Since the first upload of “OBSERVATION.imaging.exam” in 2013, there has been work on one or several archetypes to cater for findings during radiological examinations. The work has been done by several people and at several occations until now. The pattern of physical examination archetypes has now been used as a pattern for imaging, and three archetypes were sent for review in March 2022. Those were
The latter has been rejected due to it seemed to cause more confusion than it solved and there is no practical use case. It is rejected for now to discourage active use until a practical use case can be identified and the role of this archetype clarified in relation to the other two.
The other two had final overall comments as “Minor Revision” or “Accept”. There has been done major changes in wording to add clarity plus to allign with physical examination archetypes and laboratory archetypes. Some elements has changed name, but no change in meaning. No elements removed. Occurences changed to 0…* for ‘Overall result status’, ‘Modality’ and ‘Comparisation study detail’ Cluster in the OBSERVATION.
Please see the archetypes for yourself, including review and editor feedback:
OBSERVATION.imaging_exam_result: Clinical Knowledge Manager
CLUSTER.imaging_exam: Clinical Knowledge Manager
The archetypes will be published 16th of May, 2022 if no objections are made.
For the Norwegian archetype team and Heather Leslie,
Nice progress! Regarding texts like ”The result of an imaging examination performed on an individual, using radiological techniques” in both archetypes - perhaps it should be changed to something like “The result of an imaging examination performed on an individual, using radiological and other image generating techniques” since I do not believe ultrasound is included in “radiology” in all contexts.
Also, in then CLUSTER archetype’s “Additional details” slot it would be useful to include e.g. distance and area measurements so that it can be used in imaging examinations such as Echocardiography. Adding openEHR-EHR-CLUSTER.specimen_measurements.v1 would work since it contains many of the needed fields or perhaps another “measurements” CLUSTER archetype needs to be created for imaging techniques? I believe “flow” is an additional measurement used in e.g. ultrasound and MRI.
Perhaps such a new CLUSTER archetype could also be used directly im the OBSERVATION’s “Structured imaging findings” slot.
See also: Echocardiography - Change of "Imaging result" CLUSTER archetype? Reuse lab analyte design pattern for nested/repeated clusters? - #3 by erik.sundvall
In this context, it is intended to be about all of radiology. In my experience it is an umbrella term for all imaging modalities eg Wikipedia ( ) describes it thus:
Radiology is the medical discipline that uses medical imaging to diagnose diseases and guide their treatment, within the bodies of humans and other animals. It began with radiography (which is why its name has a root referring to radiation), but today it includes all imaging modalities, including those that use no electromagnetic radiation (such as ultrasonography and magnetic resonance imaging), as well as others that do, such as computed tomography (CT), fluoroscopy, and nuclear medicine including positron emission tomography (PET).
Naming/describing this whole concept has not been easy:
- It is not always diagnostic
- It is not always about testing
- It is not about photography or other imaging
- It is not about physical examination…
The modelling of measurements has been changed in the past few years. The generic measurements related archetypes have been deprecated in favour of specific measurements being included in relevant archetypes. The standalone CLUSTER.specimen_measurements is a bit of a red herring as far as the patterns are concerned, but still is a representation of this modelling approach - it has been separated out into its own CLUSTER, not to reuse a generic set of measurement attributes but to reuse the unique way we model the measurement requirements for a specimen across a number of relevant archetypes, eg unnamed 3 dimensions (a x b x c) without specifying an axis, longest axis etc, and which are not relevant to most other measurement documentation in health records.
In the specialised imaging examination CLUSTERs you will find common, relevant measurements included inline. It is anticipated that the details of these specialisations will grow over time, as requirements are identified. If Doppler flow rate or other modality-specific findings are required, it is intended that they will be added to the maximal data set for the relevant body region or structure, so that we can use the same archetype for any type of imaging modality.
If you have measurement requirements for echocardiography, then at this point I would assume that they would all be included in the currently imaginary CLUSTER.imaging_exam_heart - as the diameter of each valve will need to be recorded, no matter what the modality used to image the heart. Flow related attributes will need to be templated out for a plain chest Xray and as new technologies are added, the same archetype can be used and enhanced, rather than creating a new archetype per modality.
This is the same pattern intended for all of physical examination, with only the context-appropriate measurements inline, growing over time as the requirements are identified.