Extension Modalität PET und Nuklearmedizin
Die Extension PT & NM (PET und Nuklearmedizinische Bildgebung) ermöglicht das Erfassen relevanter DICOM-Tags, um Rückschlüsse über die Bildgewinnung ziehen zu können. Eine Besonderheit der Nuklearmedizin ist die Verwendung eines Radiopharmakons, das aus einem Tracer und einem Radioisotop besteht und somit Stoffwechselbildgebung ermöglicht. Diese Informationen über das Radiopharmakon liegen verschachtelt in dem DICOM-Tag RadiopharmaceuticalInformationSequence (0054,0016) vor, sogenannte nested DICOM-Tags.
Diese nested DICOM-Tags sind:
Radiopharmakon [(0054, 0304) RadiopharmaceuticalCodeSequence]
Applikationsstartzeit [(0018, 1072) RadiopharmaceuticalStartTime]
Halbwertszeit [(0018, 1075) RadionuclideHalfLife] in Sekunden [s]
Gesamte Radionukliddosis [(0018, 1074) RadionuclideTotalDose] in Megabecquerel [MBq] <-Nicht konsistent zwischen PET & Nuklearmedizin und unter Umständen zwischen Standorten. Angaben in MBq sind normalerweise 1- bis 5-stellig. Ist die Angabe um den Faktor 10⁶ höher, also 7- bis 12-stellig, handelt es sich um die Radionuklid-Totaldosis in Bq, und sie muss entsprechend umgerechnet werden.
Nicht nested DICOM-Tags:
ReskalierungsTyp [(0028,1054) RescaleType]
Beispiel des Zugriffs auf ein nested DICOM-Tag mit Python aus einer DICOM-Schicht(Instanz):
RadiopharmaceuticalStartTime = layer['RadiopharmaceuticalInformationSequence'][0]['RadiopharmaceuticalStartTime'].value
| Name | Status | Version | Canonical | Basis |
|---|---|---|---|---|
| MII_EX_Bildgebung_Modalitaet_PT_NM | active | 2025.0.0-ballot | https://www.medizininformatik-initiative.de/fhir/ext/modul-bildgebung/StructureDefinition/mii-ex-bildgebung-modalitaet-pt-nm | http://hl7.org/fhir/StructureDefinition/Extension |
Inhalt
| MII_EX_Bildgebung_Modalitaet_PT_NM (Extension) | I | Extension | |
| id | 0..1 | string | |
| extension | I | 0..* | Extension |
| radiopharmaceutical | S I | 0..1 | Extension |
| id | 0..1 | string | |
| extension | I | 0..0 | Extension |
| url | 1..1 | uriFixed Value | |
| value[x] | 0..1 | Binding | |
| valueCodeableConcept | CodeableConcept | ||
| id | 0..1 | string | |
| extension | I | 0..* | Extension |
| coding | Σ | 0..* | Coding |
| text | S Σ | 0..1 | string |
| radiopharmaceuticalStartTime | S I | 0..1 | Extension |
| id | 0..1 | string | |
| extension | I | 0..0 | Extension |
| url | 1..1 | uriFixed Value | |
| value[x] | 0..1 | ||
| valueDateTime | dateTime | ||
| rescaleType | S I | 0..1 | Extension |
| id | 0..1 | string | |
| extension | I | 0..0 | Extension |
| url | 1..1 | uriFixed Value | |
| value[x] | 0..1 | ||
| valueString | string | ||
| radionuclideTotalDose | S I | 0..1 | Extension |
| id | 0..1 | string | |
| extension | I | 0..0 | Extension |
| url | 1..1 | uriFixed Value | |
| value[x] | I | 0..1 | |
| valueQuantity | SimpleQuantity | ||
| id | 0..1 | string | |
| extension | I | 0..* | Extension |
| value | Σ | 0..1 | decimal |
| comparator | Σ ?! | 0..0 | codeBinding |
| unit | Σ | 0..1 | stringPattern |
| system | Σ I | 0..1 | uriPattern |
| code | Σ | 0..1 | codePattern |
| radionuclideHalfLife | S I | 0..1 | Extension |
| id | 0..1 | string | |
| extension | I | 0..0 | Extension |
| url | 1..1 | uriFixed Value | |
| value[x] | I | 0..1 | |
| valueQuantity | SimpleQuantity | ||
| id | 0..1 | string | |
| extension | I | 0..* | Extension |
| value | Σ | 0..1 | decimal |
| comparator | Σ ?! | 0..0 | codeBinding |
| unit | Σ | 0..1 | stringPattern |
| system | Σ I | 0..1 | uriPattern |
| code | Σ | 0..1 | codePattern |
| url | 1..1 | uriFixed Value | |
| value[x] | 0..0 |
Die Extension ermöglicht es die Ressourcen und Machbarkeitsanalysen auf PT & NM Daten zu erweitern. |
| Feldname |
|---|
| Extension.extension:radiopharmaceutical |
| Extension.extension:radiopharmaceutical.value[x].text |
| Extension.extension:radiopharmaceuticalStartTime |
| Extension.extension:rescaleType |
| Extension.extension:radionuclideTotalDose |
| Extension.extension:radionuclideHalfLife |
<StructureDefinition xmlns="http://hl7.org/fhir"> <id value="mii-ex-bildgebung-modalitaet-pt-nm" /> <url value="https://www.medizininformatik-initiative.de/fhir/ext/modul-bildgebung/StructureDefinition/mii-ex-bildgebung-modalitaet-pt-nm" /> <version value="2025.0.0-ballot" /> <name value="MII_EX_Bildgebung_Modalitaet_PT_NM"> <extension url="http://hl7.org/fhir/StructureDefinition/translation"> <extension url="lang"> <valueCode value="en-US" /> </extension> <extension url="content"> <valueString value="MII_EX_Imaging_Modality_PT_NM" /> </extension> </extension> </name> <title value="MII EX Bildgebung Modalität PT/NM"> <extension url="http://hl7.org/fhir/StructureDefinition/translation"> <extension url="lang"> <valueCode value="en-US" /> </extension> <extension url="content"> <valueString value="MII EX Imaging Modality PT/NM" /> </extension> </extension> </title> <status value="active" /> <experimental value="false" /> <publisher value="Medizininformatik Initiative" /> <contact> <telecom> <system value="url" /> <value value="https://www.medizininformatik-initiative.de" /> </telecom> </contact> <description value="Die Extension ermöglicht es die Ressourcen und Machbarkeitsanalysen auf PT & NM Daten zu erweitern."> <extension url="http://hl7.org/fhir/StructureDefinition/translation"> <extension url="lang"> <valueCode value="en-US" /> </extension> <extension url="content"> <valueString value="The extension allows to extend the resources and feasibility analysis to PT & NM data." /> </extension> </extension> </description> <fhirVersion value="4.0.1" /> <kind value="complex-type" /> <abstract value="false" /> <context> <type value="element" /> <expression value="ImagingStudy.Series" /> </context> <type value="Extension" /> <baseDefinition value="http://hl7.org/fhir/StructureDefinition/Extension" /> <derivation value="constraint" /> <differential> <element id="Extension.extension:radiopharmaceutical"> <path value="Extension.extension" /> <sliceName value="radiopharmaceutical" /> <min value="0" /> <max value="1" /> <mustSupport value="true" /> </element> <element id="Extension.extension:radiopharmaceutical.extension"> <path value="Extension.extension.extension" /> <max value="0" /> </element> <element id="Extension.extension:radiopharmaceutical.url"> <path value="Extension.extension.url" /> <fixedUri value="radiopharmaceutical" /> </element> <element id="Extension.extension:radiopharmaceutical.value[x]"> <path value="Extension.extension.value[x]" /> <type> <code value="CodeableConcept" /> </type> <binding> <strength value="extensible" /> <valueSet value="https://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_25.html" /> </binding> </element> <element id="Extension.extension:radiopharmaceutical.value[x].text"> <path value="Extension.extension.value[x].text" /> <mustSupport value="true" /> </element> <element id="Extension.extension:radiopharmaceuticalStartTime"> <path value="Extension.extension" /> <sliceName value="radiopharmaceuticalStartTime" /> <min value="0" /> <max value="1" /> <mustSupport value="true" /> </element> <element id="Extension.extension:radiopharmaceuticalStartTime.extension"> <path value="Extension.extension.extension" /> <max value="0" /> </element> <element id="Extension.extension:radiopharmaceuticalStartTime.url"> <path value="Extension.extension.url" /> <fixedUri value="radiopharmaceuticalStartTime" /> </element> <element id="Extension.extension:radiopharmaceuticalStartTime.value[x]"> <path value="Extension.extension.value[x]" /> <type> <code value="dateTime" /> </type> </element> <element id="Extension.extension:rescaleType"> <path value="Extension.extension" /> <sliceName value="rescaleType" /> <min value="0" /> <max value="1" /> <mustSupport value="true" /> </element> <element id="Extension.extension:rescaleType.extension"> <path value="Extension.extension.extension" /> <max value="0" /> </element> <element id="Extension.extension:rescaleType.url"> <path value="Extension.extension.url" /> <fixedUri value="rescaleType" /> </element> <element id="Extension.extension:rescaleType.value[x]"> <path value="Extension.extension.value[x]" /> <type> <code value="string" /> </type> </element> <element id="Extension.extension:radionuclideTotalDose"> <path value="Extension.extension" /> <sliceName value="radionuclideTotalDose" /> <min value="0" /> <max value="1" /> <mustSupport value="true" /> </element> <element id="Extension.extension:radionuclideTotalDose.extension"> <path value="Extension.extension.extension" /> <max value="0" /> </element> <element id="Extension.extension:radionuclideTotalDose.url"> <path value="Extension.extension.url" /> <fixedUri value="radionuclideTotalDose" /> </element> <element id="Extension.extension:radionuclideTotalDose.value[x]"> <path value="Extension.extension.value[x]" /> <type> <code value="Quantity" /> <profile value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity" /> </type> </element> <element id="Extension.extension:radionuclideTotalDose.value[x].unit"> <path value="Extension.extension.value[x].unit" /> <patternString value="Megabecquerel" /> </element> <element id="Extension.extension:radionuclideTotalDose.value[x].system"> <path value="Extension.extension.value[x].system" /> <patternUri value="http://unitsofmeasure.org" /> </element> <element id="Extension.extension:radionuclideTotalDose.value[x].code"> <path value="Extension.extension.value[x].code" /> <patternCode value="MBq" /> </element> <element id="Extension.extension:radionuclideHalfLife"> <path value="Extension.extension" /> <sliceName value="radionuclideHalfLife" /> <min value="0" /> <max value="1" /> <mustSupport value="true" /> </element> <element id="Extension.extension:radionuclideHalfLife.extension"> <path value="Extension.extension.extension" /> <max value="0" /> </element> <element id="Extension.extension:radionuclideHalfLife.url"> <path value="Extension.extension.url" /> <fixedUri value="radionuclideHalfLife" /> </element> <element id="Extension.extension:radionuclideHalfLife.value[x]"> <path value="Extension.extension.value[x]" /> <type> <code value="Quantity" /> <profile value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity" /> </type> </element> <element id="Extension.extension:radionuclideHalfLife.value[x].unit"> <path value="Extension.extension.value[x].unit" /> <patternString value="Seconds" /> </element> <element id="Extension.extension:radionuclideHalfLife.value[x].system"> <path value="Extension.extension.value[x].system" /> <patternUri value="http://unitsofmeasure.org" /> </element> <element id="Extension.extension:radionuclideHalfLife.value[x].code"> <path value="Extension.extension.value[x].code" /> <patternCode value="s" /> </element> <element id="Extension.url"> <path value="Extension.url" /> <fixedUri value="https://www.medizininformatik-initiative.de/fhir/ext/modul-bildgebung/StructureDefinition/mii-ex-bildgebung-modalitaet-pt-nm" /> </element> <element id="Extension.value[x]"> <path value="Extension.value[x]" /> <max value="0" /> </element> </differential> </StructureDefinition>
{ "resourceType": "StructureDefinition", "id": "mii-ex-bildgebung-modalitaet-pt-nm", "url": "https://www.medizininformatik-initiative.de/fhir/ext/modul-bildgebung/StructureDefinition/mii-ex-bildgebung-modalitaet-pt-nm", "version": "2025.0.0-ballot", "name": "MII_EX_Bildgebung_Modalitaet_PT_NM", "_name": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "en-US" }, { "url": "content", "valueString": "MII_EX_Imaging_Modality_PT_NM" } ] } ] }, "title": "MII EX Bildgebung Modalität PT/NM", "_title": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "en-US" }, { "url": "content", "valueString": "MII EX Imaging Modality PT/NM" } ] } ] }, "status": "active", "experimental": false, "publisher": "Medizininformatik Initiative", "contact": [ { "telecom": [ { "system": "url", "value": "https://www.medizininformatik-initiative.de" } ] } ], "description": "Die Extension ermöglicht es die Ressourcen und Machbarkeitsanalysen auf PT & NM Daten zu erweitern.", "_description": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "en-US" }, { "url": "content", "valueString": "The extension allows to extend the resources and feasibility analysis to PT & NM data." } ] } ] }, "fhirVersion": "4.0.1", "kind": "complex-type", "abstract": false, "context": [ { "type": "element", "expression": "ImagingStudy.Series" } ], "type": "Extension", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Extension", "derivation": "constraint", "differential": { "element": [ { "id": "Extension.extension:radiopharmaceutical", "path": "Extension.extension", "sliceName": "radiopharmaceutical", "min": 0, "max": "1", "mustSupport": true }, { "id": "Extension.extension:radiopharmaceutical.extension", "path": "Extension.extension.extension", "max": "0" }, { "id": "Extension.extension:radiopharmaceutical.url", "path": "Extension.extension.url", "fixedUri": "radiopharmaceutical" }, { "id": "Extension.extension:radiopharmaceutical.value[x]", "path": "Extension.extension.value[x]", "type": [ { "code": "CodeableConcept" } ], "binding": { "strength": "extensible", "valueSet": "https://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_25.html" } }, { "id": "Extension.extension:radiopharmaceutical.value[x].text", "path": "Extension.extension.value[x].text", "mustSupport": true }, { "id": "Extension.extension:radiopharmaceuticalStartTime", "path": "Extension.extension", "sliceName": "radiopharmaceuticalStartTime", "min": 0, "max": "1", "mustSupport": true }, { "id": "Extension.extension:radiopharmaceuticalStartTime.extension", "path": "Extension.extension.extension", "max": "0" }, { "id": "Extension.extension:radiopharmaceuticalStartTime.url", "path": "Extension.extension.url", "fixedUri": "radiopharmaceuticalStartTime" }, { "id": "Extension.extension:radiopharmaceuticalStartTime.value[x]", "path": "Extension.extension.value[x]", "type": [ { "code": "dateTime" } ] }, { "id": "Extension.extension:rescaleType", "path": "Extension.extension", "sliceName": "rescaleType", "min": 0, "max": "1", "mustSupport": true }, { "id": "Extension.extension:rescaleType.extension", "path": "Extension.extension.extension", "max": "0" }, { "id": "Extension.extension:rescaleType.url", "path": "Extension.extension.url", "fixedUri": "rescaleType" }, { "id": "Extension.extension:rescaleType.value[x]", "path": "Extension.extension.value[x]", "type": [ { "code": "string" } ] }, { "id": "Extension.extension:radionuclideTotalDose", "path": "Extension.extension", "sliceName": "radionuclideTotalDose", "min": 0, "max": "1", "mustSupport": true }, { "id": "Extension.extension:radionuclideTotalDose.extension", "path": "Extension.extension.extension", "max": "0" }, { "id": "Extension.extension:radionuclideTotalDose.url", "path": "Extension.extension.url", "fixedUri": "radionuclideTotalDose" }, { "id": "Extension.extension:radionuclideTotalDose.value[x]", "path": "Extension.extension.value[x]", "type": [ { "code": "Quantity", "profile": [ "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" ] } ] }, { "id": "Extension.extension:radionuclideTotalDose.value[x].unit", "path": "Extension.extension.value[x].unit", "patternString": "Megabecquerel" }, { "id": "Extension.extension:radionuclideTotalDose.value[x].system", "path": "Extension.extension.value[x].system", "patternUri": "http://unitsofmeasure.org" }, { "id": "Extension.extension:radionuclideTotalDose.value[x].code", "path": "Extension.extension.value[x].code", "patternCode": "MBq" }, { "id": "Extension.extension:radionuclideHalfLife", "path": "Extension.extension", "sliceName": "radionuclideHalfLife", "min": 0, "max": "1", "mustSupport": true }, { "id": "Extension.extension:radionuclideHalfLife.extension", "path": "Extension.extension.extension", "max": "0" }, { "id": "Extension.extension:radionuclideHalfLife.url", "path": "Extension.extension.url", "fixedUri": "radionuclideHalfLife" }, { "id": "Extension.extension:radionuclideHalfLife.value[x]", "path": "Extension.extension.value[x]", "type": [ { "code": "Quantity", "profile": [ "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" ] } ] }, { "id": "Extension.extension:radionuclideHalfLife.value[x].unit", "path": "Extension.extension.value[x].unit", "patternString": "Seconds" }, { "id": "Extension.extension:radionuclideHalfLife.value[x].system", "path": "Extension.extension.value[x].system", "patternUri": "http://unitsofmeasure.org" }, { "id": "Extension.extension:radionuclideHalfLife.value[x].code", "path": "Extension.extension.value[x].code", "patternCode": "s" }, { "id": "Extension.url", "path": "Extension.url", "fixedUri": "https://www.medizininformatik-initiative.de/fhir/ext/modul-bildgebung/StructureDefinition/mii-ex-bildgebung-modalitaet-pt-nm" }, { "id": "Extension.value[x]", "path": "Extension.value[x]", "max": "0" } ] } }
Beispiele
| Hinweis | |
|---|---|
|
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Aus Gründen der Übersichtlichkeit wurde in diesem Beispiel darauf verzichtet, alle dazugehörigen Serien bzw. Instanzen mit einzubinden. Natürlich ist es bei der Implkementierung vorgesehen, dass alle zur jeweiligen Studie gehörenden Serien und Instanzen auch in der resultierenden FHIR-Ressource enthalten sind - dafür wird dann einfach die Sequenz "series" bzw "instance" für jede Serie bzw. Instanz wiederholt und mit den entsprechenden Werten befüllt. |
Beispiel einer ImagingStudy-Ressource mit der Extension für PET Metadaten inkl. der modalitätsunabhängigen Extensions für Kontrastmittel, Instanzdetails und Gerätehersteller:
{ "resourceType": "ImagingStudy", "id": "mii-exa-bildgebung-bildgebungsstudie-pt", "meta": { "profile": [ "https://www.medizininformatik-initiative.de/fhir/ext/modul-bildgebung/StructureDefinition/mii-pr-bildgebung-bildgebungsstudie" ] }, "extension": [ { "url": "https://www.medizininformatik-initiative.de/fhir/ext/modul-bildgebung/StructureDefinition/mii-ex-bildgebung-bildgebungsgrund", "valueString": "Verdacht auf Karzinom" } ], "series": [ { "extension": [ { "extension": [ { "url": "radiopharmaceutical", "valueCodeableConcept": { "coding": [ { "code": "35321007", "system": "http://snomed.info/sct", "display": "Fluorodeoxyglucose (18-F) (substance)" } ] } }, { "url": "radiopharmaceuticalStartTime", "valueDateTime": "2024-07-19T12:03:30+02:00" }, { "url": "rescaleType", "valueString": "BQML" }, { "valueQuantity": { "unit": "Megabecquerel", "value": 196 }, "url": "radionuclideTotalDose" }, { "valueQuantity": { "unit": "Seconds", "value": 6586.2 }, "url": "radionuclideHalfLife" } ], "url": "https://www.medizininformatik-initiative.de/fhir/ext/modul-bildgebung/StructureDefinition/mii-ex-bildgebung-modalitaet-pt-nm" }, { "extension": [ { "url": "manufacturer", "valueString": "Beispielhersteller" }, { "url": "manufacturerModelName", "valueString": "Beispielmodell" } ], "url": "https://www.medizininformatik-initiative.de/fhir/ext/modul-bildgebung/StructureDefinition/mii-ex-bildgebung-geraet-hersteller" } ], "instance": [ { "extension": [ { "extension": [ { "valueQuantity": { "unit": "millimeter", "value": 2.89 }, "url": "pixelSpacingX" }, { "valueQuantity": { "unit": "millimeter", "value": 2.89 }, "url": "pixelSpacingY" }, { "valueQuantity": { "unit": "millimeter", "value": 4 }, "url": "sliceThickness" }, { "url": "imageType", "valueString": "['ORIGINAL', 'PRIMARY']" } ], "url": "https://www.medizininformatik-initiative.de/fhir/ext/modul-bildgebung/StructureDefinition/mii-ex-bildgebung-instanz-details" } ], "uid": "instance-example-uid", "sopClass": { "code": "urn:oid:1.2.840.10008.5.1.4.1.1.128", "system": "urn:ietf:rfc:3986" }, "number": 31 } ], "uid": "series-example-uid", "number": 1, "modality": { "code": "PT", "system": "http://dicom.nema.org/resources/ontology/DCM", "display": "Positron emission tomography" }, "description": "PET WB", "numberOfInstances": 195, "bodySite": { "code": "51185008", "system": "http://snomed.info/sct", "display": "Thoracic structure (body structure)" }, "laterality": { "code": "66459002", "system": "http://snomed.info/sct", "display": "Unilateral" }, "started": "2024-07-19T12:03:30+02:00" } ], "status": "available", "modality": [ { "code": "PT", "system": "http://dicom.nema.org/resources/ontology/DCM", "display": "Positron emission tomography" } ], "subject": { "reference": "Patient/PatExample", "identifier": { "type": { "coding": [ { "code": "MR", "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "display": "Medical record number" } ] }, "system": "https://system-url", "value": "study-uid" } }, "encounter": { "reference": "Encounter/EncExample" }, "basedOn": [ { "reference": "ServiceRequest/mii-exa-bildgebung-anforderung-bildgebung" } ], "numberOfSeries": 2, "numberOfInstances": 390, "procedureReference": { "reference": "Procedure/mii-exa-bildgebung-bildgebungsprozedur" }, "reasonReference": [ { "reference": "Condition/CondExample" } ], "description": "whole body aquisition" }