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Radiopharmaceutical Administration Radiation Dose Reporting

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					Radiopharmaceutical
Administration
Radiation Dose
Reporting
RARD Reporting White Paper

A RARD report proposes a solution to connect the
radiopharmaceutical management dominion with the image
modalities and imaging dominion.

Charles Smith, Lawrence Smith, George Gregg, Numa Inc.
2/13/2012
For latest version go to: www.numa-inc.com
Contents
Radiopharmaceutical Administration Radiation Dose Reporting ................................................................. 3
  Introduction .............................................................................................................................................. 3
  Who is this for? ......................................................................................................................................... 5
  Molecular Imaging Use Cases: .................................................................................................................. 5
     Considerations: ..................................................................................................................................... 5
  Review of IHE Radiation Exposure Monitoring (REM) technical framework. ........................................... 6
     IHE REM Use cases: ............................................................................................................................... 6
  Integrating Molecular Imaging workflow into REM workflow. ................................................................ 8
     RARD Actor Transaction ........................................................................................................................ 8
  Workflow diagrams ................................................................................................................................... 9
     Real-World Molecular Imaging current workflow ................................................................................ 9
     RARD Workflow with hot lab manager implemented RARD Actor..................................................... 10
     RARD Workflow administrated dose without imaging. ...................................................................... 11
     RARD Workflow with an infusion system implementing the RARD Actor. ......................................... 12
  Radiopharmaceutical Dose Check........................................................................................................... 13
     Radiopharmaceutical Dose Check workflow ...................................................................................... 14
  Challenges ............................................................................................................................................... 14
     Technoligist “Push Back”..................................................................................................................... 14
     Assay of residual dose ......................................................................................................................... 15
     DICOM Standard ................................................................................................................................. 15
     Product labels Radiation Dosimetry estimation ................................................................................. 15
     Radiopharmaceutical Quality Control, Isotope and Reagent Kit attributes ....................................... 16
     Intervention drugs and Contrast Agent characteristics report ........................................................... 16
     Product Administration Approval ....................................................................................................... 16
  Conculsion ............................................................................................................................................... 16
  Appendix ................................................................................................................................................. 17
     RARD PET\CT Sequence Example........................................................................................................ 17
     Review of Existing Standards .............................................................................................................. 18
     DICOM SAS Substance Administration Services ................................................................................. 19
  Radiopharmaceutical Administration Radiation Dose Structure Report Template................................ 20
     Radiopharmaceutical Administration Dose Template ........................................................................ 20

RARD White Paper                                                                                                                                    Page 1
    Radiopharmaceutical Administration Accumulated Dose .................................................................. 21
    Radiopharmaceutical Administration Event ....................................................................................... 22
 Substance Administration Approval Code Reference Extension ............................................................ 25
    Radiopharmaceutical administration Dose Exposure per Organ........................................................ 25
    Radioisotope Assay Data Template .................................................................................................... 26
    Patient Characteristics template......................................................................................................... 26
    Glomerular filtration rate.................................................................................................................... 27
 Current published DICOM Codes ............................................................................................................ 28
 Radiopharmaceuticals Context Id 25 ...................................................................................................... 28
    CID 25        Radiopharmaceuticals ......................................................................................................... 28
    Isotopes in Radiopharmaceuticals CID 18 ........................................................................................... 32
    PET Cardiology Radiopharmaceuticals CID 3107 ................................................................................ 33
    Nuclear Cardiology Radiopharmaceuticals CID 3111 ......................................................................... 33
    PET Radiopharmaceutical CID 4021 .................................................................................................... 33




RARD White Paper                                                                                                                           Page 2
Radiopharmaceutical Administration Radiation Dose Reporting

Introduction
The following is a white paper comprised from a review of the DICOM, IHE, HL7 standards and
current Molecular Imaging industry. The goal of this document is to raise awareness, stimulate
discussion and help begin the process of finding solution to existing problems. We assume it is
best to follow IHE and DICOM approach for X-Ray and CT exposure and develop DICOM
structure report (SR) for radiopharmaceutical administration. There are other approaches to the
problem but DICOM SR offers the best alignment with existing standards, profiles and systems.
We will identify current parts of standards that refer to radiopharmaceuticals; define attributes of
the report, define the role of the creator of the report and propose a “Dose Check” in the
workflow.

There are many opportunities for the molecular image industry with adoption of a
standardization of dose report. A Radiopharmaceutical Administration Radiation Dose Structure
Report (RARD) would create a means for communication between the radiopharmaceutical
segment of the industry and the imaging segment. With communication established there are
numerous uses for the report which could solve existing problems in the Molecular Imaging
industry.

      The report would document radiopharmaceutical exposures and distribute them as
       defined in the IHE Radiation Exposure Monitoring (REM) Profile.
      The RARD contains radiopharmaceutical administration information required by PET
       systems for accurate and consistent SUV calculations.
      A standardized report and a time managed workflow is essential for the RSNA QIBA
       PET SUV Biomarker.
      A RARD report is a DICOM object so the information would flow with the images to
       reading stations and archives.
      The report could be de-identified and transferred from site to site or information could be
       gathered from sampling of RARD reports. (e.g. dose amount, uptake times and other
       patient characteristics) This information would be valuable for clinical research and
       setting exposure benchmarks in the imaging department. A National registry could be
       established to gather dose reports.

Developing a radiation dose report for Molecular Imaging is a complex problem. The
radiopharmaceutical product causes the radiation exposure to the patient, not the imaging
system itself unlike other modalities. Doses are often created in specialized pharmacies outside
of the imaging facilities. Doses are measured and recorded in systems (hot lab managers). The
doses are often administered to patients several minutes before the patient is imaged. Hot lab
managers currently have limited HL7 and DICOM Worklist capabilities. Currently, there is no
defined standard to digital communicate radiopharmaceutical administration information
in a time managed format to radiopharmaceutical imagers. For an accurate Radionuclide
Total Dose it is essential that time is managed (consistent) for, when the dose is assayed, when
the dose is administered and when the imager records the start of the acquisition.


RARD White Paper                                                                              Page 3
The RARD report needs to contain the information required to accurately compute exposure
from a radiopharmaceutical. These components are:

       the radiopharmaceutical and radioisotope
       the measured activity and the time it was measured
       the time the product was administered
       the residual activity measured and the time it was measured
       the patient state (stress or rest) when the product was administered.

Time is a reoccurring attribute in many of the exposure components. If the imaging modality is
going to relate these components to acquired images (like in PET SUV) then it needs to be
able too relate the exposure component times to the imagers acquisition start time.

Another aspect of the radiopharmaceuticals that should be considered is that they are
substances that are administered to patients. There are many parts of the DICOM standard that
pertain to substances (e.g. Contrast Agent and Interventional drugs). The Interventional Drug
Code Sequence is now part of the Nuclear Medicine and PET IOD. For hybrid PET/CT,
SPECT/CT and PET/MR scanners, the contrast agent information is part of the CT and MR
IOD. Though not as critical as radiopharmaceutical information, contrast agents and intervention
drugs have the same problem; the technologist has to manually enter data about products
administered several minutes earlier at the modality console. Hot lab management systems can
track the administration substances other than radiopharmaceuticals. In this document we will
review and incorporate appropriate information into the RARD report. Contrast Agents and
interventional drugs should be handled in a different and separate Product Administration
report. A product administration report would share many of the same attributes and workflow
as the RARD report.

What we are proposing is a four item solution.

   1. Radiopharmaceutical Administration Radiation Dose SR IOD template (RARD SR). The
      report contains dose assay components and exposure components.
   2. A RARD Creator Actor which defines the role and features of the RARD report creator.
      The profile can then be integrated in to IHE REM profile.
   3. A Dose Alert component for the RARD Creator. It could act much like the CT Dose
      Check Initiative.
   4. A Product Administration Report SR IOD template. It is used to communicate
      Intervention drugs and contrast products to the imaging modalities. Radiopharmaceutical
      Reports are differentiated from Product Administration reports so they can easily be
      identified by REM Dose information consumers. RARD should have a different SOP
      Class UID from Product Administration Reports. A product administration report and a
      RARD would share many of the same attributes, but a product administration report is
      beyond the scope of this document.




RARD White Paper                                                                         Page 4
Who is this for?
There are many aspects to reporting exposure within the MI department. Therefore, there are
many players who should be aware and involved in developing the report. The following is a list
of potential players.

      Facilities exposing patient to radiation from radiopharmaceuticals.
      MI Physician and Technologist
      Modality Manufacturers of Nuclear Medicine, PET and Hybrid systems.
      Radiopharmaceutical manufacturers
      Radiopharmaceutical Pharmacies
      Dose Management System Developers
      Dose calibrator manufacturers
      Rubidium Generator manufacturers
      Infusion System manufacturers
      Non-Imaging Nuclear Medicine systems manufactures, Uptake Probe, Blood Volume.



Molecular Imaging Use Cases:
In the following list we will try to capture the use cases and other considerations we used for the
design of the RARD report. The RARD Report will:

   1.) Record radiopharmaceutical exposure in an IHE REM compatible format.
   2.) Record product information not entered/available to the scanner at time of the
       acquisition or must be edited after the acquisition.
   3.) Support multiple scans (and/or, multiple reconstructed images series) in a study, from 1
       product administration.
   4.) Support multiple product administration within a study (e.g. Cardiac Rest/Stress study)
   5.) Create reports for non-imaging procedures. (e.g. Thyroid Uptakes probes, Blood volume
       systems)
   6.) Create reports for administered products even if patient cancels imaging step.
   7.) Create reports for therapeutic doses that are not imaged.
   8.) Record the Patient State when the radiopharmaceutical was administered. Patient state
       affects radiopharmaceutical dose.

Considerations:
   1.) Exposure Reporting
           a. Effective Dose (as per product label)
           b. Organ Exposure (as per product label)
   2.) Model Injection/Administration as event, and include some mechanism of uniquely
    identifying that administration event (analogous to CT “irradiation event”).
   3.) Accumulated Dose
   4.) Dose Information is transferred and stored with images.
   5.) Coded Radiopharmaceutical
   6.) Coded Radioisotope
   7.) Coded Route of Administration

RARD White Paper                                                                            Page 5
   8.) PET SUV Components
           a. Total dose
           b. Administration date/time
           c. Patient Weight
           d. Patient Size (height)
   9.) Radioisotope Assay Data
           a. Observer Context
   10.) Time Management (Consistent Time when recording the dose, and product
    administration)
   11.) Patient Uptake Location
   12.) Patient Characteristics
           a. Patient State Stress\Rest
           b. Glucose level
           c. GFR/eGFR
           d. Allergies
           e. Patient Medications
   13.) Product characteristics
           a. Product Package Identifier
           b. Manufacturer
           c. Product Type Code Sequence
           d. Product Lot identifier
           e. Product Expiration Date Time
           f. Product QC data
           g. Isotope characteristics
           h. Reagent Kit characteristics
   14.) Volume Administered
   15.) Interventional Drugs (Stress Agents)
   16.) Prescription Id
   17.) Unit Dose or local compounded
   18.) Clinical Trials integration
   19.) Image report
   20.) Product administration integration (Medicine Administration Report)
   21.) Product approval
   22.) Meaningful Use (MU) component requirements

Review of IHE Radiation Exposure Monitoring (REM) technical framework.
The following is a list of the use cases identified for REM. The use cases were identified for CT,
X-ray and fluoroscopy system but most of these points are applicable to molecular imaging.

IHE REM Use cases:
   1.) Department QA (Process Control)
   2.) Patient Impact Evaluation
   3.) Population Dose and Dose Indicators
   4.) Dose Reference Levels
   5.) Site Benchmarking

RARD White Paper                                                                            Page 6
   6.) Population Epidemiology
   7.) Clinical Trials
   8.) Procedure Operational Awareness (Quasi-real time)
   9.) Clinical Management
   10.) Longitudinal Patient Dose Record




RARD White Paper                                           Page 7
Integrating Molecular Imaging workflow into REM workflow.
The following is a drawing that is identical to the Actor diagram in the IHE REM profile except for
the Acquisition modality actor has been replaced with a RARD Creator actor. Molecular Imaging
modalities, which only image, do not appear in the diagram because they do not expose
patients. For PET especially, the camera should perform the role of the Dose Information
consumer. The RARD report contains information essential for SUV calculations.




                                 Figure 1 RARD Creator in IHE Actor diagram

RARD Actor Transaction
Actor          Transactions                        Optionality     Reference

RARD Creator   Maintain Time [ITI-1]               O               IHE IT Infrastructure Vol. 1 Section 7
               Query Modality Worklist [RAD-5]     R               IHE Radiology Vol. II Section 4.5
               Store Dose Information[RAD-62]      R               IHE REM Vol. 4 Section 62
               Storage Commitment [RAD-10]         R               IHE REM Vol 4 Section 10
               Modality PS in Progress [RAD-6]     O               IHE Radiology Vol. II Section 4.6
               Modality PS in Complete [RAD-7]     O               IHE Radiology Vol. II Section 4.7




RARD White Paper                                                                                            Page 8
Workflow diagrams
Real-World Molecular Imaging current workflow
The following figure is a diagram of the “typical” current molecular imaging workflow. The blue
represents RIS\HIS scheduling workflow. The orange represents radiopharmaceutical
management workflow. The green represents the patient workflow. The red is imaging modality
workflow. Some dose management systems are connected to the HIS/RIS for ordering. Note
there is no connection between the radiopharmaceutical management and the imaging
modality. Time is not managed between dose measurement and product administration and the
imaging scanner.




                              Figure 2 Current Molecular Imaging Workflow




RARD White Paper                                                                         Page 9
RARD Workflow with hot lab manager implemented RARD Actor.
The following diagram demonstrates workflow where there is a RARD actor. It is recording the
dose measurements and the product administration measurements. In this instance the RARD
report is being sent directly to the imaging scanner. The scanner can read the report to populate
the radiopharmaceutical administration information it requires. The scanner’s images can now
reference the RARD report. The scanner images and the RARD report can be stored and read
from the image manager/archive (PACS).




                          Figure 3 Dose Management system RARD Actor Workflow




RARD White Paper                                                                         Page 10
RARD Workflow administrated dose without imaging.
The following figure shows the workflow for non-imaging dose or procedure where the patient is
administered a radiopharmaceutical but is not imaged. A record of the administration is still
produced and stored. This action may prompt the billing system that the procedure step was
performed. Time is managed between the dose assay time and the product administration time.




                             Figure 4 RARD Workflow with no imaging step




RARD White Paper                                                                       Page 11
RARD Workflow with an infusion system implementing the RARD Actor.
The following is the workflow if the RARD Actor is an infusion system or generator. The
consistent time triangle was removed from the drawing for simplifcation. Keeping consistent
time is simpler because the infusion system is electronically preforming dose assays and dose
administration. If time is managed between the infusion system and scanner then very accurate
dose reports can be achieved. Also, since the patient characteristics can be entered in to the
infusion system, patient specific dose reduction routines can be easily implemented. Dose
assys are recorded electronically without technologist “push back”.




                             Figure 5 Infusion System RARD Actor Workflow




RARD White Paper                                                                       Page 12
Radiopharmaceutical Dose Check
If the MI industry implemented a dose check feature simular to CT industry, a logical place to
put the check dose feature is in the RARD creator. RARD creator would ensure the
radiopharmaceutical attributes. The following is a list of attributes for the RARD dose check.

      Radiopharmaceutical (Coded Value)
      Radiopharmaceutical Assay Measurement
      Assay Time (Time Managed)
      Electronic setting of dose calibrator for radiopharmaceutical
      Electronic reading of dose assay values.
      Schedule Administration Time or current time in same managed time as assay.
      Patient Age
      Procedure
      Configured Notification Value
      Reason for Proceding
      Person Participant
      Allergies
      Mediciations
      Other QC data




RARD White Paper                                                                         Page 13
Radiopharmaceutical Dose Check workflow
The following is a proposed workflow for a radiopharmaceutical “Dose Check”. Patient age,
weight, scheduled start time and requested procedure are gathered from DICOM Worklist.
Products for the procedure are selected from inventory. The radiopharmaceutical is assayed in
the dose calibrator. The electronic connection to the dose calibrator is important. First the RARD
creator can ensure the dose calibrator is set to the correct isotope for the selected
radiopharmaceutical. Secondly it eliminates transcription errors. Third it ensures the dose is
assayed and the time. The patient is prepared for the administration of the radiopharmaceutical.
Then just before administration there is a check of patient id to product id. It would be possible
to check radiopharmaceutical dose using current time and last assay to ensure the dose is
being administered at the proper time. Product approval by local pharmacy, drug interaction and
patient interview results are not included in the workflow.




                                     Figure 6 Dose Check Workflow

Challenges
Technologist “Push Back”

Electronic recording of Assay
For several years, dose calibrators have had the ability to read assays electronically.
Additionally, hot lab management systems have had the ability to read dose assays from the
dose calibrators; however, today, few departments have their dose calibrators and hot lab

RARD White Paper                                                                          Page 14
managers connected. There may be several reasons for this including compatibility with the hot
lab management system and dose calibrator, inexperience of the nuclear medicine technologist,
and/or lack of recognition of the value of using integrated systems to reduce regulatory record
keeping related to each administered dose. Education is the answer. The industry should
educate physicians and technologists of the value of doses read electronically - and more
specifically, work with individual departments to assure that the technology is well understood
and super users are available within the institution for questions. An example of problems that
can occur with manual dose measurements was cited from a study that was performed for QIBA
PET SUV Biomarker that resulted in a rejection of 10% of the data because of dose calibrator
isotope setting errors. The following summarizes the value of stressing electronic readings for
dose assay:

              minimize transcription error
              minimize dose calibrator isotope setting errors
              improved accuracy of dose administration data based on time synchronization of
               the reading computer and imaging camera
              improved department efficiency and productivity (minimize time with manual data
               entry)
              improved dose reporting accuracy
              ensuring doses are validated and assayed before administration

Assay of residual dose
With the exception of PET, many departments do not record residual activity for most
procedures following administration of the radiopharmaceutical. Multiple reasons are cited
including residual dose information is not required for study interpretation; inadequate time in an
already overbooked schedule; the actual time required to measure the residual dose, which for
most dose calibrators takes longer based on the lower activity levels; the inability to enter the
data in the hot lab management system and most importantly, the additional radiation exposure
associated with handling a non-shielded radioactive syringe. The challenge is to note when the
administration step is complete. Is the administration step complete when the dose is
administered or when the residual dose has been assayed?

DICOM Standard
    Duplicate codes for the same radiopharmaceutical exist between Nuclear Medicine
     Radiopharmaceutical and Nuclear Medicine Cardiology Radiopharmaceutical. The same
     for PET and PET Cardiology.
    Not all organs reported in the radiopharmaceutical product labels appear in the DICOM
     standard. (CP 1127 Add fields for Organ Dose to Dose SR)
    TID 15101 NM/PET Protocol Context. See Appendix
    Supplement 107 Substance Administration Information Services. See Appendix

Product labels Radiation Dosimetry estimation
The radiation dose on product labels provides an estimated dose to organs. Much like CT
exposures these exposures are based on models. Patient’s actual exposure may vary.
Radiopharmaceuticals expose the whole body. This report estimates the total effective dose and

RARD White Paper                                                                           Page 15
the dose to each organ. If a better method of measuring dose is developed it would most likely
report information in the same categories.

Radiopharmaceutical Quality Control, Isotope and Reagent Kit attributes
This document attempts to identify some of the attributes for quality control and component
attributes but there may be other attributes that are needed. DICOM SRs are customizable so
local department or applications can add attributes as needed.

Intervention drugs and Contrast Agent characteristics report
Intervention drug and contrast agent were not added to the RARD report for compatibility with
REM. A SR report could be developed that would have the same workflow as RARD. It seems
that if a camera is parsing a SR file for radiopharmaceutical information, it could parse an SR
document for intervention drugs and contrast agent. The cross-enterprise document (XDS)
would provide a good solution to product administration reporting.

Product Administration Approval
Product Administration reporting. (Joint Commission Medication Management (MM) standards).
DICOM Substance Administration Services have a component to aid in integrating contrast
agent and intervention drugs with pharmacy system. See appendix

“Drug-use controls in radiology present a difficult and challenging circumstance, one in which millions of
patients per year are routinely exposed to dangerous drugs without the protections uniformly offered
elsewhere in the hospital. Pharmacy must assume responsibility for the well-being of these patients and
ensure best medication-related outcomes for patients referred for medical imaging. All patients should
be protected by the safeguards pharmacy is uniquely positioned to provide.”

http://www.pppmag.com/article/858/April_2011/Managing_Radiopharmaceuticals/

Conculsion
It is possible to leverage existing standards and systems to provide a radiation dose report for
radiopharmaceuticals. The report provides a Win-Win situation. Dose reporting systems can
now gather more information to give a more complete picture of a patient’s dose. Molecular
Imaging wins by improved accuracy and efficiency in radiopharmaceutical administration. There
are a number of challenges to completing the RARD report, but defining the report is the first
step towards solving the problem.




RARD White Paper                                                                                  Page 16
Appendix
RARD PET\CT Sequence Example
The following shows a sequence diagram to moving a RARD from the creator to PET/CT modality. PET/CT
system stores the CT radiation exposure report. Both reports are available to a DOSE information
reporter. Reports are then submitted to a Dose Registry.




                                  Figure 7 RARD PET\CT REM Sequence




RARD White Paper                                                                           Page 17
Review of Existing Standards

TID 15101 NM/PET Protocol Context
This template defines the radiopharmaceutical information that can be added to the Protocol Context in
a DICOM Schedule Worklist Step or a Performed Procedure Step. It provides a standard method to move
information to the acquisition system via Modality Worklist or MPPS.




                                Figure 8. NM/PET Protocol Context Workflow
Pros

Pros

   1.)   Coded Radiopharmaceutical
   2.)   Coded Radioisotope
   3.)   Total Dose measurement
   4.)   Radiopharmaceutical Start Time
   5.)   Route of Administration
Cons
   1.) No defined communication between worklist provider and dose measurement.
   2.) No Consistent Time with measurements
   3.) No Irradiation Event Id,Dose information could easily be confuse or duplicate duplicated
       between systems.
   4.) No Exposure Information
   5.) Difficult to relate stress dose or rest dose.




RARD White Paper                                                                              Page 18
DICOM SAS Substance Administration Services
SAS introduces a new query SOP Class for imaging modalities to request verification of contrast agents
and other drugs administered during an imaging or image-guided treatment procedure, based on the
label bar code and the patient ID.




                                 Figure 9. Substance Administration Workflow

Pros

    1.)   Defined Product Character
    2.)   Defined Substance Approval
    3.)   Remote Administration
    4.)   Defined workflow for Contrast agent and Intervention Drugs

Cons

    1.)   Radiopharmaceuticals not defined.
    2.)   No consistent time
    3.)   Few if any implementations
    4.)   No defined communication to Medicine Administration Record (MAR or eMAR)
    5.)   No defined communication to Scheduled Workflow
    6.)   No defined communication to pharmacy
    7.)   No Interface with IHE REM, or IHE PRE.

3.) Nuclear Medicine and PET DICOM IOD defines fields for radiopharmaceuticals. The imaging
modality requires that the operator manually fill in these fields. Often these fields are not
completed and the manual process is prone to errors.

4.) Cardiac Stress Structure Reports have a define section for both PET and NM
radiopharmaceuticals. It would require the information to be read from the images or manually
input from the operator.




RARD White Paper                                                                                Page 19
5.) HL7 Structured Product Labels. HL7 and FDA worked together to develop a HL7 structure
for product label. All radiopharmaceuticals have a structured product label but the SPL did not
define a structure for the Radiation Dosimetry section.



Radiopharmaceutical Administration Radiation Dose Structure Report
Template
The template provides details on proposed structure of the RARD SR document. It is laid out similar to
the DICOM standard. It draws on many different defined attributes which exist in the DICOM standard.




   1.) Radiopharmaceutical Administration Dose
   2.) Radiopharmaceutical Administration Accumulated Dose
   3.) Radiopharmaceutical Administration Dose Event Data
   4.) Radiopharmaceutical administration Dose Exposure per Organ
   5.) Radiopharmaceutical Administration Dose Measurement Data
   6.) Radiopharmaceutical Administration Exposure
   7.) Product Administration Patient Characteristics
   8.) Product Characteristics
   9.) Substance approval
   10.) Substance Administration

Radiopharmaceutical Administration Dose Template
This template defines a container (the root) with subsidiary content items, each of which
corresponds to a single Radiopharmaceutical Administration Dose event entry. There is a
defined recording observer (the system or person responsible for recording the log, generally
the system). Accumulated values shall be kept for a whole Study or at least a part of a Study, if

RARD White Paper                                                                               Page 20
the Study is divided in the workflow of the examination, or a performed procedure step. Multiple
Radiopharmaceutical Administration Dose objects may be created for one Study.

        NL   Rel with       VT             Concept Name                 VM    Req     Condition    Value Set
             Parent                                                           Type                 Constraint

1                           CONTAINER      Radiopharmaceutical Dose     1     M
                                           Report
2       >    HAS            CODE           EV (121058, DCM,             1     M                    Radiophar
             CONCEPT                       ”Procedure reported”)                                   maceutical
             MOD                                                                                   Administra
                                                                                                   tion
3       >    HAS OBS        CODE           EV (113705, DCM,             1     M                    DCID
             CONTEXT                       “Scope of Accumulation”)                                (10000)
                                                                                                   Scope of
                                                                                                   Accumulati
                                                                                                   on
4       >    HAS            UIDREF         DCID (10001) UID Types       1     M
             PROPERTIES
5       >    CONTAINSs      INCLUDE        Radiopharmaceutical          1
                                           Administration
                                           Accumulated Dose
6       >    CONTAINS       INCLUDE        Radiopharmaceutical          1-n   M
                                           Administration Event
7       >    CONTAINS       TEXT           EV (121106, DCM,             1     U
                                           “Comment”)
Content Item Descriptions

Row 1          Radiopharmaceutical Dose Report. Code needs to be defined. In CT and XRAY this is EV (113701,
               DCM. “X-Ray Radiation Dose Report”)
Row 2          Notes this is a RARD report
Row 3          Scope of Accumulation Study, Series, Performed Step, Irradiation Event, may need new Product
               Administration.
Row 4          Study Instance UID, Series Instance UID, Performed Procedure Step SOP Instance UID, Irradiation
               Event UID
Row 5          Holds accumulated does information in a sequence.


Radiopharmaceutical Administration Accumulated Dose
This general template provides detailed information on radiopharmaceutical dose value
accumulations over multiple administration events over the scope of accumulation specified for
the report (typically a Study or a Performed Procedure Step).


     NL      Rel with        VT              Concept Name               VM    Req     Condition    Value Set
             Parent                                                           Type                 Constraint

1                            CONTAINER       “Accumulated               1     M
                                             Radiopharmaceutical
                                             Administration Dose”
2    >       CONTAINS        NUM             “Total Number of           1     M                    Units = EV


RARD White Paper                                                                                        Page 21
                                          Administration Events”                              ({events}
                                                                                              UCUM,
                                                                                              “events”)
3    >     CONTAINS         NUM           Total Effective Dose     1      M                   Units = EV
                                                                                              (mSv,
                                                                                              UCUM,
                                                                                              “mSv”)
4    >     HAS              CODE          Dose Reference           1      MC                  Product
           PROPERTIES                     Authority                                           Label
5    >     CONTAINS         INCLUDE       Radiopharmaceutical      1-n    U
                                          administration Dose
                                          Exposure per Organ
6    >     CONTAINS         TEXT          EV (121106, DCM,         1      U
                                          “Comment”)
Content Item Descriptions

Row 1        Molecular Imaging Accumulated Dose Container.
Row 2        Total Number of Administration Events.
Row 3        Numa Molecular Imaging Total Effective Dose.
Row 4        Product Label or some other reference.
Row 5        Radiopharmaceutical administration Dose Exposure per Organ


Radiopharmaceutical Administration Event
The Radiopharmaceutical Administration Event conveys the dose and assay and time
information of a single radiopharmaceutical event.

     NL    Rel with         VT          Concept Name               VM     Req    Cond    Value Set Constraint
           Parent                                                         Type   ition

1                           CONTAINER   EV (123001, DCM,           1      M              BCID (25)
                                        “Radiopharmaceutical”)
                                                                                         Radiopharmaceuticals or
                                                                                         BCID (3107) PET
                                                                                         Cardiology
                                                                                         Radiopharmaceuticals or
                                                                                         BCID (3111) Nuclear
                                                                                         Cardiology
                                                                                         Radiopharmaceutical BCID
                                                                                         (4021) PET
                                                                                         Radiopharmaceutical

2    >>    HAS              CODE        EV (G-C0E8, SRT,           1      M              DCID (3629) Procedure
           CONCEPT                      “Has Intent”)                                    Intent
           MOD
3    >     CONTAINS         CODE        EV (G-C032,                1      U              TID 9002
                                        SRT,                                              (0044,0007)
                                        ”Classification”)                                Product Type Code
                                                                                         Sequence
4    >     HAS              TEXT        “Product Package           1      M              (DCM 121148 Unit
           PROPERTIES
                                        Identifier”                                      Serial Identifier)
                                                                                         Identifier of the contrast
                                                                                         agent, drug, or device

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                                                                         being
                                                                         characterized, typically
                                                                         from a package bar
                                                                         code,
                                                                         RFID, or other materials
                                                                         management ID. This ID
                                                                         might not be globally
                                                                         unique and might conflict
                                                                         with other IDs used
                                                                         within the scope of the
                                                                         institution.
5    >   HAS          TEXT        EV (111529, DCM, ”Brand      1     U
         PROPERTIES
                                  Name”)
6    >   CONTAINS     TEXT        EV(???,???, Manufacturer)    1     U   Administration Log IOD
                                                                         (0008,0070)
7    >   HAS          TEXT        EV (121145, DCM,             1     U
         PROPERTIES
                                  "Description of Material")
8    >   HAS          CODE        EV (G-C340, SRT, "Route of   1     M   BCID (11) Route of
         PROPERTIES                                                      Administration
                                  administration")
9    >   HAS          DATETIME    EV (123003, DCM,             1     M
         PROPERTIES
                                  “Radiopharmaceutical
                                  Start
                                  Time”)
10   >   HAS          DATETIME    EV (123004, DCM,             1     U
         PROPERTIES
                                  “Radiopharmaceutical
                                  Stop
                                  Time”)
11   >   CONTAINS     NUMERIC     EV (123006, DCM,             1     M   Units = DT(Bq, UCUM,
                                  “Radionuclide Total                    “Bq”)
                                  Dose”)
12   >   CONTAINS     UIDREF      EV (113769, DCM,             1     M   TID 10003
                                  “Irradiation Event UID”)
13   >   CONTAINS     NUMERIC     EV (123005, DCM,             1     U   Units = DT(cm3, UCUM,
                                  “Radiopharmaceutical                   “cm3”)
                                  Volume”)
14   >   HAS          PNAME       EV (121152, DCM, “Person     1     M
         PROPERTIES
                                  administering
                                  drug/contrast”)
15   >   CONTAINS     CODE        “Dose Type”                  1     U   “Unit Dose,
                                                                         Multidose Vial”
16   >   CONTAINER    CODE        EV (C-B1000, SRT,            1     U   BCID 18 (NM) or 4020
                                  “Diagnostic Radioisotope)              (PET)
17   >   CONTAINS     NUMERIC     Radionuclide Half Life       1     M   Units = (min, UCUM,
                                                                         minute, h, UCUM, hour, d,
                                                                         UCUM, day)
18   >   CONTAINS     NUMERIC     EV (123007, DCM,             1     U   Units = DT(Bq/mol, UCUM,
                                  “Radiopharmaceutical                   “Bq/mol”)
                                  Specific Activity”)
19   >   CONTAINS     CONTAINER   Radioisotope Assay Data      1-n
20   >   CONTAINS     CONTAINER   Radioisotope Attributes      1     U
21   >   CONTAINS     CONTAINER   Radiopharmaceutical          1     U
                                  Quality Control Attributes


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22   >     CONTAINS         CONTAINER     Reagent Kit Attributes        1
23   >     CONTAINS         NUM           Prescribed dosage             1      U                Units = DT(Bq, UCUM,
                                                                                                “Bq”)
24   >     CONTAINS         TEXT          RX Number                     1      U
25   >     CONTAINS         CODE          Substance Administration      1      U                Administration Log
                                          Approval                                              IOD(0044,0002)
26   >     CONTAINS         DATETIME      Administration Approval       1      U                Administration Log IOD
                                          Date Time                                             (0044,0004)
27   >     CONTAINS         TEXT          Approval Status               1      U                Administration Log IOD
                                          Description                                           (0044,0003)
28   >                      TEXT          Comments


Content Item Descriptions

Row 1        Numa Molecular Imaging Dose Event Data Container.
Row 2        Intent of the radiopharmaceutical, Diagnostic Intent, Therapeutic Intent, Combined Diagnostic and
             Therapeutic Procedure
Row 3        No context group is provided for the value set, but it is recommended that values from a standard
             external coding scheme, such as SRT or NDC, be used. Also see (0044,0007) Product Type Code
             Sequence RxNorm based (many radiopharmaceuticals do not have RxNorm)
Row 4        Product Package Identifier. Code needs to be defined. From DICOM Product Characteristics Module
             C.26.1 Identifier of the contrast agent, drug, or device being characterized, typically from a package
             bar code, RFID, or other materials management ID. This ID might not be globally unique and might
             conflict with other IDs used within the scope of the institution.
Row 6        Manufacturer Code needs to be defined From DICOM Product Characteristics Module C.26.1
             Manufacturer of product.
Row 9        Time of radiopharmaceutical administration to the patient for imaging purposes
Row 11       Total amount of radionuclide administered to the patient at Radiopharmaceutical Start Time
             Is a computed field from the assay times, isotope half-life, radiopharmaceutical
Row 12       Unique identification of a single irradiation event. This UID identifies unique and repeatable when
             referencing the radiopharmaceutical administration to this patient.
Row 13       Volume of radiopharmaceutical administered to the patient
Row 15       Identifies the dose type as a unit dose, multi-dose vial, capsule Codes will need to be developed for
             each type
Row 18       Activity per unit mass of the radiopharmaceutical at Radiopharmaceutical Start Time
Row 19       Radioisotope Assay Information
Row 20       Radioisotope Attributes (not defined)
Row 21       Radiopharmaceutical Quality Control Attributes (not defined)
Row 22       Reagent Kit Attributes (not defined)
Row 25       Substance Administration Approval Code needs to be defined. Status of request for substance
             administration. Administration Log IOD(0044,0002)
             Enumerated Values:
             APPROVED – Use of the substance for the patient is approved, with related notes (e.g., appropriate
             dose for age/weight) in Approval Status Further Description (0044,0003)
             WARNING – The substance may be used for the patient subject to warnings described in Approval
             Status Further Description (0044,0003)
             CONTRA_INDICATED – The substance should not be used for the patient for the reasons described
             in Approval Status Further Description (0044,0003)
Row 26       Administration Approval Date Time Code needs to be defined. DICOM SUBSTANCE APPROVAL
             MODULE ATTRIBUTES C.26-2 Timestamp for the Substance Administration Approval response


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Row 27       Approval Status Description. DICOM SUBSTANCE APPROVAL MODULE ATTRIBUTES C.26-2
             Description of warning or contra-indication, or notes on approval.




Substance Administration Approval Code Reference Extension
Coding Scheme Designator        Code Value (0008,0100)                      Code Meaning (0008,0104)
(0008,0102)
99RARDSAS                       99RARDSASAPPROVED                           APPROVED
99RARDSAS                       99RARDSASWARNING                            WARNING
99RARDSAS                       99RARDSAS CONTRA                            CONTRA_INDICATED


Radiopharmaceutical administration Dose Exposure per Organ
This general template provides detailed information on radiopharmaceutical dose value accumulations
per Organ over multiple administration events over the scope of accumulation specified for the report
(typically a Study or a Performed Procedure Step).

     NL    Rel with         VT           Concept Name                  VM     Req    Condition    Value Set
           Parent                                                             Typ                 Constraint
                                                                              e
1                           CONTAINER    "Dose Exposure Per            1      M
                                         Organ”
2    >     CONTAINS         CODE         “Exposure Anatomic            1      M                   DICOM
                                         Region”                                                  Annex I
3    >     CONTAINS         NUMERIC      Region Exposure               1      M                   Units
                                                                                                  =EV(mGy,
                                                                                                  UCUM,
                                                                                                  “mGy”)
4    >     CONTAINS         NUMERIC      Region Exposure               1      U      Not used     Units
                                         Conversion Factor                           for          =EV(mGy/B
                                                                                     accumulat    q, UCUM,
                                                                                     ed dose      “mGy/Bq”)
5    >     CONTAINS         CODE         Dose Reference Authority      1      U                   Product
                                                                                                  Label


Content Item Descriptions

Row 1        Dose Exposure Per Region
Row 2        Exposure Anatomic Region. Codes needs to be defined. DICOM Annex I MIRD Tables organ or
             regions typically reported in Radio Product label have DICOM codes
             SRT T-B3000 Adrenal gland, SRT T-A0100 Brain, SRT T-04000 Breast,T-63000 Gall bladder, SRT T-
             58000 Small intestine, SRT T-57000 Stomach, SRT T-32000 Heart, SRT T-71000 Kidney, SRT T-62002
             Liver, SRT T-28000 Lung, SRT T-13001 Muscle, SRT T-87000 Ovary, SRT T-65000 Pancreas, SRT T-
             C3000 Spleen, SRT T-94000 Testis, SRT T-B6000 Thyroid, SRT T-C8000 Thymus Gland Thymus, SRT T-
             74000 Bladder, SRT T-83000 Uterus

             The follow organ or region without DICOM defined codes. LLI Wall (lower large intestine), ULI (upper
             large intestine) Wall, Red Marrow, Bone Surfaces, Skin.
Row 3        Region Exposure Codes needs to be defined.

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Row 4        Region Exposure Conversion Factor Codes needs to be defined.
Row 5        Radiopharmaceutical label, Oak Ridge Documentation, MIRD


Radioisotope Assay Data Template
     NL    Rel with      VT             Concept Name                 VM     Req    Condition   Value Set
           Parent                                                           Type               Constraint

1                        CODE           "Radioisotope Assay Data"    1      M
2    >     CONTAINS      Numeric         “Dose Assay”                1      M                  Units =
                                                                                               DT(Bq,
                                                                                               UCUM,
                                                                                               “Bq”)
3    >     CONTAINS      DATETIME        “Dose Assay Date Time”      1      M
4    >     CONTAINS      CODE           EV (113854, DCM,             1      M                  EV
                                        “Source of Dose                                        (6862NM2
                                        Information”)                                          00,
                                                                                               LNUMA,
                                                                                               “Dose
                                                                                               Calibrator”)
5    >      CONTAINS      CODE          “Assay Reason”               1      U
6    >      HAS OBS       INCLUDE       Observer                     1-n    M                  DTID(1002)
            CONTEXT                     Context
Content Item Descriptions

Row 1        Radioisotope Assay Data. Code needs to be defined.
Row 2        Dose Measurement Code needs to be defined. Dose Amount Measured
Row 3        Dose Measurement Date Time Code needs to be defined. Dose Measured
Row 4        Source of Dose Information ”Code needs to be defined for Dose Calibrator to DCID (10021)
Row 5        Assay Reason Codes needs to be defined. Measure residual, Normal Dose Assessment, Dose
             Correction, Dose Receipt Activity


Patient Characteristics template
     NL    Rel with      VT             Concept Name                 VM     Req    Condition   Value Set
           Parent                                                           Type               Constraint

1                        CONTAINER      EV (121118, DCM, “Patient    1      M
                                        Characteristics”)
2    >     CONTAINS      CODE           EV (109054, DCM, ”Patient    1      MC     Cardiac     CID 3102
                                        State”)                                    Procedure
3    >     CONTAINS      INCLUDE        DTID (3602)                  1      M
                                        Cardiovascular Patient
                                        Characteristics
4    >     CONTAINS      NUMERIC        “Glucose Level”              1      MC                 Units =
                                                                                               DT(mg/dL,
                                                                                               UCUM,
                                                                                               “mg/dL”)
5    >     CONTAINS      CODE           Glomerular filtration rate   1      U
                                        Sequence
6    >     CONTAINS      DATETIME       Patient Weighed Date         1      U


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                                           Time
7    >       CONTAINS       TEXT           Uptake Location                1         U
8    >       CONTAINS       NUM            Uptake Duration                1         U                 Units =
                                                                                                      DT(min,
                                                                                                      UCUM,”mi
                                                                                                      n”)
9    >       CONTAINS       TEXT           “SRT R-30246 Allergy and       1-n       U
                                           Immunology”
10   >       CONTAINS       INCLUDE        DTID (9002) Medication,        1-n       U
                                           Substance
Content Item Descriptions

Row 2         Stress or Rest
Row 3         Include Patient characteristics even if study is not cardiac
Row 4         Glucose Level is important for PET studies. Provides a mean for the technologist to record the
              glucose level and move the information to the camera.
Row 5         Provides a mean to record the GFR of the patient and communicate the information to the camera.
Row 6         Date time of patient note if patient is from a previous study or is stale. Weight based dosing should
              have current weight.
Row 7         Uptake Location room number or description
Row 8         Number of minute to patient should wait before scanning
Row 9         Allergies List
Row 11        A classification of a medicinal substance.


Glomerular filtration rate
        NL    Rel with       VT               Concept Name                      VM      Req    Condition    Value Set
              Parent                                                                    Type                Constraint

1                            CONTAINER        "Glomerular filtration rate"      1       M
2       >     CONTAINS       NUMERIC          Serum Creatinine Units            1       M                   mg/dL
3       >     CONTAINS       CODE             Traceable to IDMS                 1       U                   YES NO
4       >     CONTAINS       NUMERIC          Glomerular filtration rate        1       M                   Units =
                                                                                                            DT(mL/min/
                                                                                                            1.73m2,
                                                                                                            UCUM,
                                                                                                            “mL/min/1.
                                                                                                            73m2”)
5       >     CONTAINS       CODE             GFR Formula                       1       U                   eCcr,
                                                                                                            MDRD,
                                                                                                            CKD-EPI,
                                                                                                            Mayo
                                                                                                            Quadratic,
                                                                                                            Schwartz
        >     CONTAINS       NUM              EV (121033, DCM, "Subject         1       MC     If not
                                              Age”)                                            recorded
                                                                                               else where
        >     CONTAINS       TEXT             Ethnic Group                      1       MC     If not
                                                                                               recorded
                                                                                               else where
                             CODE             EV (121032, DCM, "Subject                        If not       DCID (7455)
                                              Sex”)                                                         Sex


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                                                                                      recorded
                                                                                      else where


GFR CODES
Coding       Code Value        Code Meaning
Scheme
Designator
99RARDGFR    99RARDGFR-1       Cockcroft-Gault formula (eCcr)
99RARDGFR    99RARDGFR-2       Modification of Diet in Renal Disease (MDRD) formula (eGFR)
99RARDGFR    99RARDGFR-3       CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) formula (eGFR)
99RARDGFR    99RARDGFR-4       Mayo Quadratic formula (eGFR)
99RARDGFR    99RARDGFR-5       Schwartz formula (eGFR) for children



Current published DICOM Codes

Radiopharmaceuticals Context Id 25
CID 25 Radiopharmaceuticals
                                           Context ID 25
                                       Radiopharmaceuticals
                                 Type: Extensible Version: 20110224
   Coding Scheme          Code Value                Code Meaning                      Trade name
     Designator           (0008,0100)                (0008,0104)                    (informative)
     (0008,0102)
         SRT               C-B1302      Carbon^14^ D-xylose
         SRT               C-B1300      Carbon^14^ triolein
         SRT               C-B1304      Cholyl-carbon^14^ glycine
         SRT               C-B1140      Chromic phosphate P^32^
         SRT               C-B1012      Chromium^51^ albumin
         SRT               C-B1013      Chromium^51^ chloride
         SRT               C-B1051      Colloidal gold Au^198^
         SRT               C-B1063      Colloidal Indium^111^
         SRT               C-B1017      Copper^64^ acetate
         SRT               C-B1016      Copper^64^ versenate
         SRT               C-B1018      Copper^67^ ceruloplasmin
         SRT               C-B1021      Cyanocobalamin Co^57^
         SRT               C-B1022      Cyanocobalamin Co^58^
         SRT               C-B1023      Cyanocobalamin Co^60^
         SRT               C-B1000      Diagnostic radioisotope
         SRT               C-B1092      Diiodofluorecein I^131^
         SRT               C-B1062      Disodium indium^111^
         SRT               C-B1122      Ferrous chloride Fe^59^
         SRT               C-B1121      Ferrous citrate Fe^59^


RARD White Paper                                                                                    Page 28
        SRT        C-B1123   Ferrous sulfate Fe^59^
        SRT        C-B1082   Fibrinogen I^123^
        SRT        C-B1031   Fluorodeoxyglucose F^18^
        SRT        C-B1041   Gallium^67^ citrate
        SRT        C-145AB   Indium^111 Capromab Pendetide        Prostascint
        SRT        C-14512   Indium^111 Chloride                  Zevalin
        SRT        C-145AA   Indium^111 Pentetreotide             Octreoscan
        SRT        C-B1061   Indium^111^ pentetate
        SRT        C-B1066   Indium^111^ red cell label
        SRT        C-B1067   Indium^111^ transferrin
        SRT        C-B1065   Indium^111^-Fe(OH)>3<
        SRT        C-B1135   Indium^111^oxyquinoline
        SRT        C-B1068   Indium^113m^ bleomycin
        SRT        C-B1069   Indium^113m^ chloride
        SRT        C-B1072   Indium^113m^ oxoquinoline platelet
                             label
        SRT        C-B1073   Indium^113m^ oxoquinoline RBC
                             label
        SRT        C-B1071   Indium^113m^ oxoquinoline WBC
                             label
        SRT        C-B1070   Indium^113m^ pentetate
        SRT        C-B1084   Iodinated I^125^ albumin
        SRT        C-B1100   Iodinated I^125^ human serum
                             albumin
        SRT        C-B1094   Iodinated I^125^ levothyroxine
        SRT        C-B1093   Iodinated I^125^ oleic acid and
                             triolein
        SRT        C-B1096   Iodinated I^125^ povidone
        SRT        C-B1097   Iodinated I^125^ Rose Bengal
        SRT        C-B1098   Iodinated I^125^ sealed source
        SRT        C-B1099   Iodinated I^125^ sodium iodine
        SRT        C-B1090   Iodinated I^131^ aggregated
                             albumin
        SRT        C-B1089   Iodinated I^131^ albumin
        SRT        C-B1111   Iodinated I^131^ gamma globulin
        SRT        C-114AB   Iodine^123 15-(4-Iodophenyl)-        Cardiodine
                             3(R,S)-Methylpentadecanoic Acid
                             BMIPP
        SRT        C-B110E   Iodine^123 3-Iodobenzylguanidine
                             MIBG
        SRT        C-B112D   Iodine^131 3-Iodobenzylguanidine
                             MIBG
        SRT        C-114B6   Iodine^131 Methylnorcholestenol      Adosterol


RARD White Paper                                                                Page 29
        SRT        C-B1109   Iodine^131^ polyvinylpyrrolidone
        SRT        C-B1087   Iodocholesterol I^131^
        SRT        C-B1095   Iodohippurate I^123^ sodium
        SRT        C-B1105   Iodohippurate I^125^ sodium
        SRT        C-B1091   Iodohippurate I^131^ sodium
        SRT        C-B1108   Iofetamine I^123^ hydrochloride
        SRT        C-B1088   Iothalamate sodium I^125^
        SRT        C-B1124   Iron Fe^59^ labeled dextran
        SRT        C-173A5   Krypton^81m
        SRT        C-B1083   Oleic acid I^125^
        SRT        C-B1251   Pentetate calcium trisodium
                             Yb^169^
        SRT        C-B1151   Potassium carbonate K^42^
        SRT        C-B1152   Potassium chloride K^42^
        SRT        C-B1150   Potassium chloride K^43^
        SRT        C-B1085   Rose Bengal sodium I^131^
        SRT        C-B1172   Selenium^75^ HCAT
        SRT        C-B1171   Selenomethionione Se^75^
        SRT        C-B1176   Sodium chloride Na^22^
        SRT        C-B1175   Sodium chloride Na^24^
        SRT        C-B1011   Sodium chromate Cr^51^
        SRT        C-B1032   Sodium fluoride F^18^
        SRT        C-B1081   Sodium iodide I^123^
        SRT        C-B1086   Sodium iodide I^131^
        SRT        C-B1206   Sodium pertechnetate Tc^99m^
        SRT        C-B1142   Sodium phosphate P^32^
        SRT        C-B1180   Strontium chloride Sr^85^
        SRT        C-B1181   Strontium chloride Sr^87^
        SRT        C-B1182   Strontium nitrate Sr^85^
        SRT        C-B1183   Strontium nitrate Sr^87^
        SRT        C-B1205   Technetium Tc^99c^ albumin
                             microspheres
        SRT        C-B1200   Technetium Tc^99m^ aggregated
                             albumin
        SRT        C-B1204   Technetium Tc^99m^ albumin
                             colloid
        SRT        C-B1133   Technetium Tc^99m^ depreotide
        SRT        C-B1207   Technetium Tc^99m^ disofenin
        SRT        C-B1223   Technetium Tc^99m^ exametazine
        SRT        C-B1210   Technetium Tc^99m^ iron
                             ascorbate
        SRT        C-B1209   Technetium Tc^99m^ lidofenin


RARD White Paper                                                Page 30
        SRT        C-B1208   Technetium Tc^99m^ mebrofenin
        SRT        C-B1212   Technetium Tc^99m^ medronate
        SRT        C-B1203   Technetium Tc^99m^
                             microaggregated albumin
        SRT        C-B1225   Technetium Tc^99m^ N-substituted
                             iminodiacetate
        SRT        C-B1213   Technetium Tc^99m^ oxidronate
        SRT        C-B1214   Technetium Tc^99m^ pentetate
        SRT        C-B1215   Technetium Tc^99m^ pyro and
                             polyphosphates
        SRT        C-B1216   Technetium Tc^99m^ serum
                             albumin
        SRT        C-163AB   Technetium Tc^99m^ sestamibi
        SRT        C-B1220   Technetium Tc^99m^ sodium
                             glucoheptonate
        SRT        C-B1211   Technetium Tc^99m^ stannous
                             etidronate
        SRT        C-B1221   Technetium Tc^99m^ succimer
        SRT        C-B1222   Technetium Tc^99m^ sulfur colloid
        SRT        C-B1224   Technetium Tc^99m^ tagged red
                             cells
        SRT        C-163AC   Technetium Tc^99m^Teboroxime
        SRT        C-163AD   Technetium Tc^99m^Tetrofosmin
        SRT        C-163BD   Technetium^99m                      Kidneyscinti
                             Dimercaptosuccinic Acid DMSA
        SRT        C-163B6   Technetium^99m Galactosyl           Asialoscinti
                             Human Serum Albumin
                             Diethylenetriamine GSA
        SRT        C-163B7   Technetium^99m
                             Hydroxymethylene diphosphonate
                             HMDP
        SRT        C-163B9   Technetium^99m labeled carbon       Technegas
        SRT        C-163B8   Technetium^99m Mercaptoacetyl       MAGscinti
                             triglycine MAG3
        SRT        C-163BA   Technetium^99m N-pyridoxyl-5-       Hepatimage
                             methyltryptophan
        SRT        C-163BB   Technetium^99m Phytate
        SRT        C-163BC   Technetium^99m Stannous Colloid
        SRT        C-B1231   Thallous chloride Tl^201^
        SRT        C-B1010   Therapeutic radioisotope
        SRT        C-B1251   Yb^169^-DTPA - pentetate




RARD White Paper                                                                Page 31
Isotopes in Radiopharmaceuticals CID 18
                                       Context ID 18
                             Isotopes in Radiopharmaceuticals
                            Type: Extensible Version: 20110503
         Coding Scheme     Code Value                      Code Meaning
           Designator      (0008,0100)                      (0008,0104)
           (0008,0102)
              SRT           C-105A2       ^14^Carbon
              SRT           C-111A1       ^18^Fluorine
              SRT           C-155A1       ^22^Sodium
              SRT           C-155A2       ^24^Sodium
              SRT           C-106A1       ^32^Phosphorus
              SRT           C-135A2       ^42^Potassium
              SRT           C-135A3       ^43^Potassium
              SRT           C-129A2       ^51^Chromium
              SRT           C-144A3       ^57^Cobalt
              SRT           C-144A4       ^58^Cobalt
              SRT           C-130A3       ^59^Iron
              SRT           C-144A6       ^60^Cobalt
              SRT           C-127A2       ^64^Copper
              SRT           C-127A3       ^67^Copper
              SRT           C-131A2       ^67^Gallium
              SRT           C-116A3       ^75^Selenium
              SRT           C-173A5       ^81m^Krypton
              SRT           C-173A7       ^85^Krypton
              SRT           C-158A3       ^85^Strontium
              SRT           C-158A5       ^87m^Strontium
              SRT           C-158A6       ^89^Strontium
              SRT           C-162A7       ^90^Yttrium
              SRT           C-163A8       ^99m^Technetium
              SRT           C-145A4       ^111^Indium
              SRT           C-145A5       ^113m^Indium
              SRT           C-114A4       ^123^Iodine
              SRT           C-114A6       ^125^Iodine
              SRT           C-114B1       ^131^Iodine
              SRT           C-122A5       ^133^Barium
              SRT           C-172A8       ^133^Xenon
              SRT           C-178A8       ^153^Gadolinium
              SRT           C-B1134       ^153^Samarium
              SRT           C-181A3       ^169^Ytterbium
              SRT           C-101ED       ^177^Lutetium


RARD White Paper                                                          Page 32
               SRT              C-11906         ^186^Rhenium
               SRT              C-1018D         ^188^Rhenium
               SRT              C-146A9         ^198^Gold
               SRT              C-138A9         ^201^Thallium



PET Cardiology Radiopharmaceuticals CID 3107
                                         Context ID 3107
                              PET Cardiology Radiopharmaceuticals
                          Type: Extensible            Version: 20080927

Coding       Code Value    Code Meaning
Scheme
Designator
SRT          C-B1031       Fluorodeoxyglucose F^18^
SRT          C-107A1       ^13^Nitrogen
SRT          C-159A2       ^82^Rubidium



Nuclear Cardiology Radiopharmaceuticals CID 3111
                                         Context ID 3111
                             Nuclear Cardiology Radiopharmaceuticals
                          Type: Extensible            Version: 20080927

Coding       Code Value Code Meaning
Scheme
Designator
SRT          C-B1130       Thallium-201
SRT          C-B10A2       Tc-99m sestamibi
SRT          C-B10A4       Tc-99m tetrofosmin



PET Radiopharmaceutical CID 4021
                                         Context ID 4021
                                    PET Radiopharmaceutical
                                Type: Extensible Version: 20070625
         Coding Scheme         Code Value                       Code Meaning
           Designator          (0008,0100)                       (0008,0104)
           (0008,0102)
               SRT              C-B1043         Acetate C^11^
               SRT              C-B103C         Ammonia N^13^
               SRT              C-B07DB         ATSM Cu^64^
               SRT              C-B07DC         Butanol O^15^
               SRT              C-B103B         Carbon dioxide O^15^
               SRT              C-B1045         Carbon monoxide C^11^
               SRT              C-B103A         Carbon monoxide O^15^

RARD White Paper                                                               Page 33
              SRT   C-B103F   Carfentanil C^11^
              SRT   C-B07DD   EDTA Ga^68^
              SRT   C-B07DE   Flumazenil C^11^
              SRT   C-B07DF   Flumazenil F^18^
              SRT   C-B07E0   Fluorethyltyrosin F^18^
              SRT   C-B1031   Fluorodeoxyglucose F^18^
              SRT   C-B07E1   Fluoromisonidazole F^18^
              SRT   C-B07E2   Fluoromethane F^18^
              SRT   C-B07E3   Fluorouracil F^18^
              SRT   C-B07E4   Fluorobenzothiazole F^18^
              SRT   C-B1034   Fluoro-L-dopa F^18^
              SRT   C-B1046   Germanium Ge^68^
              SRT   C-B103D   Glutamate N^13^
              SRT   C-B07E5   Mespiperone C^11^
              SRT   C-B103E   Methionine C^11^
              SRT   C-B07E6   Monoclonal antibody I^124^
              SRT   C-B1038   Oxygen O^15^
              SRT   C-B1039   Oxygen-water O^15^
              SRT   C-B1044   Palmitate C^11^
              SRT   C-B07E7   PTSM Cu^62^
              SRT   C-B1042   Raclopride C^11^
              SRT   C-B1037   Rubidium chloride Rb^82^
              SRT   C-B1032   Sodium fluoride F^18^
              SRT   C-B07E8   Sodium iodide I^124^
              SRT   C-B1047   Sodium Na^22^
              SRT   C-B1033   Spiperone F^18^
              SRT   C-B1036   Thymidine (FLT)F^18^




RARD White Paper                                           Page 34

				
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