Stress Testing Workflow

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This integration profile defines ordering and collecting multi-modality data during diagnostic Stress testing procedures


The Stress Testing Workflow Profile defines a means of ordering and performing cardiac stress tests involving both ECG and imaging (echocardiographic or nuclear) procedure components. All the acquired data is collected in a uniform format (DICOM). The profile is aligned with the Actors and Transactions of the Echocardiography Workflow and Scheduled Workflow Integration Profiles, so that a common infrastructure can be used in an integrated manner.


Cardiac stress testing with both ECG and imaging has traditionally be performed almost as two independent procedures due to the technical interoperability limitations of the equipment. This integration profile establishes an industry consensus position that the clinically desirable unified approach should be based on the DICOM standard, and leverage the DICOM workflow management and object management/archiving capabilities available in the cardiology department.


The Stress Testing Workflow Integration Profile describes the workflow associated with cardiac stress test procedures. This profile deals with patient identifiers, orders, scheduling, status reporting, multi-stage exams, and data storage. It specifies the scheduling and coordination of procedure data across a variety of imaging, ECG acquisition, measurement, and analysis systems, and its reliable storage in an archive from where it is available to support subsequent workflow steps, such as reporting.

This profile has much in common with the Echocardiography Workflow and the Radiology Scheduled Workflow Profiles, but deals more explicitly with the multi-modality coordination, and with stress-specific data requirements. In fact, stress echo acquisition modalities should claim compliance to the Echo Workflow Profile and nuclear acquisition modalities should claim compliance to the Radiology Scheduled Workflow and Nuclear Medicine Image (Cardiology Opiton) Profiles.

One requirement is that a workstation (Image Display actor) claiming compliance to this profile must be truly multi-modality capable; it must support display of ECGs, echo images, and nuclear images. A workstation that does not support all three modalities could still claim compliance to the Echo Workflow or Nuclear Medicine Image Profile, but not Stress Workflow.

Systems Affected

  • Cardiovascular Information Systems (CVIS) manage the multi-modality stress testing workflow.
  • Stress ECG, stress echo, and nuclear medicine (SPECT) acquisition modalities acquire data during the procedure, and appropriately annotate it for the stress protocol.
  • PACS systems receive, store, and manage the multi-modality acquired data.
  • Display workstations query, retrieve and display the acquired data in a manner conducive to stress test analysis and reporting.
  • Acquisition modalities or workstations may perform measurements or analysis of the data, and store those results in DICOM Structured Report evidence documents.

Actors & Transactions:

The actor-transaction diagram is identical to that for the Echocardiography Workflow Profile.


Profile Status: Trial Implementation


Stress Testing Supplement for Trial Implementation

Underlying Standards:

See Also

Related Profiles

This page is based on the Profile Overview Template