Radiology response prostate

(1) Present updates based on updates based on Olhas input

(2) Discuss status changes in anomaly and physical properties archetype

(3) Discuss status changes in anomaly archetype

(4) Discuss modelling of other findings - see Claudias proposal i AD

(5) continue discussion on unique identifier for findings, instead of just a serial number for instance for incidental findings but even for anomaly findings in prostate

(6) Present change in handling quality issues

May 27, 2025

Sweden

@Claudia Ehrentraut

@Manna Vosta

Gustaf Claesson

Switzerland (Basel)

@Simon Egli

Norway

@Bjørn Næss

(1) Discuss pathology use case for anatomical location

Gustaf, who works together with @Linda Aulin Lundeqvist in order to model information that needs to be documented for a prostate biopsy, joined in order to present how they intend to use anatomical location in order to capture from which sectors the biopsy was taken, i.e.

• use “Body site name” to capture Snomed CT code for prostate (since it’s a mandatory attribute) and then

• use “Specific site” in order to capture all sectors from which biopsy was taken.

This would however conflict with how we intend to use anatomical location for radiology, i.e.,

• rename “Body site name” to “Main sector” and then use it to capture the main sector where the lesion is found

• use “Specific site” in order to capture all sectors where lesion can be found

Open

Open

During the meeting we discussed some of the different alternatives on how to align the usage of anatomical location:

1. Create a separate prostate specific CLUSTER archetype for prostate sector (similar would have to be done for prostate zone in order to align these two) which would contain attributes for body site name, sector and main sector (where body site name is set to 1..1, sector/zone 0..* och main sector/zone 0..1)

   1. Open

      

       

2. Create specialization of Anatomical location archetype and add 0..1 attribut “Main specific site”

   1. Open

      

       

3. Update Anatomical location archetype and add 0..1 attribut “Main specific site”

   1. Same as for specialization

4. Create new general archetype (similar to circular, precise and relative anatomical location) just for subdivision of a body structure into an area of some kind (sector, section, zone etc) and add attributes for body site name, area and main area (where body site name is set to 1..1, area 0..* och main area 0..1)

   1. Open

      

       

5. Use anatomical location slightly different for pathology and radiology

6. Use anatomical location two times, once where specific site is used to capture all sectors and once where specific site is used to capture the main sector, distinction is made by renaming anatomical location in the template. (Same would have to be done for zone)

   1. Open

      

Bjørn mentions that similar has been discussed in Norway and can be found in modelling-sjk/local at main · bjornna/modelling-sjk

May 9, 2025

Sweden

@Claudia Ehrentraut

@Manna Vosta

Switzerland (Basel)

@Olha Nikolaieva

Norway

@LivL

@Vebjørn Arntzen

(0) Changes in AD regarding template and archetypes

(1) Clarification if physical properties is going to replace specimen measurement archetype, in that case the concept description of physical properties needs to be updated to include fluids

(2) Info regarding first test on creating form based on template

(3) Discuss modelling of amount - see Mannas and Claudias proposal i AD

(4) Discuss modelling of other findings - see Claudias proposal i AD

(5) Discuss Olhas input

(6) continue discussion on unique identifier for findings, instead of just a serial number for instance for incidental findings but even for anomaly findings in prostate

(7) Present change in handling quality issues

(0) Changes in AD regarding template and archetypes

• Claudia gives a brief summary of what has changed in regionstockholm/CKM-mirror-via-modellbibliotek at prostate-cancer-radiology, i.e., old archetypes that were created for prostate cancer template were deleted and the names or remaining archetypes changed, i.e. numbers were removed since not needed anymore

• Even template will change name, i.e. 3 will be removed from name

(1) Clarification if physical properties is going to replace specimen measurement archetype, in that case the concept description of physical properties needs to be updated to include fluids

• Physical properties will replace specimen measurement- archetype

• Physical properties will probably change name.

• Vedbjörn invited Manna to review of physical properties in order to give feedback on fluids

 (2) Info regarding first test on creating form based on template

• Claudia and Manna have tested to create form from template, revealed among other missing units in templates and and value sets. Template will be updated and further test with creating forms will be made

• Input från Olha to save composition based on form, usually reveals errors in templates.

(3) Discuss modelling of amount - see Mannas and Claudias proposal i AD

• Looked at proposal for amount and group thinks it looks good

• Olha has also heard about the need,

• Idea to put information on discourse and describe the problem it trys to solve, amount is very unspecific

 (4) - (7) were not discussed

Other

 Discussed to make change request for anomaly

Open

Apr 25, 2025

Sweden

@Claudia Ehrentraut

@Manna Vosta

Switzerland (Basel)

@Simon Egli

Norway

@LivL

@Vebjørn Arntzen

(1) Continue discussion on incidental findings

• if possible look at form

• continue discussion on

  unique identifier for findings, instead of just a serial number for instance for incidental findings but even for anomaly findings in prostate

(2) How to handle quality issues

(3) Is there a “general” cluster archetype that can be used for capturing amount (similar to the physical properties archetype but where you can document a number)?
In order to for instance capture the number of metastases in the brain detected by imaging examination or the total amount of examined lesions in the prostate

Couldn’t find an attribute in “imaging examination of...” where one can document the amount...

Status Physical properties archetype

• Review is ongoing, comments need to be handled, shouldn’t be too much discussion – as soon as possible it will be discussed

Status anomaly archetype

• not done yet, still unclear when first version will be available

• usage of version 0 archetypes

  • if on wants to use a v0 archetype, add something like _swe.v1 (better studio probably doesn’t allow to use a v0 archetype in template when creating form), or see screenshot below

    • Open

      

  • this is according to information on Archetype content & style guide - openEHR Clinical - Confluence (see screenshot below for relevant part)

    • Open

      

(1) Continue discussion on incidental findings

• there hasn’t been the time to create the form yet, postponed to next meeting

• we discussed unique identifiers a little bit in combination with (3) but needs more discussion

(2) How to handle quality issues

• Postponed to next meeting

(3) Is there a “general” cluster archetype that can be used for capturing amount

• There is no cluster

• Try to create a cluster for counts with

  • total number, e.g., 5

  • specific number, e.g., 1 (of 5), 2 (of 5) …

• Try to have unique identifier for lesion under label

Apr 4, 2025

Sweden

@Claudia Ehrentraut

@Manna Vosta

Switzerland (Basel)

@Olha Nikolaieva

@Simon Egli

Norway

@LivL

@Vebjørn Arntzen

How to handle incidental findings

• Liv mentions that Physical properties archetype is on review: Clinical Knowledge Manager. Archetype can be put under Physical properties slot or additional details slot

• Short discussion on anomaly archetype, Clinical Knowledge Manager. Work is still ongoing (some changes have been made, i.e. move dimension to physical properties archetype and add slot physical properties). Will take a while before its done but Norway is using the archetype as is in lack of a better alternative

• According to Vebjørn it is a pragmatic way to use imaging examination of body structure archetype instead of specialization for prostate since we add everything via clusters.

• Discussion on how to handle incidental findings

  • Claudia presents what needs to be captured:

    • Open

      
    • Open

      

  • Discussed to used anomaly archetype to capture this information

    • Vebjørn mentions that there has been discussions on what incidental findings are, and one definition was that it is something “that was not in the referral or not ordered” and that it’s intented to be used for unexpected findings

    • One idea is to set body site to pelvis and label to serial number and the type of the incidental finding under type. Opens up to capture that we don’t know which other incidental findings that need to be handled. We can then use several instances of that cluster in the form. Another idea is to have several instances of the cluster in the template and set body site to bladder, rectum etc

      • Discussion on whether to use local coding or try to map codes to Snomed CT. Found Snomed CT codes for “Tumor-suspicious change in the bladder” and “Previous operation with inguinal hernia mesh”

      • Discussion on whether we should have a unique identifier for the findings, instead of just a serial number.

    • Open

      

       

Mar 21, 2025

Sweden

@Claudia Ehrentraut

@Manna Vosta

Switzerland (Basel)

@Olha Nikolaieva

@Simon Egli

Norway

@Bjørn Næss

@LivL

Questions about measurement archetype

How to handle findings i lymph nodes and bone marrow and incidental findings

Questions about measurement archetype

• Seems that Physical properties is not a new archetype but a new version of existing openEHR-EHR-CLUSTER.specimen_measurements.v1.adl, i.e. Specimen measurements. When trying to import the Physical properties archetype into our GitHub-branch (see error message below, seems it’s due to the fact that the branch already contains version 1.0 of the specimen measurement archetype). Shouldn’t the Physical properties archetype be it’s own archetype, since the name has changed, instead of a new version of the Specimen measurement archetype

  • Open

    

• Answer from Liv

  • Yes, the Physical properties archetype is supposed to become it’s own archetype

  • But, there is another archetype with the name physical property so they cannot use the name for the new archetype, hopefully this will resolve within the near future

How to handle findings i lymph nodes and bone marrow and incidental findings

• Claudia presents information specification which describes which information needs to be captured in the radiology report for MR prostate in Sweden

• Discussion on lymph nodes

  • The idea is to capture information using the Specialization Imaging examination of a lymph node

  • Input by Liv: this archetype is not reviewed yet, it might be better to use Imaging examination of a body structure instead for lymph node specialization archetype

• Discussion on bone marraw changes

  • The idea is to capture information on bone marrow using the Imaging examination of a body structure archetype and then using Imaging examination of an anomaly the in order to capture information on the changes

  • Input Liv, Bjørn, Olha:

    • Agreed that it sounds reasonable to use the anomaly archetype (according to Liv it shouldn't take to long until its done, it will maybe change name to findings and will probably have a broader scope than just imaging)

    • 14016003 | Bone marrow structure (body structure) | can be used

    • Bjørn shares information on a template for Colonoscopy that they modelled 4 years ago. Then, they created a specific archetype (due to time constraints), i.e., openEHR-EHR-CLUSTER.colonscopy_lesion_findings_dips.v2 (see screen shot below), but he presumes that this could be replace with the new anomaly archetype (The modelling for colonoscopy is public available here: https://github.com/bjornna/Arena-Tarmjournal )

      • Open

        

• Other

  • Liv shares a template that can be used before the MDT conference https://tools.openehr.org/designer/#/viewer/shared/Pz9zaGFyZWRJZD0xJDIyZjc2ZjI1YTQyZDQyODViNzU5NmU0ZGZmZmIxY2U0

    • Open

      

Mar 7, 2025

Sweden

@Claudia Ehrentraut

@Manna Vosta

Switzerland (Basel)

Olha Nikolaieva

Norway

@Bjørn Næss

@Vebjørn Arntzen

@LivL

@Lise Kristin Knutsen

@Eli Larsen

@Kanika Kuwelker

@Mona Didriksen

@John Tore Valand (Unlicensed)

Anne Karine Aaserud Fossum

Martine Lousie Nalum

Ciprian-Virgil Gerstenberger

Helge Egil Seime Pettersen

Morten Paicevic Hørthe

Presentation of latest template version

• Liv mentions that new separate archetype for measurements is being created Clinical Kno

• wledge Manager which can be used for organ or lesion.

• Liv and Kanika inform that even anomaly archetype is gonna change, but discussion is still ongoing, maybe it could change to some sort of findings archetype that can be used for tumors, cuts etc.

• Vebjørn: The design pattern of Physical examination findings and Imaging examination findings were decided some years ago, and are oriented around the body structure or organ in which findings are found. An alternative that were abandoned were to orient the archetypes around the finding, and add in which organ and modality of imaging technique used and the way the finding were discovered. There are pros and cons of both. If the design pattern are to be flipped, it will take a lot of work to redesign, and there is no appetite to prioritise this, nor any volunteers. Any discussion on a potential such change must be done in the soon-to-be Clinical Operation Program (COP) led by Chief Clinical Information Officer, Heather Leslie. Note that the parent archetype of both Physical examination finding and Imaging examination finding can be used as a general archetype, if there are no specialisation available.

• John proposed idea to use relative anatomical location for following attributes

• Open

  

• Bjørn thinks that approach so far works well with the different clusters but that it is important to consider which attributes are more general

Dec 20, 2024

@Bjørn Næss

@Claudia Ehrentraut

Discussion on how to handle sectors and PSA-density

Claudia presented input from radiologist regarding PSA-density, se below. Based on this input and discussion at Karolinska Claudia has created a CLUSTER archetype for PSA density, similar to the CLUSTER-archetype for pirads.

• Usually present in the MRI response, should/could be included in the assessment of PI-RADS (MRI in a clinical context)

• Could be added the urologist once the answer has come from the radiologist

Discussion on how to represent sector and zone

• Claudia presented idea on using Specific site in Anatomincal location multiple times in order to capture sector, main sector, zone and main zone

• Björn introduces idea of using Anatomical location two times, for sector and zone, and using body site namn för the main zone or sector and then specific site for capturing all sectors and zones where lesion is located (since lesion can be spread over multiple sectors and up to two zones

• Björn introduces of adding new Snomed CT codes for when the lesion is spread over two zones TZ (PZ) and PZ (TZ).

Dec 6, 2024

@Heather Leslie

@Vebjørn Arntzen

@Bjørn Næss

@Claudia Ehrentraut

Discussion of events

Discussion on how to handle sectors

• Agreed to use single event in imaging examination result-part av template

  • Claudia clarified that template is supposed to be used for capturing the radiology response that the radiologist sends back to urologist (as a result of that the urologist requested an MRI and assessment of it)

• Discussed that our focus needs to be on SLOT Structured imaging findings in imaging examination of a bodystructure (prostate), i.e., thats where main part of the information should go

• Resoned to have contrast use at finding level, i.e. having information under imaging examination of the prostate

• Overall impression could be used to capture for narrative report

• Discussion PSA-density

  • Reasoned to put PSA-density into a separate OBSERVATION (called vital signs?) or CLUSTER archetype (Cluster would be suitable if PSA-ensity is mainly used under imaging

Nov 22, 2024

@Heather Leslie

@LivL

@Bjørn Næss

@Vebjørn Arntzen

@Claudia Ehrentraut

Continue to discuss action items

• Discussed action point “How to represent MRI technique details?”. Claudia presented outline of cluster-archetype for MRI technique, see screenshot below.

  • Open

    

  • Discussed if information in this archetype, especially contrast use, should be put under protocol or rather under data

  • Björn talked about a use case within research where they had an approach of having several events in the observation archetype OBSERVATION.imaging examination result in order to reflect different “tests”, i.e.

    • Test 1 without contrast

    • Test 2 with contrast X

    • Test 3 with contrast Y

    • Test 4 with contrast Z

  • Tested this approach in the template, se screenshot below. In this approach information can be captured per test, but the radiologist may need the possibility to give an overall assessment for all tests. That would require a change in the OBSERVATION-archetype. Claudias impression is that radiologists give one overall response that is based on all images taken. Unclear if its common to perform several “tests” with and without contrast even in clinical setting

  • Open

    

Nov 8, 2024

@Silje Ljosland Bakke

@Vebjørn Arntzen

@LivL

@Bjørn Næss

@Claudia Ehrentraut

First start up meeting

• Discussed different points in time that are of relevance in radiology response and how they can be captured in imaging examination result-archetype, based on question raised in previous meeting, i.e., “How to document 'when the image was examined? Another Event? Or using the Event’s RM element ‘time’?”´, see Modelling radiology response for prostate cancer biopsy - Clinical - openEHR

  • Discussed that Event time in Reference model (RM) for Imaging examination result should reflect the relevant physiological point in time, in this case when images were taken.

    • Open

      

  • Discussed that Data.Study date should capture point in time when the MRI study (examination) is performed, i.e. when the MRI image(s) are taken of the patient. Thus Study date and Event time will essentially be set to the same time

    • Open

      

• Discussed how to capture date for when assessment by the radiologist is performed and response is written

  • Resoned that Date and Time Recorded in the RM for Result report is more of a technical date/time and should not be used

  • Discussed that we could add an explicit data element for date of assessment by radiologist in Imaging examination result

  • Discussed the alternative option that, given implicit is sufficient, we could use Data.Status timestamp in in Imaging examination result for capturing the date when assessment by the radiologist is performed and response is written. In case of two responses being written for the same pictures, that could result in two instances of the template where Study date and Event time are the same, but where Status timestamp is set to different date/times, and where possibly Overall result status is first set to Preliminary and then to Final.

    • Open

      

How to represent when MRI study was performed, i.e., images were taken of the patient?

Use Data.Study date and RM.Event time in Imaging examination result date when the MRI study (examination) is performed, i.e. when the MRI image(s) are taken of the patient

REVIEW

How to represent when radiologist assessed the images?

Use Data.Status timestamp in in Imaging examination result for capturing the date when the radiologist assesses the images and writes the response.

REVIEW

How to represent MRI technique details?

• Suggest to create a separate Cluster with element for ‘magnetic field strength’ as a starting point, instead of using Dose-archetype

Create CLUSTER MRI technique details containing

• Magnetic field strength

• Contrast use

• Image capturing

Open

ongoing

How to represent sector and zone of the prostate where lesion is situated?

• There are 24 sectors in Sweden, but not sure they’re internationally recognised. May be not universal.

• Can use Anatomical location archetype, ‘Prostate’ in element Body site name, and use the ‘Specific site’ to carry the sector. Can use SCT codes or other terminologies. Alternatively add the 24 sectors in Sweden in template as a local value set or external terminology, as SCT codes.

• There are several Snomed CT codes regarding regions of the prostate: SNOMED CT - Region of prostate (ihtsdotools.org)

• Or specialise the Anatomical location archetype to something in the line of “Anatomical location – Prostate”? This CLUSTER can be reused both for Pathological exam and findings, and in treatment (targeted treatment). Further discussion needed.

• In which other organs are “Sector” commonly used? These will have similar requirements, and should be handled in the same way.

• In Norway, Snomed CT codes for quadrant for breast are used

Use Anatomical location two times, once for sector and once for zone and changing

• body site to “main sector”, and “main zone” respectively

• specific site to “sector”, and “zone” respectively

Open

REVIEW

How to represent PI-RADS?

• There is a separate archetype for PI-RADS (soon to be published) that can be used in the anomaly-archetype. Clinical Knowledge Manager

Add existing PI-RADS CLUSTER-archetype to anomaly-archetype

Open

REVIEW

How to represent PSA-density

Create and add PSA density CLUSTER-archetype to Imaging examination of a body structure (prostate)

Open

REVIEW