Scheduled Procedure Step - DICOM

This is a discussion on Scheduled Procedure Step - DICOM ; Hello all-- I'm implementing C-FIND for our SCP, and I could use some clarification as to what some of the terms mean. For Example, (0040, 0002) is "PRC Scheduled Procedure Step Start Date." What is a 'Step'? I'm reading it ...

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Thread: Scheduled Procedure Step

  1. Scheduled Procedure Step

    Hello all--

    I'm implementing C-FIND for our SCP, and I could use some clarification
    as to what some of the terms mean. For Example, (0040, 0002) is "PRC
    Scheduled Procedure Step Start Date." What is a 'Step'? I'm reading it
    to be that (0040, 0100) is a Sequence of steps to be completed for a
    particular procedure. So there might, for example, be a CT scan
    scheduled for 5-12-2006, and then an MRI scan scheduled on 5-13-2006,
    and if they were in preparation for the same thing, they would be part
    of the same sequence.

    There's also, inside each item of the Step Sequence, an Action Item
    code. What is that?

    Thanks in advance,

    Aaron Lehmann

  2. Re: Scheduled Procedure Step

    Hi Aaron,

    There are a several different operational models being promoted in
    structure of modality worklist entries attempting to account for the
    fact that imaging procedures often incorporate multiple workflow steps
    which may or may not be separately billable; or may require different
    equipment; or may require different equipment setup.

    I'll take a flying leap here and assume your initial question is based
    on an observation that a requested procedure can have multiple steps,
    but it goes even higher than that. A single imaging service request (ie
    a single order) can included multiple requested procedures. This
    approach is taken when the imaging procedure includes multiple billable
    steps --ie a CT study which encompasses chest, abdoment, and pelvis. A
    single order might be detailed as three separate entries on the MWL
    which launches us into the whole group procedure controversy/encoding
    problem. I won't go there except to note, it is part of discussion
    behind the question "what is a step?"

    Since "billability" is generally driven by the reading process/report
    production and billing is driven by request codes, in the above case
    the multiple actions to be performed are mapped to requested
    procedures. Multiple Steps are really driven by the need for separate
    technician actions within a single requested procedure. While multiple
    steps could be defined, say for different series with a CT or MR exam,
    remember the problem MWL was supposed to address: technician
    productivity and consistent coding of imaging data produced during the
    image acquisition. Making separate steps for different series within a
    single procedure is only going to add work for the technicians to have
    to go and select a new entry for each series. They already have to do
    series specific work with the modality console application. The vast
    majority of the data received from the MWL and used in the image data
    would be gathered in the first selection. So, multiple imaging modes
    performed by a single modality would not be a good use of Scheduled
    Steps, unless those steps are widely separated in time - ie something
    like a nuc med procedure where the with and without constrast steps
    might be performed over successive days -- ie each step has a
    separately scheduled time and the machine is used to image other
    patients in between steps. Another example is when multiple modalities
    are used to image a patient for a single procedure. I've seen
    facilities where Fluoro procedures routinely incorporate a CR image as
    a reference for the RF video sequences. In that case, a separate step
    for the CR acquisition and RF acquisition would be justified. Different
    modality devices would need query to worklist with different Modality
    Codes or Scheduled AE Titles, but the images would be incorporated into
    a single study and single requested procedure.

    The Action Items within a Step are for the case cited above - a
    sequence of different imaging modes used for a single acquisition on a
    single modality. Action items are procotocol codes describing what
    imaging modes, such as with and without contrast, or different types of
    MR series, or different tranducer types in an ultrasound procedure.

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