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Exposure to diagnostic system equipments (CT, MRI, etc.) can be included in device_exposure?

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#1

Is diagnostic system equipments (CT, MRI, etc.) exposure data also included in the ‘Device’ area?
I know we can indirectly figure out the exposure from procedure records like “4303663 | CT angiography | procedure | SNOMED”, but I wonder if we can also transform EMR diagnostic device applied data to device_exposure itself.

And I wonder if there is some cases of converting those data with device concepts.

The concepts of the device area seems to be mostly consumable items, but according to the device_exposure table description below, it seems that the diagnostic equipment can also be converted.

The device exposure domain captures information about a person’s exposure to a foreign physical object or instrument that which is used for diagnostic or therapeutic purposes through a mechanism beyond chemical action. Devices include implantable objects (e.g. pacemakers, stents, artificial joints), medical equipment and supplies (e.g. bandages, crutches, syringes), other instruments used in medical procedures (e.g. sutures, defibrillators) and material used in clinical care (e.g. adhesives, body material, dental material, surgical material).

The following concepts are not the exact one what I mean, but seem to be related.

4290594 ‘Endoscope’ (SNOMED)
45771689 ‘MRI system gantry’ (SNOMED)
45768256 ‘Computed tomography system thermography system’ (SNOMED)

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#2

Good question.
From my perspective, device_exposure should be populated with those devices that have influence on a person and/or are used in her treatment (like prosthesis or cardiac implant). In other words, with the objects a patient can be exposed to (that’s why it’s called device_exposure not device_used or something). That’s why I’m not sure if we should put MRI into device_exposure (and MRI system gantry has a different meaning from the whole MRI).
For those that are relevant, you can follow the links ‘Has dir device’, ‘Has proc device’, ‘Using acc device’, ‘Using device’ from SNOMED procedure to it’s device. For example, Implantation of joint prosthesis into knee joint has relation to Knee joint prosthesis.
Does it help?

#3

I had a similar question regarding ECGs taken during patient care (12-lead ECG). It was suggested to me that procedure are for those actions that are done to a patient so an ECG (and other diagnostic “procedures”) be captured in the device_exposure only. This is the direction we are taking for all ECG data - device_exposure captures when the 12-lead ECG was done, measurements captures global and lead level measurement values (ex ST J-point uV), observations for mapped SNOMED cardiologist findings, note to capture all other cardiologist notes not mapped to standard concepts.

#4

@mkwong how do you link the device exposure to the measurement with your 12-lead ECG example? Do you use the fact_relationship table?

#5

The EHR ETL sets up the person.person_id and person.visit_occurrence_id - derived from the known EHR medical record number. When I receive a confirmed ECG from our heartstation (ECG was reviewed by a cardiologist), it contains the medical record associated with the patient visit - thus now I have when the ECG was done (measurement.measurement_datetime), the person.person_id, and the person.visit_occurrence_id.

I can then enter a device_exposure entry using the above information (person_id, visit_occurrence_id, device_exposure_start_datetime, . The device_exposure.device_concept_type_id is “EHR Detail” (“Device Type”). The device_exposure.device_concept_id is “12 lead ECG”.

The measurements would be linked via person_id, visit_occurrence_id, measurement_datetime (same as device_exposure_start_datetime), and measurement.measurement_type_concept_id -> new type concept “Derived from ECG”.

This makes it fairly straight forward to finding all patients with ST elevation in the inferior leads by querying the measurements table only. I suspect this would work as well for CT and other diagnostic procedures.

#6

@aostropolets Thank you.
What I understood are,
a. when a procedure was done, we can figure out the applied device through the concept relationship, and also (usually) be captured in device_exposure table, too.
b. some devices, not considered to have influence on patients, don’t required to be recorded, and those don’t have device concept ids (like MRI system, CT system).

so then,
c. if some devices not having concept_ids currently but do influence on patients, then we need to adding concepts, right?
(and relationships with existing SNOMED procedures, too, if possible)

#7

All correct.

Please share the list. We will try to find them first :slight_smile:

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