysfunction medication● Nitrates● Warfarin● Antiarrhythmics● Digitalis● Metformin● Lipid-lowering medication (niacin,statins, fibrates, etc.)● Other antihypertensives● Aminophylline or theophylline● Dipyrdiamole● Inhaler● Diabetic medications● NoneIf history of reaction to contrast agent,list all applicable:● Iodinated 426722004● Gadolinium 105879004● Echocardiography agent 409290009Allergies and Other AdverseReactions Section1.3.6.1.4.1.19376.1.5.3.1.3.13Parent Template CCD 3.8(2.16.840.1.113883.10.20.1.2)__________________________________________________________________________17Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________● Radionuclide(radiopharmaceutical)349358000● N/AStudy ID(Recommended)Study acquisitiondate(Recommended)Unique study identifier. ClinicalDocument /documentationOf / ServiceEvent/ idIndicate the date of the image acquisition. ClinicalDocument /documentationOf / ServiceEvent/ effectiveTimePhysician NPI—studyinterpretation andreport(Recommended)Physician boardcertification—studyinterpretation andreport(Recommended)Indicate the National Provider Identifier(NPI) of the physician interpreting the studyand producing the report. This number,assigned by the Centers for Medicare &Medicaid Services (CMS), is used touniquely identify physicians for Medicarebilling purposes. If there is more than onephysician, enter the billing physician’s NPI.Indicate the Board certification of thephysician interpreting the study andproducing the report.Choose 1 or more of the following:● Cardiovascular Disease● Internal Medicine● Radiology● Nuclear Medicine● OtherClinicalDocument / author /AssignedAuthor / id @root=2.16.840.1.113883.4.8@extensionorClinicalDocument /legalAuthenticator /AssignedEntity / id @root=2.16.840.1.113883.4.8@extensionorClinicalDocument /documentationOf / ServiceEvent/ performer / AssignedEntity / id@root=2.16.840.1.113883.4.8@extensionroleLink?__________________________________________________________________________18Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________● NonePhysiciansubspecialtycertification—studyinterpretation andreport(Recommended)Imaging studyperformed(Recommended)Acquisitionparameters:Contrast/imagingagent use(Recommended)Indicate whether the physician interpretingthe study and producing the report holds asubspecialty certification specific to theimaging modality being performed.● Certification Board of Nuclear Cardiology(CBNC)● American Board of Nuclear Medicine(ABNM)● Certification Board of CardiovascularComputed Tomography (CBCCT)● National Board of Echocardiography, Inc.(NBE)● Certificate of Added Qualification—Nuclear Medicine (ACR)● American Board of Internal MedicineCertification in Interventional Cardiology● American Board of Internal MedicineCertification in Electrophysiology● Certificate of Proficiency in CCTA (ACR)Indicate the type of diagnostic imaging testperformed.Choose 1 of the following:● Nuclear: SPECT MPI● Nuclear: PET● Nuclear: RNA● Echocardiography: stress TTE● Echocardiography: TTE● Echocardiography: TEE● CCT: CACS● CCT: CCTA● CCT: CACS and CCTA● CMR: CMR● CMR: stress CMR● Cardiac catheterization: ICA● Cardiac catheterization: ICA and LVGIf echo, CCT, or CMR study was performed,indicate whether contrast orradiopharmaceutical was used during thestudy.Choose 1 of the following:● YesClinicalDocument /documentationOf / ServiceEvent/ codeProcedure description section2.16.840.1.113883.10.20.18.2.2(ProcNote)__________________________________________________________________________19Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________● NoAcquisitionparameters:Echocardiography(Recommended—TTE/TEE)Acquisitionparameters: Contrastuse(Recommended)If TTE or TEE was performed, indicate theacquisition parameter used. Choose allapplicable from the following:● M-mode and 2-D● 3-D● Spectral Doppler● Doppler—color● Perfusion● Tissue Doppler● OtherList all contrast/imaging agents used:● Radionuclide—F-18 FDG for viability—Rubidium-82 perfusion—Nitrogen-13 ammonia perfusion—Tc-99m tetrofosmin (Myoview)—Tc-99m sestamibi (Cardiolite)—Tl-201● Echo contrast—Optison (Perflutren)—Definity (Perflutren Lipid Microsphere)—Agitated saline—Iodinated contrast● High osmolar contrast media (ionic)—Diatrizoate meglumine and diatrizoatesodium (Renografin, etc.)—Ioxithalamate (Telebrix)—Iothalamate dimeglumine (Conray)● Low osmolar nonionic contrast media—Iopamidol (Isovue)—Iohexol (Omnipaque)—Ioversol (Optiray)—Ioxaglate (Hexabrix)—Iomeprol (Iomeron)—Iopromide (Ultravist)● Iso-osmolar nonionic contrast media—Iodixanol (VisiPaque)● Paramagnetic agent—Gadopentetate dimeglumine (Magnevist)—Gadodiamide (Omniscan)—Gadoversetamide (Optimark)—Gadobenate dimeglumine (MultiHance)Procedure description section2.16.840.1.113883.10.20.18.2.2(ProcNote)Procedure description section2.16.840.1.113883.10.20.18.2.2(ProcNote)__________________________________________________________________________20Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________● NoneAcquisitionparameters forSPECT or PET:Radionuclide dose(Recommended)Acquisitionparameters: Gating(Recommended—CCT, CMR, SPECT,PET)Acquisitionparameters:Attenuationcorrection(Recommended—SPECT, PET)Acquisitionparameters for CCT:Number of slices(Recommended)Acquisitionparameters for CCT:Temporal resolution(Optional)Acquisitionparameters for CCT:Contrast volume(Recommended)Acquisitionparameters for CCT:Radiation exposureIf radionuclide was used during the study,indicate the dose of eachradiopharmaceutical in mCi.If a nuclear, CCT, or CMR study wasperformed, indicate whether gating wasused.Choose 1 of the following:● Yes—Prospective—Retrospective—Both● NoIf a SPECT/PET study was performed,indicate whether attenuation correctionwas used for the nuclear imaging study.Choose 1 of the following:● Yes● NoIf CCT was the study performed, indicate ifthe number of “slices” was greater than orequal to 64.Choose 1 of the following:● Yes● NoIf CCT was the study performed, indicatethe gantry rotation speed in milliseconds.If iodinated or paramagnetic contrast wasused during the study, indicate the volumeof contrast used, in milliliters (ml) or notused.If a CCT was performed, indicate the totalradiation exposure in mGy cm (the doselengthproduct).Procedure description section2.16.840.1.113883.10.20.18.2.2(ProcNote)Procedure description section2.16.840.1.113883.10.20.18.2.2(ProcNote)Procedure description section2.16.840.1.113883.10.20.18.2.2(ProcNote)Procedure description section2.16.840.1.113883.10.20.18.2.2(ProcNote)Procedure description section2.16.840.1.113883.10.20.18.2.2(ProcNote)Procedure description section2.16.840.1.113883.10.20.18.2.2(ProcNote)Procedure description section2.16.840.1.113883.10.20.18.2.2(ProcNote)__________________________________________________________________________21Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________(Recommended)Acquisitionparameters:Medications used(Recommended)Acquisitionparameters: Heartrate (bpm) duringacquisition(Recommended—CTA)Acquisitionparameters for CMR:Method(Recommended—CMR)Acquisitionparameters forcatheterization:Fluoroscopy time(Recommended)Primary clinicalreason for test(Recommended)Indicate whether or not a medication wasused during the procedure.Choose 1 or more of the following:● Beta-blocker● Nitrates● Calcium-channel blocker● Aminophylline (bronchodilator)● NoneIndicate the heart rate (bpm) duringacquisition.If CMR was the study performed, indicatethe methods used.Choose 1 or more of the following:● Morphology and function● Delayed enhancement● Flow/velocity quantification● MR angiography● Perfusion● OtherIndicate total fluoroscopy time recorded,during the catheterization laboratory visit,to the nearest 0.1 min. The time recordedshould include the total time for theprocedure.Choose 1 of the following:● Detection of CAD● Risk assessment of CAD● Pre-operative assessment● Post-revascularization assessment● Determination of viability—candidacy forrevascularization● Congenital heart disease● Pericardial disease● Pulmonary vein assessment● Cardiac morphology (including cardiacProcedure description section2.16.840.1.113883.10.20.18.2.2(ProcNote)Procedure description section2.16.840.1.113883.10.20.18.2.2(ProcNote)Procedure description section2.16.840.1.113883.10.20.18.2.2(ProcNote)Procedure description section2.16.840.1.113883.10.20.18.2.2(ProcNote)section Indications (Proc Note IG)__________________________________________________________________________22Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________mass)● Assessment of ventricular function● Evaluation for cardiomyopathy● Evaluation for valvular heart disease● Evaluation for great vessels● Symptom/signs evaluation not related toabove categoriesOther clinicalreasons for test(Optional)Type of stress(Recommended—stress CMR, stressTTE, stress SPECT,stress PET)Type of stress:Exercise(Recommended)Choose any of the following:● Detection of CAD● Risk assessment of CAD● Pre-operative assessment● Post-revascularization assessment● Determination of viability● Congenital heart disease● Pericardial disease● Pulmonary vein assessment● Cardiac morphology (including cardiacmass)● Assessment of ventricular function● Evaluation of cardiomyopathy● Evaluation of valvular heart disease● Evaluation of great vessels● Assessment of symptoms suspected ofcardiac etiology● No other indicationIndicate if both pharmacologic stress testingand exercise stress testing were performed.Choose 1 of the following:● Exercise● Pharmacologic● Combined exercise and pharmacologicIf exercise stress testing was performedduring the study, indicate the type ofprotocol used to perform the study.Choose 1 of the following:● Bicycle● Treadmill exercise testing—Naughton—Bruce—Modified Bruce—Low level—Othersection Indications (Proc Note IG)Procedure description section2.16.840.1.113883.10.20.18.2.2(ProcNote)Procedure description section2.16.840.1.113883.10.20.18.2.2(ProcNote)__________________________________________________________________________23Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________Type of stress:Exercise time(Recommended)Type of stress:Pharmacologic(Recommended)If exercise stress testing was performedduring the study, indicate exercise durationin minutes.If pharmacologic stress testing wasperformed during the study, indicate theagent(s) administered:● Adenosine● Atropine● Dipyridamole● Dobutamine● Regadenoson● OtherProcedure description section2.16.840.1.113883.10.20.18.2.2(ProcNote)Procedure description section2.16.840.1.113883.10.20.18.2.2(ProcNote)Baseline ECG: Q-wave pathology(Optional)Baseline ECG:Rhythm(Recommended—CCTA, SPECT, CMR)Baseline ECG: STsegmentdepression(Optional)Indicate if pathologic Q waves were presenton the baseline electrocardiogram (leads).Choose 1 of the following:● Yes● No● N/AIndicate the patient’s baseline ECG rhythm.Choose 1 of the following:● Normal sinus rhythm● Atrial fibrillation● Premature atrial contractions● Premature ventricular contractions● Paced rhythm● Atrial flutter● Sinus tachycardia● Sinus bradycardiaIndicate if there was negative deflectionbelow the isoelectric line greater than orequal to 0.1 mV on the electrocardiogram(in mm).Choose 1 of the following:● Yes● No● N/AFindings section2.16.840.1.113883.10.20.18.2.15(ProcNote)Findings section2.16.840.1.113883.10.20.18.2.15(ProcNote)Findings section2.16.840.1.113883.10.20.18.2.15(ProcNote)Baseline ECG Indicate whether any additional ECG Findings section__________________________________________________________________________24Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________readings(Recommended—stress TTE, stressSPECT, stress PET,CCTA, stress CMR)Exercise capacity:METS(Optional)HR response:Baseline heart rate(Recommended—stress TTE, stressSPECT)HR response: %Predicted heart rateresponse achieved(Derived)HR response: Maxheart rate(Recommended—stress TTE, stressSPECT)HR response: Heartrate recovery(Optional)BP response:Baseline systolicblood pressurefindings were present.Choose any of the following:● Left bundle branch block● Right bundle branch block● Ventricular paced rhythm● Pre-excitation● OtherIf exercise stress testing was performedduring the study, indicate the number ofMETS achieved (based on time completedfor a specific protocol, using standardizedtables)If stress testing was performed during thestudy, indicate the baseline heart rate.If stress testing was performed during thestudy, indicate the % predicted heart rateresponse achieved.If stress testing was performed during thestudy, indicate the maximum heart rate.If exercise stress testing was performedduring the study, indicate the heart raterecovery, defined as the reduction in theheart rate from the rate at peak exercise tothe rate 1 minute after the cessation ofexercise.Choose 1 of the following:● Adequate (greater than 12 bpm)● Inadequate (less than or equal to 12 bpm)● UnknownIf stress testing was performed during thestudy, indicate the first measurement orearliest record of systolic blood pressure (in2.16.840.1.113883.10.20.18.2.15(ProcNote)Findings section2.16.840.1.113883.10.20.18.2.15(ProcNote)Findings section2.16.840.1.113883.10.20.18.2.15(ProcNote)Findings section2.16.840.1.113883.10.20.18.2.15(ProcNote)Findings section2.16.840.1.113883.10.20.18.2.15(ProcNote)Findings section2.16.840.1.113883.10.20.18.2.15(ProcNote)Findings section2.16.840.1.113883.10.20.18.2.15(ProcNote)__________________________________________________________________________25Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________(Recommended—stress echo, stressSPECT)BP response:Baseline diastolicblood pressure(Recommended—stress echo, stressSPECT)BP response: Maxsystolic bloodpressure(Recommended—stress TTE, stressSPECT)BP response: Maxdiastolic bloodpressure(Optional)BP and HR response:Double product(Derived)Stress testing: Chestpain during exercise(Recommended—exercise SPECT,exercise TTE, stressPET)Sufficient heart ratefor exercise testing(Derived)mm Hg) for this episode of care.If stress testing was performed during thestudy, indicate the baseline diastolic bloodpressure (in mm Hg).If stress testing was performed during thestudy, indicate the maximum systolicpressure (in mm Hg).If stress testing was performed during thestudy, indicate the maximum diastolicpressure (in mm Hg).If stress testing was performed during thestudy, indicate the double product (heartrate systolic blood pressure).If exercise stress testing was performedduring the study, indicate the type of chestpain.Choose 1 of the following:● Limiting chest pain● Nonlimiting chest pain● Anginal equivalent● NoneIf exercise stress testing was performedduring the study, indicate whether thepatient is able to achieve 85% or greater ofmaximum predicted heart rate [(220 agein years) 0.85].Choose 1 of the following:● Yes● No● N/AFindings section2.16.840.1.113883.10.20.18.2.15(ProcNote)Findings section2.16.840.1.113883.10.20.18.2.15(ProcNote)Findings section2.16.840.1.113883.10.20.18.2.15(ProcNote)Findings section2.16.840.1.113883.10.20.18.2.15(ProcNote)Findings section2.16.840.1.113883.10.20.18.2.15(ProcNote)Findings section2.16.840.1.113883.10.20.18.2.15(ProcNote)__________________________________________________________________________26Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________ECG: ST-segmentdepression(Optional)Results: Abnormalitylocation, segments(Recommended—stress SPECT, stressPET, stress TTE,stress CMR)Results: Abnormalityextent(Derived)Report conclusions:ECG findings(Recommended)Evidence of viabilityin the infarct zone(Optional)Indicate additional ST-segment depressionbeyond baseline. If baseline ST-segmentdepression is greater than 1 mm, thenuninterpretable.Choose 1 of the following:● None● Less than 1 mm● 1 mm● 1.5 mm● 3 mmFor each of the 17 myocardial segments,indicate whether it was normal, scarred,ischemic, or mixed. If an abnormality wasobserved, indicate the severity as mild,moderate, or severe.An example of how this information couldbe collected, along with a diagram of the 17segments, is included in Appendix D.Extent of abnormality based on number ofsegments within 17-segment model:● None● Small: 1 to 2 segments● Moderate: 3 to 4 segments● Large: greater than 5 segmentsIndicate the conclusion derived from theECG findings. Choose 1 of the following:● Ischemia● Equivocal● Normal● Nondiagnostic● N/AIf perfusion defects or wall motionabnormalities are present, indicate thedegree of viability.Choose 1 of the following:● Small● Moderate● Large● NoneFindings section2.16.840.1.113883.10.20.18.2.15(ProcNote)Findings section2.16.840.1.113883.10.20.18.2.15(ProcNote)Findings section2.16.840.1.113883.10.20.18.2.15(ProcNote)Findings section2.16.840.1.113883.10.20.18.2.15(ProcNote)Findings section2.16.840.1.113883.10.20.18.2.15(ProcNote)__________________________________________________________________________27Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________Coronary calciumscore(Recommended—CACS)Coronaryangiography (ICA andCCTA): Arterialsegments(Recommended—CCTA or ICA)Coronaryangiography(invasive and CCTA):Dominance(Recommended—CCTA or ICA)Coronaryangiography (ICA andCCTA): Coronaryanomalies(Optional)If coronary CT calcium score is performed,provide Agatston score.If coronary angiography was performed,indicate the arterial segments visualized.Choose any of the following:● Left main● Proximal LAD and 1st diagonal branches● Mid/Distal LAD, D2 and D3 branches● LCX, OMs, LPDA and LPL branches● RCA, RPDA, RPL, AM branches● Ramus● Saphaneous vein grafts or free arterialgrafts, if relevant● Internal mammary artery (LIMA, RIMA), ifrelevantFor each segment visualized, indicate thepercent stenosis:● Normal● Less than 50%● 50% to 70%● Greater than 70%● OccludedAn example of how this information couldbe collected is included in Appendix C.Indicate the anatomic coronary dominance(which coronary provides the posteriordescending artery and PL branches).● Left● Right● CodominantIf coronary angiography was performed,indicate whether coronary anomalies, suchas abnormal origin or location, are present.● Yes● NoFindings section2.16.840.1.113883.10.20.18.2.15(ProcNote)Findings section2.16.840.1.113883.10.20.18.2.15(ProcNote)Findings section2.16.840.1.113883.10.20.18.2.15(ProcNote)Findings section2.16.840.1.113883.10.20.18.2.15(ProcNote)LV diastolic function(Recommended)Indicate the overall assessment of LVdiastolic function.Findings section2.16.840.1.113883.10.20.18.2.15__________________________________________________________________________28Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________Resting LV systolicfunction: Global wallmotionabnormalities:Ejection fraction(EF)/LVEF(Optional)Method of LVEFcalculation(Optional)Resting LV systolicfunction: Globalfunction: Ejectionfraction(EF) (Recommended)LV wall motionabnormalities—17segment(Recommended—SPECT, echo, CMR)(Optional—CCTA)LV wall motionabnormalities—10segment(Optional—LVG)Choose 1 of the following:● Normal for age● Abnormal for age● N/AIndicate the calculated ejection fraction(actual value or midpoint of range). Or notapplicable.Indicate the method of LVEF calculation.Choose 1 of the following:● Visual● QuantitativeIndicate the ejection fraction category.Choose 1 of the following:● Hyperdynamic: greater than 70%● Normal: 50% to 70% (midpoint 60%)● Mild dysfunction: 40% to 49% (midpoint45%)● Moderate dysfunction: 30% to 39%(midpoint 35%)● Severe dysfunction: less than 30%Assess regional function in each of the 17myocardial segments by indicating if it wasnormal, hypokinetic, akinetic, dyskinetic, ornot visualized.An example of how this information couldbe collected, along with a diagram of the 17segments, is included in Appendix E.Assess regional function in each of the 10myocardial segments by indication if it wasnormal, hypokinetic, akinetic, dyskinetic ornot visualized.An example of how this information couldbe collected, along with a diagram of the 10segments, is included in Appendix F.(ProcNote)Findings section2.16.840.1.113883.10.20.18.2.15(ProcNote)Findings section2.16.840.1.113883.10.20.18.2.15(ProcNote)Findings section2.16.840.1.113883.10.20.18.2.15(ProcNote)Findings section2.16.840.1.113883.10.20.18.2.15(ProcNote)Findings section2.16.840.1.113883.10.20.18.2.15(ProcNote)__________________________________________________________________________29Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________Chamber volume:Left ventricle(Recommended)Chamber volume:Left ventricle,systolic(Optional)Chamber volume:Left ventricle,diastolic(Optional)Chamber size: Rightventricle(Recommended—TTE, TEE, CMR)(Optional—CCT)Chamber size: Leftatrium(Recommended—TTE, TEE, CMR)(Optional—CCT)Chamber size: Rightatrium(Recommended—TTE, TEE, CMR)(Optional—CCT)Wall thickness: Leftventricle: Septum:end-diastolicthickness(Optional)Wall thickness: Leftventricle:Inferolateral wall:end-diastolicthicknessChoose 1 of the following:● Normal● Enlarged● Small● Not reportedDescribed in ml or not reported.Described in ml or not reported.Choose 1 of the following:● Normal● Enlarged● Not reportedChoose 1 of the following:● Normal● Enlarged● Not reportedChoose 1 of the following:● Normal● Enlarged● Not reportedIndicate the end-diastolic thickness of themid-septum, in mm.Indicate the end-diastolic thickness of themid-inferolateral wall, in mm.Findings section2.16.840.1.113883.10.20.18.2.15(ProcNote)Findings section2.16.840.1.113883.10.20.18.2.15(ProcNote)Findings section2.16.840.1.113883.10.20.18.2.15(ProcNote)Findings section2.16.840.1.113883.10.20.18.2.15(ProcNote)Findings section2.16.840.1.113883.10.20.18.2.15(ProcNote)Findings section2.16.840.1.113883.10.20.18.2.15(ProcNote)Findings section2.16.840.1.113883.10.20.18.2.15(ProcNote)Findings section2.16.840.1.113883.10.20.18.2.15(ProcNote)__________________________________________________________________________30Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________(Optional)Wall thickness: Rightventricle: Free wall:end-diastolicthickness(Optional)Left ventricularmyocardial mass(Optional)Left ventricularmyocardial mass:By body surface area(Derived)Pulmonary veins(Optional—CMR,CCT)Intracardiac(nonvalvular) mass:Type(Optional)Indicate the end-diastolic thickness of themid-free wall.Choose 1 of the following:● Normal● Increased● Not reportedIndicate assessment of left ventricularmyocardial mass.Choose 1 of the following:● Normal● Increased● Not reportedIndicate the left ventricular myocardial massindexed by body surface area.Choose 1 of the following:● Normal● Increased● Not reportedAssessment of pulmonary venousconfiguration in preparation for pulmonaryvein isolation/radiofrequency ablation ofatrial fibrillation.Choose 1 of the following:● Normal (4 pulmonary veins, normalpulmonary venous drainage into left atrium)● Variant (variant number of pulmonaryveins (usually 3 or 5), but with normalpulmonary venous drainage into left atrium)● Anomalous (anomalous drainage of 1 ormore pulmonary veins into a chamber otherthan the left atrium)If an intracardiac mass is present, indicatethe type of intracardiac mass.Choose 1 of the following:● None● Vegetation● Thrombus● Neoplasm● UnknownFindings section2.16.840.1.113883.10.20.18.2.15(ProcNote)Findings section2.16.840.1.113883.10.20.18.2.15(ProcNote)Findings section2.16.840.1.113883.10.20.18.2.15(ProcNote)Findings section2.16.840.1.113883.10.20.18.2.15(ProcNote)Findings section2.16.840.1.113883.10.20.18.2.15(ProcNote)__________________________________________________________________________31Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________Intracardiac shunt(Optional)Pericardial: Effusion(Recommended—TTE, TEE, CCT, CMR)Pericardial: Effusion:Size(Optional)Pericardial effusion:Evidence ofincreasedintrapericardialpressure(Optional)Pericardial:Thickness(Optional)Valvular: Aortic:Structure(Recommended—TTE, TEE, CCT, CMR)Indicate if the patient has evidence for anintracardiac shunt and etiology.Choose 1 of the following:● None● PFO● ASD● VSD● PDA● OtherIndicate if pericardial effusion is present.Choose 1 of the following:● Present● AbsentIf pericardial effusion is present, indicatethe overall assessment of its size and/or themaximal endsystolic dimension of thepericardial effusion.Choose 1 or more of the following:● Trivial● Small● Moderate● LargeIf pericardial effusion is present, indicate iftamponade is present.Choose 1 of the following:● Present● Absent● Equivocal● Not assessedIndicate the thickness of the pericardium.Choose 1 or more of the following:● Normal● Thickened● Calcified● Not assessedIndicate if the structure of the aortic valve isabnormal.Choose 1 of the following:● NormalFindings section2.16.840.1.113883.10.20.18.2.15(ProcNote)Findings section2.16.840.1.113883.10.20.18.2.15(ProcNote)Findings section2.16.840.1.113883.10.20.18.2.15(ProcNote)Findings section2.16.840.1.113883.10.20.18.2.15(ProcNote)Findings section2.16.840.1.113883.10.20.18.2.15(ProcNote)Findings section2.16.840.1.113883.10.20.18.2.15(ProcNote)__________________________________________________________________________32Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________● Abnormal● Prosthetic● Not assessedValvular: Aortic:Structure: Cause ofabnormality(Optional)Valvular: Aortic:Stenosis(Recommended—TTE, TEE, CMR,cardiac cath)Valvular: Aortic:Regurgitation(Recommended—TTE, TEE, CMR,cardiac cath)Valvular: Mitral:Structure(Recommended—TTE, TEE, CMR)Valvular: Mitral:Structure: Abnormal(Recommended—TTE, TEE, CMR)If the aortic valve is abnormal, indicate thecause of abnormality in the aortic valve.Choose any of the following:● Congenital leaflet abnormality● Leaflet thickening/calcification● Vegetation/mass● Other● None● N/AIndicate the severity of stenosis in the aorticvalve.Choose 1 of the following:● Mild● Moderate● Severe● None● Not assessedIndicate the severity of regurgitation in theaortic valve.Choose 1 of the following:● Mild● Moderate● Severe● None● Not assessedIndicate if the structure of the mitral valve isabnormal.Choose 1 of the following:● Normal● Abnormal● Prosthetic● Annuloplasty ring● Not assessedIf the mitral valve is abnormal, indicate thelocation of the abnormality of the mitralvalve.Choose 1 or more of the following:Findings section2.16.840.1.113883.10.20.18.2.15(ProcNote)Findings section2.16.840.1.113883.10.20.18.2.15(ProcNote)Aortic: Stenosis 60573004Severities 272141005Findings section2.16.840.1.113883.10.20.18.2.15(ProcNote)Aortic Regurgitation 60234000Severities 272141005Findings section2.16.840.1.113883.10.20.18.2.15(ProcNote)Findings section2.16.840.1.113883.10.20.18.2.15(ProcNote)__________________________________________________________________________33Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________● Congenital leaflet abnormality● Leaflet thickening/calcification● Vegetation/mass● Flail● Prolapse● None● Not assessedValvular: Mitral:Annular calcification(Recommended—TTE, TEE, CCT, CMR,cardiac cath)Valvular: Mitral:Stenosis(Recommended—TTE, TEE, CMR,cardiac cath)Valvular: Mitral:Regurgitation(Recommended—TTE, TEE, CMR,cardiac cath)Valvular: Tricuspid:Structure(Recommended—TTE, TEE, CMR)Valvular: Tricuspid:StenosisIndicate if there is annular calcification inthe mitral valve.Choose 1 of the following:● Present● Absent● Not assessedIndicate the severity of stenosis in the mitralvalve.Choose 1 of the following:● Mild● Moderate● Severe● None● Not assessedIndicate the severity of regurgitation in themitral valve.Choose 1 of the following:● Mild● Moderate● Severe● None● Not assessedIndicate if the structure of the tricuspidvalve is abnormal.Choose 1 of the following:● Normal● Abnormal● Prosthetic● Annuloplasty ring● None● Not assessedIndicate the severity of stenosis in thetricuspid valve.Findings section2.16.840.1.113883.10.20.18.2.15(ProcNote)Findings section2.16.840.1.113883.10.20.18.2.15(ProcNote)Mitral: Stenosis 79619009Severities 272141005Findings section2.16.840.1.113883.10.20.18.2.15(ProcNote)Mitral Regurgitation 48724000Severities 272141005Findings section2.16.840.1.113883.10.20.18.2.15(ProcNote)Findings section2.16.840.1.113883.10.20.18.2.15__________________________________________________________________________34Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________(Recommended—TTE, TEE, CMR)Valvular: Tricuspid:Regurgitation(Recommended—TTE, TEE, CMR)Valvular: Pulmonic:Structure(Recommended—TTE, TEE, CMR)Valvular: Pulmonic:Stenosis(Recommended—TTE, TEE, CMR)Valvular: Pulmonic:Regurgitation(Optional)Aorta: Dissection(Recommended—Choose 1 of the following:● Mild● Moderate● Severe● None● Not assessedIndicate the severity of regurgitation in thetricuspid valve.Choose 1 of the following:● Mild● Moderate● Severe● None● Not assessedIndicate if the structure of the pulmonicvalve is abnormal.Choose 1 of the following:● Normal● Abnormal● Prosthetic● None● Not assessedIndicate the severity of stenosis in thepulmonic valve.Choose 1 of the following:● Mild● Moderate● Severe● None● Not assessedIndicate the severity of regurgitation in thepulmonic valve.Choose 1 of the following:● Mild● Moderate● Severe● None● Not assessedIndicate if the aorta is dissected.Choose 1 of the following:(ProcNote)Tricuspid: Stenosis 49915006Severities 272141005Findings section2.16.840.1.113883.10.20.18.2.15(ProcNote)Tricuspid Regurgitation111287006Severities 272141005Findings section2.16.840.1.113883.10.20.18.2.15(ProcNote)Findings section2.16.840.1.113883.10.20.18.2.15(ProcNote)Pulmonic: Stenosis 56786000Severities 272141005Findings section2.16.840.1.113883.10.20.18.2.15(ProcNote)Pulmonic Regurgitation91434003Severities 272141005Findings section2.16.840.1.113883.10.20.18.2.15__________________________________________________________________________35Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________TTE, TEE, CMR, CCTA,cardiac cath)Aorta: Dissection:Present: StanfordClassification(Recommended—TTE, TEE, CMR, CCTA,cardiac cath)Aortic Root: Dilation:Enlarged● Present● Absent● Not assessedIf the aorta is dissected, indicate the type ofdissection that is present in the aorta.Choose 1 of the following:● Stanford type A—all dissections involvingthe ascending aorta regardless of site oforigin● Stanford type B—all dissections notinvolving the ascending aortaIndicate if the aortic root is dilated.Choose 1 of the following:● Present● Absent● Not assessed(ProcNote)Findings section2.16.840.1.113883.10.20.18.2.15(ProcNote)Findings section2.16.840.1.113883.10.20.18.2.15(ProcNote)Report conclusions:Overall summary(Recommended—ICA)Report conclusions:Ischemia(Recommended—CCTA, ICA, stressSPECT, stress echo)Report conclusions:Ventricular function(Recommended)Indicate conclusions derived from ischemicheart disease assessment. Choose 1 of thefollowing:● Normal● Abnormal● Equivocal● N/AIndicate whether there is evidence forischemia on the study. Choose 1 of thefollowing:● Yes● No● Equivocal● N/AIndicate the conclusion derived from theventricular function assessment. Choose 1of the following:● Normal● Equivocal● Abnormal● N/A__________________________________________________________________________36Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.


IHE Cardiology Technical Framework SupplementCardiac Imaging Report Content (CIRC)______________________________________________________________________________Date of Prior Study(Recommended)Significant changesfrom prior study(Recommended)Report finalized withsignature date(Recommended)Indicate the date of prior imaging studydone.Indicate if there are significant changesfrom prior study. Choose 1 of the following:● Yes—Describe changes from prior study● No● N/AIndicate the date the report was finalizedand signed by the interpreting physician.Header- author,legalAuthenticator__________________________________________________________________________37Rev. 1.0 – 2011-04-22Copyright © 2011: IHE International, Inc.

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