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EPIC UPGRADE NOVEMBER 2017
RADIOLOGY STAFF – RESEARCH GUIDE
Radiology Research Order forms will be phased out due to the EPIC upgrade.
After EPIC go-live, Radiology research orders will be placed electronically in eStar and will be supplemented
with Clinical Trial Imaging Instruction (CTII) forms.
Clinical Trial Imaging Instruction forms will ONLY be created for trials that involve an imaging component
with special imaging instructions and/or sponsor-paid imaging.
The Clinical Trial Imaging Instructions will be emailed to study coordinators and accessible via a hyperlink
within eStar.
The Clinical Trial Imaging Instruction forms will contain the same pertinent information as the former
Radiology research “order” forms: scheduling guidelines; exam types, technical parameters.
Each Clinical Trial Imaging Instructions form will contain a three or four digit (modifier) number that is used
to identify the trial within Imagecast.
Trials meeting certain requirements will be identified in Imagecast using a specific three or four digit
modifier code assigned to that trial.
Imagecast research modifiers will ONLY be created for trials that involve an imaging component with
special imaging instructions and/or sponsor-paid imaging.
The research team MUST associate research imaging order(s) to the trial in eStar, or Radiology exams will
not be tagged with three or four digit Imagecast modifier number that identifies the exam is for research.
The three or four digit Radiology research modifier number will be added to the Imagecast exam entry
automatically as order information is sent from EPIC to Imagecast, no need for Radiology staff to add the
research modifier#. (There is NO need to add a “read” or “no-read” modifier either.)
After EPIC go-live, individual research exam codes will no longer be used in Imagecast.
Instead of the current method of using multiple individual research exam codes, we will begin using routine
Imagecast exam codes PLUS a modifier that identifies that the exam is for a particular trial.
GENERAL Imagecast notes (not specific to research):
o Do NOT manually enter exams into Imagecast, exams must come from EPIC only.
o Do NOT change patient location in Imagecast.
o Do NOT change the referring or attending physician names in Imagecast.
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Imagecast changes for EPIC upgrade
After go-live, Radiology exams associated with clinical trials will be identified in Imagecast
using current routine exam code(s) PLUS a new three or four digit research modifier number:
You can hover over the research modifier number in the worklist to show the full name of the
clinical trial and confirm the study name matches the study name that is listed in the eStar
study page:
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Multiple “old” research order form numbers
will be converted to ONE research modifier#
Historically, one trial may have been assigned multiple Radiology research order forms.
In the new system, only ONE modifier number will be to identify to ONE trial in Imagecast.
When performing follow-ups identical to baseline, the old research exam code in Imagecast records may
not match the new modifier # in Imagecast.
Watch for the “formerly known as” section at the top of the Clinical Trial Imaging Instruction forms.
Make sure you find the correct “old” Imagecast exam that correlates to the new modifier number.
Instead of the current method of using multiple individual research exam codes, we will begin using routine
Imagecast exam codes PLUS a modifier # that identifies the exam as a research exam for a particular trial.
For the example trial above, when reviewing old Imagecast records on exams performed PRIOR to
go-live, you might see the following:
NM1499
CT1500B
CT1500N1
PT1501
MR1502N
CT1503
For the example trial above, the following is a list of example exam types and modifiers that will be
used for this trial AFTER go-live:
NMWB4/1500
CTCAP/1500
CTH1/1500
PTTTUMTH/1500
MRHGAD/1500
CTPBX/1500
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eStar Radiology research notes
Exams associated with clinical trials will be identified in eStar with research flask/link icon:
To access the Clinical Trial Imaging Instructions in eStar, click on the “Research: Active” section
in patient banner:
When eStar study information page/tool opens, please confirm the name of the clinical trial
and click on the Clinical Trials Imaging Instructions (CTII) form hyperlink:
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When CTII form opens in eStar, confirm study name and the three or four digit Radiology
research modifier number and review any study-specific imaging acquisition instructions:
(You should also refer to any study-specific research notes in your modality work area.)
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QUESTIONS/NOTES
Continue to refer to any research notes, binders, or lists in your modality work area for additional information
about the trial in addition to reviewing the Clinical Trial Imaging Instructions for the trial in eStar.
Watch for eStar order “comments”:
o Watch eStar orders for additional “comments".
o Example comments: “Use FSPG tracer for PET” or “US Renal with Definity contrast”.
o eStar order comments will automatically transfer to the “comment” section of Imagecast exam entry.
What if clinician orders an exam that is NOT listed on the Clinical Trial Imaging Instructions form?
o Clinician can order any imaging exam that they feel is appropriate.
o Exam may not have been listed in study documentation, so Radiology research staff will not aware of
additional imaging needs. As a result, specific acquisition guidelines for these additional exams will not be
available, so please perform these exams using standard of care/departmental guidelines.
No-read trials:
o Clinical Trial Imaging Instruction forms for “no-read” trials will have indication at top of form stating:
“Prof reading: NO”
o The following note will appear on all Clinical Trial Imaging Instruction forms for no-read trials:
“All imaging exams for this clinical trial are set up as “no-read” at the request of the sponsor and/or
clinic. VUMC Radiologist dictation/report will NOT be created for the imaging exams.”
o All “no-read” trials will be set up in Imagecast as “no-read”
Mixed-read trials:
o Some trial exams are read, some are no-read.
o Clinical Trial Imaging Instruction forms for “mixed-read” trials will have indication at top of form:
“Prof reading: MIXED”
o All “mixed-read” trials will be set up in Imagecast as “no-read”
o A note to researchers will appear on all Clinical Trial Imaging Instruction forms for mixed-read trials:
Example: “This is a MIXED-READ trial. Some imaging exams for the trial are read, some imaging
exams for the trial are not read. However, for mixed-read trials, the Radiology computer systems
must default to "no-read". If/when professional reading is required for particular exams, please
contact the Clinical Trials Radiology Support Core at radiologysupportcore@vanderbilt.edu. The core
will work with IT to ensure that these exams are routed for professional reading.”
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QUESTIONS/NOTES (CONTINUED)
Amended orders
o If the exam cannot be performed as ordered (change to w/o contrast, or change in modality, etc is
warranted) then every effort must be made to contact the ordering physician and/or study coordinator to
enter a new eStar research order. (At this time, the Department of Radiology has not determined whether or
not Radiologists will enter new orders for clinical trials if the researcher cannot be reached.)
Use of specific Radiologist modifiers:
o Some clinical trial imaging exams are assigned to a specific Radiologist for dictation.
o Radiologist name modifiers will no longer be used per IT department.
o Based on trial, exams will default to a specific Radiologist’s worklist or there will be a note on the Clinical
Trials Imaging Instructions for tech to notify a specific Radiologist that exam is ready for dictation.
Special note for CT: Cancer clinic exams with two payors (sponsor and patient) will continue to require the following:
o Two separate orders, two separate accession numbers, and two dictations/reports.
o Example: CT Chest/Abdomen paid by sponsor + CT Pelvis paid by patient.
o The cancer clinic & billing compliance office may make changes to this ordering method at a later date.
ORG location: Almost every clinical trial is set up for imaging to be performed exclusively at VUMC main campus.
However, please check the specific scheduling and technologist notes on the Clinical Trials Imaging Instructions to
determine if there are specific requirements regarding what facility and equipment must be used. (Do not rely on the
“Org” section at top of Instruction form, as this section is for IT use only.)
What if exam has research flask/link icon in eSTAR (indicating research), but there is no Imagecast modifier? Or,
what if an order comment refers to research and there is no eSTAR flask/link icon or Imagecast modifier?
o Only trials that have sponsor-paid imaging or special imaging instructions are set up with Imagecast
modifier and Clinical Trial Imaging Instruction forms.
o Trial may have research instructions & modifier set up. However, if researcher fails to associate imaging order
to the trial, then no flask/link icon will appear in eStar & no research modifier # will appear in Imagecast.
o If there is NO Imagecast modifier and/or Clinical Trial Imaging Instructions form, please perform the exam
using department protocol/standard of care technique.
Questions: Refer questions to the modality research lead in your area. If research lead is not available, contact the
Clinical Trials Radiology Support Core at 322-6886.
