{ "vercy": "1.0-draft", "publication": { "status": "research-draft", "adjudicationStatus": "unreviewed", "publishableCanonical": false, "generatedAt": "2026-09-12T08:59:28Z", "providers": [ "Codex" ], "breadth": "recalled by Codex without web access - no source was read", "missingProviders": [], "pass": 2, "cost": { "grok": { "seconds": 20.2, "error": "Reading additional input from stdin...\nOpenAI Codex v0.153.4\n--------\nworkdir: R:\\02_PROJECTS\\02_Meta_Models_Platforms\\Ver.cy\\current\\thing-registry-backlog\nmodel: gpt-6-astra\nprovider: openai\napproval: never\nsandbox: read-only\nreasoning effort: none\nreasoning summaries: none\nsession id: 01a094d6-9516-7e03-9fa5-96c30320a8b4\n--------\nuser\nDescribe what is already known about one registered thing. Answer as JSON only, no prose around it.\n\nThing: cystography\nSense to describe: (none recorded)\nDomain code: INF.KNW\nAlso known as: (none)\n\n\nContext for this batch of 1001 things:\n# Batch 043: 1001 reg", "usd": 0.0, "recall": true }, "codex": { "seconds": 83.0, "error": "Reading additional input from stdin...\nOpenAI Codex v0.153.4\n--------\nworkdir: R:\\02_PROJECTS\\02_Meta_Models_Platforms\\Ver.cy\\current\\thing-registry-backlog\nmodel: gpt-6-astra\nprovider: openai\napproval: never\nsandbox: read-only\nreasoning effort: none\nreasoning summaries: none\nsession id: 01a094d6-9516-7242-9b98-01ee6cf47799\n--------\nuser\nYou are drafting a Vercy meta-model for one registered thing. Answer as JSON only, no prose around it.\n\nThing: cystography\nRegistry id: vr.tr.cystography\nPlane / domain: INF / INF.KNW\nRegistry definition: (none recorded)\nNames folded into this entry: (none)\n\n\n" } }, "enrichment": { "pass": 3, "engine": "claude", "producedAt": "2026-10-06T12:00:00Z", "ingestedAt": "2026-10-06T08:46:32+00:00", "fields": [ "agent_conduct", "ethics", "failure_modes_and_hazards", "owners", "standards_and_regulation" ] }, "revisions": [ { "at": "2026-10-07T11:26:48+00:00", "engine": "codex", "fields": [ "definition", "distinguishing_features" ], "answering_review": "3435a3d18746271271cf1884757b59209d3ff4c0089cf6990f41beedc0354441" } ], "gate": { "passed": true, "version": "1.0", "at": "2026-10-07T12:16:31+00:00", "evidence": [ "completeness 1.00", "sense: Wikidata description", "2 live sources", "review by codex: pass" ] } }, "metaModel": { "id": "THING-Q246052", "registryId": "vr.tr.cystography", "name": "cystography", "version": "0.1.0-research.1", "entryKind": "thing", "family": "Thing Registry", "domain": [ "INF.KNW" ], "status": "research-draft" }, "canonicalUrl": "https://ver.cy/models/thing/q246052/", "model": { "registry_id": "vr.tr.cystography", "name": "cystography", "purpose": "Enable an agent to recognize cystography, record whether an examination can answer its bladder-focused clinical question, and identify the review needed before acting on its results.", "definition": "Cystography is diagnostic X-ray imaging of the urinary bladder using an introduced contrast agent to assess its anatomy, integrity, or function, sometimes including imaging during urination.", "scope_statement": "This model owns the procedural knowledge of cystography for vr.tr.cystography: contrast-based imaging of the urinary bladder, its examination variants, acquisition requirements, interpretive limits, and clinical handoffs; the INF / INF.KNW placement represents knowledge of a procedure rather than a standalone academic discipline.", "in_scope": [ "Definition of cystography and relationships among conventional, CT, and voiding examination variants", "Bladder-focused referral questions and selection of an appropriate examination variant", "Contrast administration, bladder filling, acquisition phases, and examination completeness", "Recording bladder leakage, reflux observations, and relevant bladder morphology", "Procedure-specific safety checks, interpretive uncertainty, and result handoff" ], "out_of_scope": [ "Cystoscopy and endoscopic inspection or treatment of the bladder", "Urodynamic pressure testing and comprehensive functional diagnosis", "General CT urography and investigation of the entire urinary tract", "Standalone urethrography protocols", "Treatment models for bladder trauma, vesicoureteral reflux, infection, or malignancy", "Radiology as a profession, academic discipline, or institutional service" ], "distinguishing_features": [ "The examination deliberately evaluates the bladder using X-ray imaging with contrast; merely including the bladder in a pelvic image is insufficient.", "A voiding cystourethrogram includes observation during urination and assessment of the urethra; these are not defining requirements of every cystogram, as described by [RadiologyInfo: Pediatric VCUG](https://www.radiologyinfo.org/en/info/voidcysto).", "For bladder-trauma evaluation, dedicated retrograde cystography must be distinguished from bladder opacification produced by excreted intravenous contrast, as described by [EAU: Urological Trauma](https://uroweb.org/guidelines/urological-trauma/chapter/urogenital-trauma-guidelines).", "Cystoscopy directly inspects the bladder through an endoscope, whereas cystography produces an imaging examination.", "Cystography records imaging observations; it does not itself constitute pressure-flow testing or a treatment intervention." ], "characteristics": [ { "name": "Examination variant", "kind": "category", "unit_or_values": "Conventional radiographic cystography; CT cystography; voiding cystourethrography; other explicitly defined variant", "why_it_matters": "Identifies which acquisition and interpretation requirements apply." }, { "name": "Clinical question", "kind": "category", "unit_or_values": "Suspected bladder leak or injury; healing assessment; reflux assessment; other documented bladder question", "why_it_matters": "Determines what the examination must demonstrate to be useful." }, { "name": "Contrast administration route", "kind": "category", "unit_or_values": "Retrograde intravesical; intravenous with excretory filling; other specified; unknown", "why_it_matters": "Prevents treating examinations with different filling mechanisms as interchangeable." }, { "name": "Administered contrast preparation", "kind": "relation", "unit_or_values": "Reference to agent, formulation, dilution, and administration record", "why_it_matters": "Connects image appearance and exposure assessment to the material actually used." }, { "name": "Instilled bladder volume", "kind": "measurement", "unit_or_values": "mL, with filling endpoint and reason for stopping", "why_it_matters": "Supports assessment of filling adequacy without imposing one volume across ages and indications." }, { "name": "Acquisition phases completed", "kind": "category", "unit_or_values": "Filling; filled bladder; voiding; postvoid; postdrainage; other protocol-defined phases", "why_it_matters": "Shows which dynamic events and anatomical states were actually observed." }, { "name": "Question-specific diagnostic adequacy", "kind": "state", "unit_or_values": "Adequate; limited; nondiagnostic; not yet assessed, with reason", "why_it_matters": "Separates absence of an observed abnormality from failure to assess it." }, { "name": "Leak assessment", "kind": "state", "unit_or_values": "Detected; not detected; indeterminate; not assessed, with location and distribution when applicable", "why_it_matters": "Preserves uncertainty and supports a focused clinical handoff." }, { "name": "Reflux assessment", "kind": "state", "unit_or_values": "Detected; not detected; indeterminate; not assessed, with side, phase, and named grading system if used", "why_it_matters": "Prevents importing reflux conclusions from examinations that did not adequately assess it." }, { "name": "Radiation exposure record", "kind": "measurement", "unit_or_values": "Modality-appropriate reported quantities and units, such as dose-area product in Gy·cm² or CT dose-length product in mGy·cm", "why_it_matters": "Preserves exposure information without equating different dose metrics." } ], "affordances": [ "Classify a requested or completed examination by cystography variant and flag ambiguous terminology.", "Compare the referral question with the selected variant and recorded acquisition phases.", "Check for missing filling, contrast, safety, or image-quality information before interpretation.", "Represent leak and reflux observations with anatomical location, examination phase, and uncertainty.", "Prepare a traceable summary for radiologist or referring-clinician review.", "Identify whether an unresolved clinical question requires clinician consideration of further evaluation." ], "agent_conduct": { "may": [ "Explain what a cystography involves in general terms from medical sources.", "Help a patient or parent prepare questions for the clinical team." ], "must_not": [ "Diagnose reflux, bladder injury or other conditions from images a user shares.", "Advise skipping or delaying a test a clinician has recommended.", "Share imaging records without consent.", "Give radiation dose advice that contradicts the clinical team." ], "requires_human": [ "Ordering, performing or interpreting the test." ] }, "ethics": { "considerations": [ "The test is intimate and can be distressing, especially for children; consent and dignity matter.", "Radiation exposure should be justified and kept as low as possible." ], "affected_parties": [ "Patients, especially children", "Parents", "Clinicians" ] }, "owners": { "steward": "The treating clinician orders it; the imaging department performs it.", "master_systems": [ "Patient health records", "Radiology information systems" ] }, "failure_modes_and_hazards": [ "Urinary infection can follow catheterisation.", "Radiation exposure, though low, adds up over repeated tests." ], "standards_and_regulation": [ "Council Directive 2013/59/Euratom laying down basic safety standards for protection against ionising radiation, European Union." ], "what_it_is_for": [ "Cystography is used in radiology and urology to investigate suspected bladder leakage, structural abnormalities or reflux toward the upper urinary tract.", "Imaging during urination can provide additional information about bladder emptying and the urethra when relevant to the clinical question." ], "facets_not_applicable": { "recognition": "Cystography is an imaging procedure whose identity is established from examination records rather than an intrinsic visual appearance." } }, "sources": [ { "id": "wikidata", "title": "Wikidata item Q246052: cystography", "url": "https://www.wikidata.org/wiki/Q246052", "url_status": "live", "what_it_supports": "identity and sense of the item", "checked_by": "wikidata-api" }, { "id": "wikipedia-en", "title": "Wikipedia: Cystography", "url": "https://en.wikipedia.org/wiki/Cystography", "url_status": "live", "what_it_supports": "general description of the item", "checked_by": "wikidata-api sitelink" } ], "structure": { "bundles": [ { "id": "cystography-identity", "name": "Cystography identity and variants", "description": "Establish what counts as cystography and which examination variant a record denotes.", "rationale": "A bladder image, a cystogram, and a voiding study can be mislabeled as equivalent despite answering different questions.", "layers": [ { "id": "procedure-boundary", "name": "Procedure boundary", "description": "Define the bladder-imaging procedure and its neighbouring techniques.", "findings": [ { "id": "bladder-directed-imaging", "name": "Bladder-directed imaging identity", "description": "Record the intended bladder assessment and imaging mechanism rather than inferring cystography from anatomical coverage alone.", "questions": [ { "text": "What bladder-focused imaging procedure does the term cystography denote in this record?", "kind": "definition", "id": "bladder-directed-imaging-q01" }, { "text": "What distinguishes this examination from cystoscopy, general pelvic imaging, or urography?", "kind": "boundary", "id": "bladder-directed-imaging-q02" } ] } ] }, { "id": "variant-relationships", "name": "Variant relationships", "description": "Represent named variants without assuming every variant has the same phases or capabilities.", "findings": [ { "id": "voiding-study-specificity", "name": "Voiding study specificity", "description": "A fluoroscopic VCUG evaluates the contrast-filled bladder and urinary tract during filling and emptying; its voiding component must be explicit. [RadiologyInfo: Pediatric VCUG](https://www.radiologyinfo.org/en/info/voidcysto)", "questions": [ { "text": "Which named cystography variant was requested and which was actually performed?", "kind": "definition", "id": "voiding-study-specificity-q01" }, { "text": "Was voiding and urethral visualization intended, completed, or outside this examination's scope?", "kind": "boundary", "id": "voiding-study-specificity-q02" } ] } ] } ] }, { "id": "clinical-question-fit", "name": "Clinical question and examination fit", "description": "Connect the reason for examination to the evidence the selected technique can provide.", "rationale": "A study suitable for detecting a bladder leak may not answer a reflux or voiding question.", "layers": [ { "id": "referral-target", "name": "Referral target", "description": "Identify the suspected abnormality or follow-up question.", "findings": [ { "id": "explicit-diagnostic-target", "name": "Explicit diagnostic target", "description": "Record the target as a question to be resolved, with its referral context, rather than treating an indication as an established diagnosis.", "questions": [ { "text": "Is the examination intended to assess leakage, healing, reflux, or another specified bladder abnormality?", "kind": "definition", "id": "explicit-diagnostic-target-q01" }, { "text": "Which referral, prior examination, operation, or injury record establishes this question?", "kind": "provenance", "id": "explicit-diagnostic-target-q02" } ] } ] }, { "id": "technique-suitability", "name": "Technique suitability", "description": "Assess whether the technique can resolve the stated question.", "findings": [ { "id": "dedicated-trauma-cystography", "name": "Dedicated bladder-trauma technique", "description": "For suspected bladder injury, passive filling from excreted intravenous contrast does not replace adequately performed retrograde cystography. [EAU: Urological Trauma](https://uroweb.org/guidelines/urological-trauma/chapter/urogenital-trauma-guidelines)", "questions": [ { "text": "Does the documented filling route and acquisition technique meet the applicable requirements for this clinical question?", "kind": "boundary", "id": "dedicated-trauma-cystography-q01" }, { "text": "What clinician review is needed if the requested technique cannot answer the referral question?", "kind": "action", "id": "dedicated-trauma-cystography-q02" } ] } ] } ] }, { "id": "filling-and-acquisition", "name": "Bladder filling and image acquisition", "description": "Describe how the bladder was opacified and which imaging states were captured.", "rationale": "Interpretation depends on actual filling and phase coverage, not merely the examination label.", "layers": [ { "id": "opacification-record", "name": "Opacification record", "description": "Capture contrast delivery, filling endpoint, and departures from the intended protocol.", "findings": [ { "id": "documented-filling-conditions", "name": "Documented filling conditions", "description": "The proposed model records agent, dilution, access route, instilled volume, and stopping reason so a reviewer can assess filling conditions.", "questions": [ { "text": "What contrast preparation and route were used, and where is their administration documented?", "kind": "provenance", "id": "documented-filling-conditions-q01" }, { "text": "What volume was instilled, what endpoint was reached, and did discomfort, leakage, or another event stop filling?", "kind": "measurement", "id": "documented-filling-conditions-q02" } ] } ] }, { "id": "phase-coverage", "name": "Phase coverage", "description": "Identify the acquired phases and their suitability for the diagnostic target.", "findings": [ { "id": "observable-states", "name": "Observable bladder states", "description": "Record required versus completed phases and views, including whether motion, incomplete filling, or inability to void limited the intended assessment.", "questions": [ { "text": "Which filling, filled-bladder, voiding, and drainage-related phases were required and acquired?", "kind": "measurement", "id": "observable-states-q01" }, { "text": "Which missing phase, view, or anatomical coverage limits the conclusion that can be drawn?", "kind": "boundary", "id": "observable-states-q02" } ] } ] } ] }, { "id": "access-and-exposure-safety", "name": "Access and exposure safety", "description": "Record the checks and events associated with urinary access, contrast, and imaging exposure.", "rationale": "Cystography combines bladder instrumentation and imaging, so procedural readiness cannot be inferred from an imaging order alone.", "layers": [ { "id": "urinary-access-readiness", "name": "Urinary access readiness", "description": "Establish how intravesical access is obtained and whether concerns require review.", "findings": [ { "id": "access-review", "name": "Access review", "description": "Record existing or proposed access and the responsible clinician's assessment of relevant urethral injury, infection, or recent reconstruction concerns.", "questions": [ { "text": "What urinary access is available or proposed, and what documented concerns could affect its use?", "kind": "provenance", "id": "access-review-q01" }, { "text": "Who must resolve an access concern before catheter placement or bladder filling proceeds?", "kind": "action", "id": "access-review-q02" } ] } ] }, { "id": "exposure-and-tolerance", "name": "Exposure and tolerance", "description": "Track applicable exposure checks and the patient's tolerance of the examination.", "findings": [ { "id": "procedure-specific-safety-record", "name": "Procedure-specific safety record", "description": "The proposed record includes relevant contrast-reaction history, pregnancy assessment where applicable, radiation quantities, symptoms, and reasons for interruption.", "questions": [ { "text": "Which contrast and radiation checks were required by the selected protocol, and where were they recorded?", "kind": "provenance", "id": "procedure-specific-safety-record-q01" }, { "text": "Did pain, catheter difficulty, a suspected reaction, or another event require stopping or escalating the examination?", "kind": "action", "id": "procedure-specific-safety-record-q02" } ] } ] } ] }, { "id": "interpretation-and-handoff", "name": "Interpretation and clinical handoff", "description": "Represent observed abnormalities, the strength of negative conclusions, and responsibility for acting on the report.", "rationale": "A useful cystography record must distinguish observed absence, inadequate assessment, and findings requiring clinical review.", "layers": [ { "id": "anatomical-observations", "name": "Anatomical observations", "description": "Keep leakage, reflux, and other bladder observations distinct and traceable to images.", "findings": [ { "id": "leak-and-reflux-localization", "name": "Leak and reflux localization", "description": "Record suspected extravasation separately from reflux into the ureters, with location, side, phase, and interpreter confidence where applicable.", "questions": [ { "text": "What images and phases support each reported leak, reflux event, or bladder contour abnormality?", "kind": "provenance", "id": "leak-and-reflux-localization-q01" }, { "text": "What location, distribution, laterality, or explicitly named classification did the interpreter assign?", "kind": "measurement", "id": "leak-and-reflux-localization-q02" } ] } ] }, { "id": "conclusion-and-follow-through", "name": "Conclusion and follow-through", "description": "Connect interpretation to examination adequacy and an accountable clinical recipient.", "findings": [ { "id": "qualified-result-handoff", "name": "Qualified result handoff", "description": "Preserve the distinction between an adequate negative assessment and an unresolved question, and record report verification and any required communication.", "questions": [ { "text": "Does the examination support a negative conclusion for the referral target, or does a stated limitation leave it unresolved?", "kind": "boundary", "id": "qualified-result-handoff-q01" }, { "text": "Who verified the report, and what result or limitation requires communication to the responsible clinical team?", "kind": "action", "id": "qualified-result-handoff-q02" } ] } ] } ] }, { "id": "evidence-and-external-alignment", "name": "Evidence and external alignment", "description": "What the world already says about this thing, gathered so the model can be checked against it.", "rationale": "A model that cannot be lined up against existing standards, identifiers and practice cannot be adopted by anyone who already uses them.", "layers": [ { "id": "reported-evidence", "name": "Reported evidence", "description": "Findings from the breadth pass, kept separate from the structural claims.", "findings": [ { "id": "evidence-confidence-notes", "name": "Check these first", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Cystography is an imaging procedure, not ordinarily a discipline or field of knowledge; the supplied domain classification warrants review.", "Some terminology reserves cystography for radiographic examinations, while broader usage includes radionuclide and ultrasound techniques.", "This description is based on recall; specific procedural standards, identifier codes, and numerical protocols have not been verified." ], "questions": [ { "id": "evidence-confidence-notes-q01", "text": "Which of these check these first hold for the sense of cystography this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-kinds", "name": "Kinds and varieties", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Conventional retrograde X-ray cystography", "Voiding cystourethrography", "CT cystography", "Direct radionuclide cystography", "Indirect radionuclide cystography", "Contrast-enhanced voiding urosonography" ], "questions": [ { "id": "evidence-kinds-q01", "text": "Which of these kinds and varieties hold for the sense of cystography this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-real-world-use", "name": "Real-world use", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Detecting and characterizing bladder rupture or urinary leakage", "Investigating vesicoureteral reflux", "Assessing bladder healing after injury or surgery", "Demonstrating bladder diverticula or selected fistulas", "Evaluating the bladder and urethra during voiding" ], "questions": [ { "id": "evidence-real-world-use-q01", "text": "Which of these real-world use hold for the sense of cystography this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-failure-modes-and-hazards", "name": "Failure modes and hazards", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Insufficient bladder distension can obscure a leak and produce a false-negative examination.", "Intermittent reflux may not occur during the examination and can be missed.", "Catheterization can cause discomfort, urethral injury, or urinary tract infection.", "Excessive filling pressure can injure the bladder.", "X-ray, CT, and radionuclide techniques involve ionizing radiation; contrast-related adverse reactions depend on the agent and route." ], "questions": [ { "id": "evidence-failure-modes-and-hazards-q01", "text": "Which of these failure modes and hazards hold for the sense of cystography this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-regional-variation", "name": "Regional variation", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Voiding cystourethrography is also called micturating cystourethrography, particularly in British usage." ], "questions": [ { "id": "evidence-regional-variation-q01", "text": "Which of these regional variation hold for the sense of cystography this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-neighbours", "name": "Neighbouring kinds and how to tell them apart", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ { "name": "Cystoscopy", "difference": "Cystoscopy directly inspects the bladder interior with an endoscope; cystography produces diagnostic images using contrast or a radiotracer." }, { "name": "Cystometry", "difference": "Cystometry measures bladder pressure and filling behavior; cystography primarily depicts anatomy, leakage, or reflux." }, { "name": "CT urography", "difference": "CT urography generally images the urinary tract after intravenous contrast administration; dedicated CT cystography uses retrograde bladder filling." }, { "name": "Urethrography", "difference": "Urethrography targets the urethra; cystography targets the bladder, with overlap in voiding cystourethrography." } ], "questions": [ { "id": "evidence-neighbours-q01", "text": "Which of these neighbouring kinds and how to tell them apart hold for the sense of cystography this model covers, and on what evidence?", "kind": "provenance" } ] } ] } ] } ] }, "openQuestions": [ "Does an existing Vercy world model already own cystography or a sufficiently encompassing procedure concept, requiring this registry entry to link to it?", "Which authoritative terminology should determine whether radionuclide cystography and contrast-enhanced voiding urosonography are variants within this entry or related procedures?", "Which population- and indication-specific protocols should supply filling endpoints, required phases, and adequacy criteria?", "Which current guidelines and local policies govern infection assessment, antimicrobial prophylaxis, sedation, and access after suspected urethral injury?", "Which reporting classifications and coding systems should be adopted for reflux, bladder leakage, and examination variants, and which versions apply?" ], "statistics": { "bundles": 6, "layers": 11, "findings": 16, "questions": 26 } }