DE19854676A1 - Patient administration method for triggered urodynamics has data in digital archive for retrieval from workplace computer - Google Patents

Abstract

The method involves delivering patients' historical data and illness-related data for use at an examination location, where a digitally created urodynamic examination is combined with a digital X-ray system. The examination data from the urodynamics are used to supply certain commands to the X-ray system, under the doctor's control, and are also placed in a digital archive. Data can be retrieved from the archive at a workplace computer, and break compliance, break volume and detrusor risk can be calculated from the urodynamics.

Description

Triggered video urodynamics with digital video recordings high frequency and their storage replaced in the conventional Videoourodynamics the analog recording of continuous fluoroscopy with curve and their archiving on video tapes that as Archives are unsuitable because the access to the tapes one represents high personnel costs. Today's Possibilities of digital recording allow the doctor a quick and direct access to current and past investigations. At Assessment of dynamic processes as they change when Bladder palsy is a common and quick access Possibility to compare an urgent requirement to one today designed workplace.

The change in hospital legislation requires that Head of department quality control of the treating patient and patient groups based on data such as diagnosis, therapy, Complications, age. Direct access to the A core examination in neuro-urology is therefore another urgent request. The connection of the examination site to the existing and proven EDP patients registration is therefore a prerequisite for the workplace.  

Costs, the diagnosis and the therapy in the hospital cause today also play a role in health policy. Legal requirements stipulate that the provided Transparent diagnosis and treatment services being represented. The designed workplace is costly intensive and usually delivers a single examination exact diagnosis, which is the basis for conservative and operative Therapy forms. By connecting to the Neuro-Urology network the workplace will be able to go through this parent Network access to workplace benefits too enable. This is the only way to calculate the clinic administration to collect exact data.

1. Urological table with digital X-ray and picture amplifier and TV

The urological examination table should be combined with an X-ray standard diagnostic device with digital X-ray technology.

1.1 Urological table

The table should be adjustable in height from 80 to about 150 cm. A tilt option of 19-90 ° is desired. The lengths Shift of the lying surface should be 40 cm, the transverse shift 20 cm.

Possible impurities should be cleaned to clean the device liquids containing contrast media can be easily removed.

If possible, the tube should be moved to a parking position can become easier transfers from disabled patients.

Remote control options for all movements of the table are desirable, but not a requirement. A foot switch is supposed to  be constructed so that all the functions of the table that Features for fluoroscopy and x-rays, through the examining doctor is possible without an assistant.

An emergency alarm switch, with the examiner's knee operable, should be connected to the existing UFD emergency alarm system be connected.

Accessories: support mat, leg holder with gas springs and Children's bowls, shoulder supports, table extension, table cover lengthening with footrest (for examination in a standing position), Infusion stick with centimeter division, infusion stick without Measurement, armrest, micturition seat mobile, drain bag, no gyro flush.

Radiation protection for examiners, as in the existing uroscope Side room, maybe better.

Rope ladder from the ceiling to patient-assisted transfers. Automatic aiming device for X-rays 13 × 18 bis 35 × 43.

1.2. roentgen 1.2.1. generator

80 kW, microprocessor controlled, HF generator, continuous falling load technology (fully utilize 100% performance), programmed recording technology for direct recording and digital Recordings, minimizing switching times (children), with and without Automatic exposure control (important for patients with extreme vertebrae column curvatures etc).  

Hand switch can also be triggered in the examination room, as there are many neuro-urological examinations the direct contact between Make examiners and examined people necessary, especially with Functional images of the lower urinary tract with micturition with Instructions from the examiner. In these cases the trigger is with an x-ray behind the closed door often not useful and leads to unnecessary inclusion with the proper radiation exposure of patient and examiner.

1.2.2. X-ray tube

Grid-controlled X-ray tube with image frequencies from 3-10 Frames / sec., Double focus (stone search), fast rotating tube for Generator 80 kW.

Automatic diaphragm with iris diaphragm, rotatable diaphragm. Integrated pre-filtering of radiation for children (aluminum).

1.2.3. Automatic registration of radiation exposure

Area dose product calculation e.g. B. with Diamentor M 4, online networked. Data should be on all archives under the Patient data are available (laser image, printer image, digital Archive).

1.2.4. Grid-pulsed digital fluoroscopy

• 1. Because of radiation savings through fractional, situa tion-dependent admission control z. B. Cystogram Storage phase three frames / second, in the spastic Phase eight frames / second with falling detrusor pressure six frames / second. The X-rays adapt dynamically the density of the x-ray object. benefits compared to permanent fluoroscopy: the as through  Illumination appearing images with less X-ray current and therefore less stress on the Patients and employees made with similar Quality through the use of exact square pulses.
• 2. Each of the images is a digital x-ray image storable. In digital urodynamics one should Reference to the X-ray image will appear. The reference should in post-processing the X-ray saved in the archive can call picture.
• 3rd advantage: No conventional fluoroscopy, no direct X-rays and no 100 mm camera recordings are routinely necessary.
  Disadvantage: Dynamic examination is shown in single pictures, but up to eight pictures / second. Disadvantage not important for urodynamic speeds.

1.2.5. Digital recording technology

Fast image memory (RAM 3 × 64), multi-image at the end of the Investigation. Selection criteria with infrared remote control, Contrast change for specific images, subtraction, Text entry, magnifying glass, patient data entry from the network, DICOM III exit to the network, taking pictures, fixing them and storage during digital fluoroscopy without it to interrupt.

1.2.6. Archiving digital X-ray

• 1. A buffer should have at least three examinations be able to record. This means that everyone during the Examined digital recordings in this  Cache. When using grid controlled shots is with a maximum of 60 frames each Investigation to be expected.
• 2. The final archive must all be in post-processing set x-rays and access possibility from the set described under 1. Allow markers in urodynamics. The final one digital archive is said to be recordings from the past 5 years ready for direct access.

1.2.7. Laser camera

• 1. In examinations without urodynamics, post- processing selected the recordings to be archived and in a predefined format with the laser camera printed out.
• 2. In the case of combination examinations, the X-rays should be taken along with and to the urodynamic curve X-ray image associated markers are mapped. Per Examination results in about six to eight pictures. By doing The upper field of the picture should show the patient-specific Data and assessment of the study entered become.
• 3. The diagnosis or the report of the report can be made later from the medical workplace (three IT workplaces) to be possible. The report text must be bound to the Be exportable because it is used in Printer and patient management. The loss of The quality of the X-ray images has to be accepted because Examiner and assessor in post-processing the It is the same as the one who wrote the report. The Reminder of the original pictures can be assumed since the  Description of findings a maximum of seven hours later he follows. This point is necessary to the Combination work station as quickly as possible to the next one To make patients available.

1.2.8. Printer

For each examination, the medical record should be archived Documents are created. A4 sheets should be used for this become.

• 1. In the upper part of the arch, patient- and examination data and examiner must be registered.
• 2. The urodynamic curves should be on the rest of the curve a printout of the associated X-ray image be mapped.
• 3. The last sheet (usually the third) is documented in addition to patient data with radiation exposure calculated parameters from the MMS device together with the Findings report.

1.3. BV

With a real 38 cm diameter from different providers, pictures should be compared and particular attention should be paid to the edge distortion, since a larger diameter obviously does not automatically lead to a larger, evaluable image quality. Triple switchable format.
Note the distance between the top edge of the table top and the BV entrance.
Two monitors mounted on ceiling trolleys (reference picture).

1.4. 100 mm camera

Not applicable.

2. MMS urodynamics 2.1. Technical additives

• 1. Automatic temperature measurement of the filling liquid Entry into the catheter.
• 2. Blood pressure measurement triggered by examiners, whereby the Sphygmomanometer when reaching systolic Summit a marker with the measured value on the Urodynamic curve writes.
• 3. Possibility of connecting a skin temperature (infrared camera) or skin moisture meter.

2.2. software

• 1. Standard situations of urodynamics, as in one of the developed the first concepts for the company in 1990/1991, must be created arithmetically. These different Situations are said to be different programmed digital Help trigger X-ray sequences. The ent speaking standard situations must therefore be simultaneous permanently during the creation of the urodynamic curve can be calculated. This has to be done at high speed take place because the triggering of the situation X-ray should be done semi-automatically.  
• 2. In addition to the previously known functional formulas (Schäfer et al.) should also be calculated data (break Volume, reflection volume, detrusor effectiveness) according to im post-processed adjusted curve for archiving the printer and for export to the Neuro-Urology network WWK are created.
• 3. Higher-level networks (WWK administration, WWK neuro-urology, MMS)
• 4. The not yet established network of the administration of the house must have access to the technical data included with the cost of diagnostics and therapy are necessary (screening time, images, archi vation, laser camera, printer, digital archive).
• 5. The existing network of the Clinic for Neuro-Urology, WWK, provides patient data regarding personal Data, diagnosis code and therapy code to the MMS Urodynamics or directly to the x-ray system if this Investigations without simultaneous urodynamic measurements gene performed. For combination examinations the patient data for the radiological part the urodynamics are taken over. Without taking over The X-ray system should not operate patient data go (for economic reasons). Also logged become the names of the examiner.
• 6. With certain fixed changes in the urody Namikkurve various programs should the examiner support to trigger X-ray sequence images. Out legal reasons, this must not be automatic happen, but could via a so-called dead-man Circuit or via light signals. That was done  Recording or recording sequence sends an individual Marker on the urodynamic curve.
• 7. Links between organization, X-ray and urodynamics is a prerequisite for (1.) and a prerequisite for the Findings in post-processing. Here, the Urodynamic curve on the monitor the digitized X-ray image on the same or a second monitor be available. It has to be clarified whether the post-processing done by the X-ray company or MMS. To be considered What is clear here is that the workplace too can be used separately (X-ray or urodynamics) can.

Claims (1)

Procedure for patient management for which patient Master data and disease-related data for a sub search space are delivered, the digitally created, urodynamic examination with a digital x-ray system is combined, the examination data from urodynamics gives certain commands to the X-ray system in a doctor-controlled manner, that are managed together in a digital archive that Retrieve the data from the digital archive via a Computer control unit in the workplace to the computers of the Patient management is passed on, from there all Data can be called up together and terms such as break compliance, Break volume and detrusor risk index from urodynamics can be calculated.