Digital Imaging and Communications in Medicine (DICOM)dicom.nema.org/dicom/supps/Sup65_pc.pdf ·...

Digital Imaging and Communications in Medicine (DICOM)

Supplement 65: Chest Computer-Aided Detection SR SOP Class

Status: Public Comment Draft – November 2, 2001

DICOM Standards Committee

1300 N. 17th Street, Suite 1847

Rosslyn, Virginia 22209 USA

Supplement 65: Chest CAD SR SOP Class

Table of Contents

Table of Contents ..........................................................................................................................................2 Foreword 6 Scope and Field of Application......................................................................................................................7

OPEN ISSUES........................................................................................................................................8 Part 3, Annex A Addendum...........................................................................................................................9

A.35 STRUCTURED REPORT DOCUMENT INFORMATION OBJECT DEFINITIONS .......................9 A.35.X CAD SR Information Object Definition .................................................................................9

A.35.X.1 Chest CAD SR Information Object Description ..........................................................9 A.35.X.2 Chest CAD SR IOD Entity-Relationship Model...........................................................9 A.35.X.3 Chest CAD SR IOD Module Table............................................................................10

A.35.X.3.1 ...Chest CAD SR IOD Content Constraints...............................................10 A.35.X.3.1.1.. Template Constraints ....................................................................10 A.35.X.3.1.2.. Value Type ....................................................................................10 A.35.X.3.1.3.. Relationship Constraints................................................................11

Part 3, Annex X Addendum.........................................................................................................................12 ANNEX X (INFORMATIVE) ..................................................................................................................12

X.1 Chest CAD SR Content Tree Structure ...................................................................................12 X.2 Chest CAD SR Observation Context Encoding .......................................................................16 X.3 Chest CAD SR Examples ........................................................................................................17 Example 1: Lung Nodule Detection with No Findings ....................................................................17 Example 2: Lung Nodule Detection with Findings..........................................................................18 Example 3: Lung Nodule Detection, Temporal Differencing with Findings ....................................22 Example 4: Lung Nodule Detection in Chest Radiograph, Spatially Correlated with CT..............25

Part 4 Addendum.........................................................................................................................................32 B.5 STANDARD SOP CLASSES..........................................................................................................32

B.5.1.5 Structured Reporting Storage SOP Classes......................................................................32 I.4 MEDIA STANDARD STORAGE SOP CLASSES............................................................................32 O.1 OVERVIEW..............................................................................................................................32 O.X BEHAVIOR OF AN SCU..........................................................................................................32

O.X.1 Chest CAD SR SOP Class................................................................................................32 O.2 BEHAVIOR OF AN SCP..........................................................................................................33

O.2.x Chest CAD SR SOP Class................................................................................................33 O.4 CONFORMANCE ....................................................................................................................33

O.4.1 Conformance Statement for an SCU ................................................................................33 O.4.1.x Chest CAD SR SOP Class .........................................................................................33

O.4.2 Conformance Statement for an SCP.................................................................................33 O.4.2.x Chest CAD SR SOP Class .........................................................................................33

Part 6 Addendum.........................................................................................................................................34 ANNEX A (NORMATIVE): REGISTRY OF DICOM UNIQUE IDENTIFIERS (UID) .............................34

Part 16 Addendum.......................................................................................................................................35 Annex A DCMR Templates (Normative) ................................................................................................35

A.X: CHEST CAD SR IOD TEMPLATES .............................................................................................35 TID XX00 Chest CAD Document Root Template........................................................................36 TID XX01 Chest CAD Findings Summary Template...................................................................38 TID XX02 Chest CAD Inferred Anatomy/Pathology Template....................................................39 TID XX03 Chest CAD Inferred Diseases Template ....................................................................40


TID XX04 Chest CAD Differential Diagnosis Template...............................................................41 TID XX05 Chest CAD Composite Feature Template ..................................................................42 TID XX06 Chest CAD Composite Feature Body Template.........................................................43 TID XX07 Chest CAD Single Image Finding Template...............................................................45 TID XX08 Chest CAD Modifiers ..................................................................................................47 TID XX09 Chest CAD Image Quality Template ..........................................................................48 TID XX10 Chest CAD Detections Performed Template..............................................................49 TID XX11 Chest CAD Analyses Performed Template ................................................................50 TID XX12 Chest CAD Detection Performed Template................................................................51 TID XX13 Chest CAD Analysis Performed Template .................................................................52 TID XX14 Chest CAD Image Library Entry Template .................................................................53 TID XX15 Chest CAD Geometry Template.................................................................................54 TID XX16 Chest CAD Disease Relationships Template .............................................................54 TID 4019 CAD Algorithm Identification Template .......................................................................55 TID 4022 CAD Observation Context Template ...........................................................................55 TID 1400 Linear Measurement Template ...................................................................................56 TID 1401 Area Measurement Template......................................................................................57 TID 1402 Volume Measurement Template .................................................................................58

Annex B DCMR Context Groups (Normative) ........................................................................................59 Annex D DICOM Controlled Terminology Definitions (Normative).........................................................88


DOCUMENT HISTORY

Document Version

Date Content

Initial draft 11 December 2000 A copy of Supplement 50, Mammography CAD SR, Rev. 24, with “mammography” changed to “chest” or “chest radiograph”

Rev 2 16 January 2001 Updated templates and context groups to be specific to Chest CAD, reusing some templates from Supplement 50, Mammography CAD SR, Rev. 24, and Supplement 53, Content Mapping Resource, Public Comment Based on Chest Terminology, Rev 1

Rev 3 26 February 2001 Updated to reflect style of Supplement 50, Mammography CAD SR, Letter Ballot, and Supplement 53, Content Mapping Resource, Letter Ballot Updated to reflect Chest Terminology, Rev 4 (before Dr. Tocino’s comments) Removed open issues regarding Rendering Intent (resolved in Supplement 50, Letter Ballot) Assigned temporary codes to all Concept Names (reused many codes from Supplements 50 & 53, Letter Ballot) Removed concepts of “Overall Impression/ Recommendation”, “Assessment Category”, and “Probability of Cancer”

Rev 4 23 April 2001 Example 4 added: correlation of findings on projection x-ray images and CT image slices.

Rev 5 7 May 2001 Updated to reflect Supplement 50, Draft Final Text, Supplement 53, Draft Final Text, and discussion at April 24-25 WG 15 meeting: removed “Individual Impression/Recommendation” level, added Interpretation (Inferred Disease) sub-tree separate from Single Image Findings and Composite Features

Rev 6 16 May 2001 Updated based on feedback from WG 6 during early draft presentation: 65 is the assigned Supplement number; recommended adding references to Mammography CAD SR templates that Chest CAD SR templates were “derived from”.

Rev 7 29 June 2001 Updated after discussion at June 13-14 WG 15 meeting. Restructured chest terminology categories and inference structure of Chest CAD SR. Added Anatomy/Pathology Interpretations, Disease Interpretations, and Association of Inferred Diseases sub-trees, separate from CAD Findings. Updated associated context groups.

Rev 8 7 September 2001 Revise TIDs XX03 and XX04, add XX16 for differential diagnosis (July 23 teleconference), and provide example (PS 3.3, Annex X); introduce CP-274, template parameters, potentially eliminating TID XX10-XX13, XX09 and XX14

Rev 9 1 October 2001 J Marshall updated examples. Added Include of TID 4019, CAD Algorithm Identification to TID XX04.


Rev 10 7 October 2001 J Marshall updated examples further following comments from J Keyes.

Rev 11 16 October 2001 J Marshall added some pictures to examples. J Keyes added content tree relationship pictures and explanations, and definitions to Part 16, Annex D.

Public Comment 2 November 2001 Feedback from WG 6 for Public Comment: clarify Open Issues, and change Likelihood of Related Disease relationship to Inferred Disease from R-INFERRED FROM to R-HAS PROPERTIES.


Foreword

This supplement to the DICOM standard introduces the DICOM format for the results of computer-aided detection (CAD) of potential malignancies in chest radiographs. The supplement provides the means for encoding a CAD system’s chest analysis. This includes such basic information as:

• Lesion type, e.g., lung nodule • Bounding regions of lesions, as given by a rectangle, ellipse or polyline

The supplement also defines the DICOM format for advanced chest findings more commonly associated with computer-aided diagnosis. Examples of such findings include the morphology of lesions, descriptions of the chest architecture, image quality metrics, and interpretations of inferred disease for the chest radiograph. The inclusion of computer-aided diagnosis information is optional, so makers of systems that produce only detection results can still use the format described herein.

This draft Supplement to the DICOM Standard was developed according to DICOM Committee Procedures. The DICOM Standard is developed in liaison with other Standards Organizations including HL7, CEN/TC 251 in Europe and MEDIS-DC, JAMI, and JIRA in Japan, with review by other organizations.

The DICOM Standard is structured as a multi-part document using the guidelines established in the following document:

- ISO/IEC Directives, 1989 Part 3 - Drafting and Presentation of International Standards.

This document is a Supplement to the DICOM Standard. It is an extension to PS 3.3, PS 3.4, PS 3.6 and PS 3.16 of the published DICOM Standard which consists of the following parts:

PS 3.1 - Introduction and Overview PS 3.2 - Conformance PS 3.3 - Information Object Definitions PS 3.4 - Service Class Specifications PS 3.5 - Data Structures and Encoding PS 3.6 - Data Dictionary PS 3.7 - Message Exchange PS 3.8 - Network Communication Support for Message Exchange PS 3.9 - Point-to-Point Communication Support for Message Exchange PS 3.10 - Media Storage and File Format PS 3.11 - Media Storage Application Profiles PS 3.12 - Media Formats and Physical Media PS 3.13 - Print Management - Point-to-point Communication Support PS 3.14 - Grayscale Standard Display Function PS 3.15 - Security Profiles PS 3.16 - Content Mapping Resource

These Parts are independent but related documents.


Scope and Field of Application

This supplement to the DICOM standard only defines how the results of a computer’s chest analysis should be encoded. It does not define or describe inputs to the chest CAD system other than use of chest CAD output (e.g. prior report) as input to subsequent temporal analyses; nor does it describe output for studies other than chest radiographs. Note that the input may be comprised of digitized or digitally acquired X-ray images, CT slices or other germane 2-D chest images. Some of the information described is beyond that which current chest CAD systems can produce. However, the DICOM committee includes it because it is expected to become relevant during the lifetime of the supplement.

The chest CAD output is in the form of a DICOM Structured Report. The report can be used on its own, for example for displaying the detected lesions on a monitor or printer. It can be used within a larger Structured Report document, e.g., as part of a comprehensive chest imaging report. It can even be used as input to a chest CAD system, for example to provide information on detections in prior chest radiography procedures. In all cases, the output is a Structured Report (SR), so readers should become familiar with the Comprehensive SR IOD and corresponding SOP class. In addition, provision has been made to allow description of the chest CAD output using common chest terminology and nomenclature (see additions to PS 3.16, Normative References). International organizations are being encouraged to contribute additional terminology and nomenclature.

This document specifies the Chest CAD SR IOD and the corresponding Chest CAD Storage SOP class. It is modeled after the DICOM Mammography CAD SR IOD and its corresponding Mammography CAD SR Storage SOP class. Since this supplement proposes changes to existing parts of DICOM, the reader should have a working understanding of the Standard.

The Chest CAD SR IOD is designed to allow minimal content, depending on the capabilities of the chest CAD system producing this object. Since the content tree defined in this document can incorporate many of the same interpretations a human observer would make (at least for a period of time), it is not a requirement that chest CAD systems be able to fully encode all content items in the content tree templates. Instead, chest CAD systems may populate optional content items as they see fit, to meet the requirements of the market; different chest CAD systems may produce different content.

The content sparseness does put more burden onto devices parsing and interpreting the content tree. Interoperability needs may force parsers to handle a broad array of sparsely populated content trees.


OPEN ISSUES

1. All of the Concept Names and Context Groups defined in this Supplement must be assigned Code Values. WG 15 will work with the Codes AHG, ACR, and CAP to complete this.

2. WG 15 will support language translation of Code Meanings as defined by the WG6 Codes AHG. Terms that do not have an existing English language equivalent may be added to context groups, if an English language description (maximum 64 characters) is provided.

3. Do the lists of Composite Feature categories and terms make sense compared to the list of Single Image Finding terms (see CID YY20, YY21, YY35)? Do correlation types other than temporal and spatial apply for Composite Features (see CID 6035, duplicated from Supplement 50)?

4. Confirm reuse of templates and context groups from Supplement 50 (Mammography CAD SR): TID 4019, TID 4022; CID 6034, 6035 (?), 6036, 6040, 6042, 6044, 6046, 6047.

5. Confirm reuse of generalized Measurement templates and context groups from Supplement 53 (DICOM Content Mapping Resource): TID 1400, 1401, 1402; CID 7460, 7461, 7462, 7470, 7471, 7472. The Linear and Area Measurement templates do not handle multi-planar measurements (pending CP-265).

6. CID YY18 (Change Since Last Chest Radiograph or Prior Surgery) is present, but not referenced. If there is no use for it, it will be deleted. If it is applicable, to which level does it apply (differential diagnosis, inferred disease, inferred anatomy/pathology, composite feature, single image finding), and what should the Concept Name be?

7. Verify Value Multiplicity of content items in general, but especially in TID XX08, Modifiers.

8. At this point, Patient Clinical History is not included in the Chest CAD SR. Is it acceptable to leave it out? Note: There is no standard means at this time for a CAD device to obtain Patient Clinical History information. WG 8 (Structured Reporting) currently has an approved work item to define a standard for the exchange of Patient Clinical History information.

9. Is the generalizing, then reuse of some CAD templates a desirable approach? Pending approval of CP-274, template parameters, WG 15 intends to reuse TIDs 1415-1418 (Detections and Analyses Performed) from Supplement 50, Mammography CAD SR (with modifications to add parameters for value set constraints) in place of TIDs XX10-XX13, TID 1414 (Image Quality) in place of TID XX09, and TID 1420 (Image Library Entry) in place of TID XX14. Note: The modifications to the Mammography CAD SR templates will be included in this Supplement. The modifications will not affect the Mammography CAD SR structure or content, and thereby do not break the rule that templates invoked as Enumerated cannot be changed.

10. Should the concept of Differential Diagnosis that is applied to Inferred Diseases also be applied to Inferred Anatomy/Pathology and/or Composite Features and Single Image Findings? Does the representation of Differential Diagnoses for Inferred Diseases represent all of the use cases? In particular, the ability to subdivide a differential diagnosis.


Add the following to PS 3.3 Section 4 Symbols and Abbreviations

Chest CAD Computer-Aided Detection and/or Computer-Aided Diagnosis for Chest Radiography

Part 3, Annex A Addendum

Add the following to PS 3.3 Annex A

Update the Composite Module Table to include Chest CAD SR IOD and Modules

IODs Modules

Chest CAD SR

Patient M

Specimen Identification

C

General Study M

Patient Study U

SR Document Series

M

General Equipment

M

SR Document General

M

SR Document Content

M

SOP Common M

A.35 STRUCTURED REPORT DOCUMENT INFORMATION OBJECT DEFINITIONS

A.35.X CAD SR Information Object Definition A.35.X.1 Chest CAD SR Information Object Description The Chest CAD SR IOD is used to convey the detection and analysis results of a chest CAD device. The content may include textual and a variety of coded information, numeric measurement values, references to the SOP Instances, and spatial regions of interest within such SOP Instances. Relationships by-reference are enabled between Content Items.

A.35.X.2 Chest CAD SR IOD Entity-Relationship Model The E-R Model in Section A.1.2 of this Part applies to the Chest CAD SR IOD. The Frame of Reference IE, and the IEs at the level of the Image IE in Section A.1.2 are not components of the Chest CAD SR IOD. Table A.35.X-1 specifies the Modules of the Chest CAD SR IOD.


A.35.X.3 Chest CAD SR IOD Module Table Table A.35.X-1 specifies the Modules of the Chest CAD SR IOD.

Table A.35.X-1 CHEST CAD SR IOD MODULES

IE Module Reference Usage Patient Patient C.7.1.1 M Specimen Identification C.7.1.2 C - Required if the Observation Subject is a

Specimen Study General Study C.7.2.1 M Patient Study C.7.2.2 U Series SR Document Series C.17.1 M Equipment General Equipment C.7.5.1 M Document SR Document General C.17.2 M SR Document Content C.17.3 M SOP Common C.12.1 M

A.35.X.3.1 Chest CAD SR IOD Content Constraints A.35.X.3.1.1 Template Constraints • The document shall be constructed from TID XX00 Chest CAD Document Root invoked at the root

node. • When a content item sub-tree from a prior document is duplicated by-value, its observation context

shall be defined by TID 1001, Observation Context, and its subordinate templates, as described in PS 3.16, DCMR Templates [Editor’s note: Supplement 53, DICOM Content Mapping Resource (DCMR), Final Text].

Note: All Template and Context Group definitions are located in PS 3.16, DICOM Content Mapping Resource,

in the Annexes titled DCMR Templates and DCMR Context Groups, respectively.

A.35.X.3.1.2 Value Type Value Type (0040,A040) in the Content Sequence (0040,A730) of the SR Document Content Module is constrained to the following Enumerated Values (see Table C.17.3-1 for Value Type definitions):

TEXT CODE NUM DATE TIME PNAME SCOORD COMPOSITE IMAGE CONTAINER UIDREF

[Editor’s note: This is a subset of the list for Comprehensive SR, omitting DATETIME, TCOORD and WAVEFORM. Confirm that this limitation is acceptable for the long term.]


A.35.X.3.1.3 Relationship Constraints

The Chest CAD SR IOD makes extensive use of by-reference INFERRED FROM and by-reference SELECTED FROM relationships. Other relationships by-reference are forbidden. Table A.35.X-2 specifies the relationship constraints of this IOD. See Table C.17.3-2 for Relationship Type definitions.

Table A.35.X-2 RELATIONSHIP CONTENT CONSTRAINTS FOR CHEST CAD SR IOD

Source Value Type Relationship Type (Enumerated Values)

Target Value Type

CONTAINER CONTAINS CODE, IMAGE1, CONTAINER.

CODE HAS OBS CONTEXT TEXT, CODE, DATE, PNAME, UIDREF, COMPOSITE1.

IMAGE HAS ACQ CONTEXT TEXT, CODE, DATE, TIME, NUM.

CONTAINER, CODE, COMPOSITE

HAS CONCEPT MOD CODE2.

TEXT, CODE, NUM HAS PROPERTIES TEXT, CODE, NUM, DATE, IMAGE1, SCOORD.

CODE, NUM INFERRED FROM CODE, NUM, SCOORD, CONTAINER, IMAGE1.

SCOORD SELECTED FROM IMAGE1.

Note: 1. Which SOP Classes the IMAGE or COMPOSITE Value Type may refer to, is documented in the Conformance Statement for an application (see PS 3.2 and PS 3.4). 2. The HAS CONCEPT MOD relationship is used to modify the meaning of the Concept Name of a Source Content Item, for example to provide a more descriptive explanation, a different language translation, or to define a post-coordinated concept.

[Editor’s note: This is a subset of the table for Comprehensive SR, reflecting only the combinations used by the templates for Chest CAD SR, and omitting several source-relationship-target combinations. Confirm that these limitations are acceptable for the long term.]


Part 3, Annex X Addendum

Add the following to PS 3.3

ANNEX X (INFORMATIVE)

X.1 Chest CAD SR Content Tree Structure The templates for the Chest CAD SR IOD are defined in PS 3.16, Annex A, DCMR Templates. Relationships defined in the Chest CAD SR IOD templates are by-value, unless otherwise stated. Content items referenced from another SR object instance, such as a prior Chest CAD SR, are inserted by-value in the new SR object instance, with appropriate original source observation context. It is necessary to update Rendering Intent, and referenced content item identifiers for by-reference relationships, within content items paraphrased from another source.

CONTAINS

CONTAINS

INFERRED FROM

• • •

Document Root(CONTAINER)

CompositeFeatureCategory(CODE)

Single ImageFinding

Category(CODE)

HAS PROPERTIES HAS PROPERTIES

• • •

Summary ofDetections

(CODE)

Image Library(CONTAINER)

CONTAINS

CAD Processing andFindings Summary

(CODE)

(IMAGE) (IMAGE)

• • •

HASACQUISITIONCONTEXT

HASACQUISITIONCONTEXT

• • •

INFERRED FROM

• • •

Summary ofAnalyses(CODE)

INFERRED FROM

• • •

Anatomy/PathologyInterpretations(CONTAINER)

Association ofInferred Diseases

(CONTAINER)

• • •

CONTAINS

• • •

DiseaseInterpretations(CONTAINER)

CONTAINS

• • •

Figure x.x.x.1: Top Levels of Chest CAD SR Content Tree

The Document Root, Image Library, CAD Processing and Findings Summary, Anatomy/Pathology Interpretations, Disease Interpretations, Association of Inferred Diseases, and Summaries of Detections and Analyses sub-trees together form the content tree of the Chest CAD SR IOD.

The Inferred Anatomy/Pathology content items in the Anatomy/Pathology Interpretations sub-tree may reference (i.e., have a by-reference inferred from relationship to) single image finding and/or composite feature content items in the CAD Processing and Findings Summary sub-tree. The Inferred Disease content items in the Disease Interpretations sub-tree may reference content items in the CAD Processing and Findings Summary and/or Anatomy/Pathology Interpretations sub-trees. The Associations of Inferred Diseases content items may reference content items in the Disease Interpretations sub-tree. These relationships are depicted in Figures x.x.x.2 and x.x.x.3.


CONTAINS


CAD Processing andFindings Summary

(CODE)

DiseaseInterpretations(CONTAINER)

CONTAINS

Inferred Disease(CODE)Composite Feature

Category (CODE)Single Image

Finding Category(CODE)

Single ImageFinding Category

(CODE)

Inferred Disease(CODE)

R-INFERREDFROM

Anatomy/PathologyInterpretations(CONTAINER)

InferredAnatomy/Pathology

(CODE)


(CODE)


(CODE)

Composite FeatureCategory (CODE)

R-INFERREDFROM

R-INFERREDFROMSingle Image

Finding Category(CODE)

Single ImageFinding Category

(CODE)

R-INFERREDFROM

Inferred Disease(CODE)

R-INFERREDFROM

Figure x.x.x.2: Example of Sub-tree Relationships within Chest CAD SR Content Tree

Figure x.x.x.2 depicts an example of the intended use of the by-reference relationships between content items in the Disease Interpretations, Anatomy/Pathology Interpretations, and CAD Processing and Findings Summary sub-trees, as defined in TID XX01, XX02, XX03, XX05 and XX07.


CONTAINS


Association ofInferred Diseases

(CONTAINER)

CONTAINS

• • •DiseaseInterpretations(CONTAINER)

CONTAINS

• • •

Inferred Disease(CODE) Pulmonary

infarct DifferentialDiagnosis/Impression

(CODE) Infiltrate in lungInferred Disease

(CODE) Pneumonia

Inferred Disease(CODE) Pneumo-

coccal

Inferred Disease(CODE) Staph-

pneumonia

Inferred Disease(CODE) Lung

cancer

Likelihood ofRelated Disease

(NUM) 95%


(NUM) 5%


(NUM) 5%


(NUM) 80%


(NUM) 15%

HAS PROP

HAS PROP

R-HASPROPERTIES

R-HASPROPERTIES

R-HASPROPERTIES

• • •

Figure x.x.x.3: Example of Disease Interpretations and Association of Inferred Diseases sub-trees

of Chest CAD SR Content Tree

Figure x.x.x.3 depicts the intended use of the Association of Inferred Diseases sub-tree with the Disease Interpretations sub-tree, as defined in TID XX03, TID XX04, and TID XX16. Every Inferred Disease that makes up a Differential Diagnosis/Impression must be instantiated by-value in the Disease Interpretations sub-tree. However, every Inferred Disease in the Disease Interpretations sub-tree does not have to be referenced by a Differential Diagnosis/Impression. It is recommended that the sum of the values of sibling Likelihood of Related Disease content items be 100% (e.g., 15% + 80% + 5% = 100%, and 95% + 5% = 100%). TID XX16 allows further subdivision within a referenced inferred disease, by self-invocation of TID XX16 as a child content item of Likelihood of Related Disease.


• • •

CONTAINS

Successful Detections(CONTAINER)

Successful Analyses(CONTAINER)

Failed Detections(CONTAINER)

Detection Performed(CODE)



CONTAINS

• • •

• • •• • •• • • • • •

Analysis Performed(CODE)



• • •

• • •• • •• • •

CONTAINS




• • •

• • •

Failed Analyses(CONTAINER)

CONTAINS

INFERRED FROM

Summary of Detections(CODE)




• • •

• • •

By-Reference to ImageLibrary (IMAGE)

Image Region(SCOORD)

SELECTED FROM

• • •

• • •

By-Reference to ImageLibrary (IMAGE)

Image Region(SCOORD)

SELECTED FROM

• • •

• • •

INFERRED FROM

Summary of Analyses(CODE)

Figure x.x.x.4: Summary of Detections and Analyses Levels of Chest CAD SR Content Tree

Editor’s note: If CP-274 is approved, delete this figure and reference the corresponding figure in the Mammography CAD SR informative annex and reword the description below to be general to all CAD.

The Summary of Detections and Summary of Analyses sub-trees identify the algorithms used and the work done by the chest CAD device, and whether or not each process was performed on one or more entire images or selected regions of images. The findings of the detections and analyses are not encoded in the summary sub-trees, but rather in the Chest CAD Findings Summary sub-tree. Chest CAD processing may produce no findings, in which case the sub-trees of the Chest CAD Findings Summary sub-tree are incompletely populated. This occurs in the following situations:

a. All algorithms succeeded, but no findings resulted b. Some algorithms succeeded, some failed, but no findings resulted c. All algorithms failed

Note 1: If the tree contains no Composite Feature or Single Image Finding nodes and all attempted detections

and analyses succeeded then the CAD device made no findings. Note 2: Detections and Analyses that are not attempted are not listed in the Summary of Detections and

Summary of Analyses trees. Note 3: If the code value of the Summary of Detections or Summary of Analyses codes in TID XX00 is “Not

Attempted” then no detail of which algorithms were not attempted is provided.


DETECTIONS

INFERRED FROM

• • •

CAD Processing and FindingsSummary (Code)

INFERRED FROM

Composite FeatureCategory (Code)

Single Image FindingCategory(Code)

Single Image FindingCategory (Code)


INFERRED FROM INFERRED FROM



HAS PROPERTIES

• • •

HAS PROPERTIES

• • •

HAS PROPERTIES

• • •

Single Image FindingCategory(Code)

HAS PROPERTIES

• • •

ANALYSES

Figure x.x.x.5: Example of CAD Processing and Findings Summary sub-tree of Chest CAD SR Content Tree

The shaded area in Figure x.x.x.5 demarcates information resulting from Detection, whereas the unshaded area is information resulting from Analysis. This distinction is used in determining whether to place algorithm identification information in the Summary of Detections or Summary of Analyses sub-trees.

The identification of a lung nodule within a single image is considered to be a Detection, which results in a Single Image Finding. The temporal correlation of a lung nodule in two instances of the same view taken at different times, resulting in a Composite Feature, is considered Analysis.

Once a Single Image Finding or Composite Feature has been instantiated, it may be referenced by any number of Composite Features higher in the CAD Processing and Findings Summary sub-tree, or any Inferred Anatomy/Pathology or Inferred Disease in those separate sub-trees.

X.2 Chest CAD SR Observation Context Encoding • Any content item in the Content tree that has been inserted (i.e., duplicated) from another SR object

instance has a HAS OBS CONTEXT relationship to one or more content items that describe the context of the SR object instance from which it originated. This mechanism may be used to combine reports (e.g., Chest CAD 1, Chest CAD 2, Human).

• By-reference relationships within Single Image Findings and Composite Features paraphrased from prior Chest CAD SR objects need to be updated to properly reference Image Library Entries carried from the prior object to their new positions in the present object.

The CAD Processing and Findings Summary section of the SR Document Content tree of a Chest CAD SR IOD may contain a mixture of current and prior single image findings and composite features. The content items from current and prior contexts are target content items that have a by-value INFERRED FROM relationship to a Composite Feature content item. Content items that come from a context other


than the Initial Observation Context have a HAS OBS CONTEXT relationship to target content items that describe the context of the source document.

In Figure x.x.x.6, Composite Feature and Single Image Finding are current, and Single Image Finding (from Prior) is duplicated from a prior document.

HAS PROPERTIES

HAS OBS CONTEXT

HAS PROPERTIES




from prior

Source DocumentContext Info.

• • • • • •

Figure x.x.x.6: Example of Use of Observation Context

X.3 Chest CAD SR Examples The following is a simple and non-comprehensive illustration of an encoding of the Chest CAD SR IOD for Chest computer aided detection results. For brevity, some Mandatory content items are not included, such as several acquisition context content items for the images in the Image Library.

Example 1: Lung Nodule Detection with No Findings A chest CAD device processes a typical screening Chest case, i.e., there is one image and no nodule findings. Chest CAD runs lung nodule detection successfully and finds nothing. Chest CAD does no anatomy/pathology interpretations, nor does it make disease interpretations or associate inferred diseases.

The Chest radiograph resembles:

PROJECTION CHEST

Figure x.x.x.7: Chest radiograph as Described in Example 1

The content tree structure would resemble:

Node Code Meaning of Concept Name Code Meaning or Example Value

TID



TID

1 Chest CAD Report XX00 1.1 Image Library XX00 1.1.1 IMAGE 1 XX14 1.1.1.1 Image View Antero-posterior XX14 1.1.1.2 Study Date 19980101 XX14 1.2 CAD Processing and Findings Summary All algorithms succeeded;

without findings XX01

1.3 Summary of Detections Succeeded XX00 1.3.1 Successful Detections XX10 1.3.1.1 Detection Performed Nodule XX12 1.3.1.1.1 Algorithm Name “Lung Nodule Detector” 4019 1.3.1.1.2 Algorithm Version “V1.3” 4019 1.3.1.1.3 Reference to node 1.1.1 xx12 1.4 Summary of Analyses Not Attempted XX00

Example 2: Lung Nodule Detection with Findings and Anatomy/Pathology Interpretation A chest CAD device processes a screening Chest case with one image, and a lung nodule detected. Additional CAD analysis infers a possible pathology. The Chest radiograph resembles:

PROJECTION CHEST

Figure x.x.x.8: Chest radiograph as Described in Example 2

The content tree structure in this example is complex. Structural illustrations of portions of the content tree are placed within the content tree table to show the relationships of data within the tree. Some content items are duplicated (and shown in boldface) to facilitate use of the diagrams. (Editor’s note: Illustrations to be completed later)


CHESTCAD REPORTCONTAINER

IMAGE LIBRARYCONTAINER

1.1

CAD PROCESSINGAND

FINDINGS SUMMARYCODE

1.2

SUMMARY OFDETECTIONS

CODE: Succeeded1.4

SUMMARY OFANALYSES

CODE: Succeeded1.5

CONTAINS

ANATOMY/PATHOLOGYINTERPRETATIONS

CONTAINER1.3

Figure x.x.x.9: Content Tree Root of Example 2 Content Tree

The content tree structure would resemble:


TID

1 Chest CAD Report XX00 1.1 Image Library XX00 1.2 CAD Processing and Findings Summary All algorithms

succeeded; with findings

XX01

1.3 Anatomy/Pathology Interpretations XX00 1.4 Summary of Detections Succeeded XX00 1.5 Summary of Analyses Succeeded XX00


IMAGE LIBRARYCONTAINER

1.1

CONTAINS

IMAGE

HAS ACQCONTEXT

Image View

Study Date

Referencesfrom elsewherein content tree

Figure x.x.x.10: Image Library Branch of Example 2 Content Tree


TID

1.1 Image Library XX00 1.1.1 IMAGE 1 XX14 1.1.1.1 Image View Antero-posterior XX14 1.1.1.2 Study Date 19990101 XX14

CAD PROCESSING ANDFINDINGS SUMMARY

CODE: All algorithms succeeded; with findings

1.2

SINGLE IMAGE FINDING

CATEGORY CODE 1.2.1

INFERREDFROM


Figure x.x.x.11: CAD Processing and Findings Summary Portion of Example 2 Content Tree


TID

1.2 CAD Processing and Findings Summary All algorithms succeeded; with findings

XX01

1.2.1 Single Image Finding Category Abnormal Opacity XX07 1.2.1.1 Rendering Intent For Presentation XX07 1.2.1.2 Single Image Finding Nodule XX07 1.2.1.3 Algorithm Name “Lung Nodule Detector” 4019 1.2.1.4 Algorithm Version “V1.3” 4019 1.2.1.5 Center POINT XX15 1.2.1.5.1 Reference to Node 1.1.1 XX15 1.2.1.6 Outline POLYLINE XX15 1.2.1.6.1 Reference to Node 1.1.1 XX15 1.2.1.7 Diameter 2 cm 1400 1.2.1.7.1 Path POLYLINE 1400 1.2.1.7.1.1 Reference to Node 1.1.1 1400 1.3 Anatomy/Pathology Interpretations XX00 1.3.1 Inferred Anatomy/Pathology Fibrosis XX02 1.3.1.1 Associated Chest Component Lungs XX02 1.3.1.2 Certainty of inference 85% XX02 1.3.1.3 Probability of pathology 79% XX02 1.3.1.4 Pathology presence Clearly present XX02 1.3.1.5 Algorithm Name “Fibrosis from Nodule” 4019 1.3.1.6 Algorithm Version “V5.2” 4019 1.3.1.7 Reference to Node 1.1.1 XX02 1.4 Summary of Detections Succeeded XX00 1.4.1 Successful Detections XX10 1.4.1.1 Detection Performed Nodule XX12 1.4.1.1.1 Algorithm Name “Lung Nodule Detector” 4019 1.4.1.1.2 Algorithm Version “V1.3” 4019 1.4.1.1.3 Reference to node 1.1.1 XX12 1.5 Summary of Analyses Succeeded XX00 1.5.1 Successful Analyses XX11



TID

1.5.1.1 Analysis Performed XX13 1.5.1.1.1 Algorithm Name “Fibrosis from Nodule” 4019 1.5.1.1.2 Algorithm Version “V5.2” 4019 1.5.1.1.3 Reference to node 1.1.1 XX13

Example 3: Lung Nodule Detection, Temporal Differencing with Findings The patient in Example 2 returns for another Chest radiograph. A more comprehensive chest CAD device processes the current Chest radiograph, and analyses are performed that determine some temporally related content items for Composite Features. Portions of the prior chest CAD report (Example 2) are incorporated into this report. In the current Chest radiograph the lung nodule has increased in size. (Editor’s note: pictures to be inserted later)

PRIOR PROJECTION CHEST

CURRENT PROJECTION CHEST

Figure x.x.x.12: Chest radiographs as Described in Example 3

Italicized entries (xxx) in the following table denote references to or by-value inclusion of content tree items reused from the prior Chest CAD SR instance (Example 2).


TID

1 Chest CAD Report XX00


While the Image Library contains references to content tree items reused from the prior Chest CAD SR instance, the images are actually used in the chest CAD analysis and are therefore not italicized as indicated above.


TID

1.1 Image Library XX00 1.1.1 IMAGE 1 XX14 1.1.1.1 Image View Antero-posterior XX14 1.1.1.2 Study Date 20000101 XX14 1.1.2 IMAGE 2 XX14 1.1.2.1 Image View Antero-posterior XX14 1.1.2.2 Study Date 19990101 XX14 The CAD processing and findings consist of one composite feature, comprised of single image findings, one from each year. The temporal relationship allows a quantitative temporal difference to be calculated:


TID


XX01

1.2.1 Composite Feature Category Abnormal Opacity XX05 1.2.1.1 Rendering Intent For Presentation XX05 1.2.1.2 Composite Feature Nodule XX05 1.2.1.3 Composite Type Target content items are

related temporally XX06

1.2.1.4 Scope of Feature Feature detected on multiple images

XX06

1.2.1.5 Algorithm Name “Nodule Change” 4019 1.2.1.6 Algorithm Version “V2.3” 4019 1.2.1.7 Certainty of Feature 85% XX06 1.2.1.8 Difference in size 2 cm XX06 1.2.1.8.1 Reference to Node

1.2.1.9.7 XX06

1.2.1.8.2 Reference to Node 1.2.1.10.7

XX06

1.2.1.9 Single Image Finding Category Abnormal Opacity XX07 1.2.1.9.1 Rendering Intent For Presentation XX07 1.2.1.9.2 Single Image Finding Nodule XX07 1.2.1.9.3 Algorithm Name “Lung Nodule Detector” 4019 1.2.1.9.4 Algorithm Version “V1.3” 4019 1.2.1.9.5 Center POINT XX15



TID

1.2.1.9.5.1 Reference to Node 1.1.1 XX15 1.2.1.9.6 Outline POLYLINE XX15 1.2.1.9.6.1 Reference to Node 1.1.1 XX15 1.2.1.9.7 Diameter 4 cm 1400 1.2.1.9.7.1 Path POLYLINE 1400 1.2.1.9.7.1.1 Reference to Node 1.1.1 1400 1.2.1.10 Single Image Finding Category Abnormal Opacity XX07 1.2.1.10.1 Rendering Intent For Presentation XX07 1.2.1.10.2 Single Image Finding Nodule XX07 1.2.1.10.3 Algorithm Name “Lung Nodule Detector” 4019 1.2.1.10.4 Algorithm Version “V1.3” 4019 1.2.1.10.5 Center POINT XX15 1.2.1.10.5.1 Reference to Node 1.1.2 XX15 1.2.1.10.6 Outline POLYLINE XX15 1.2.1.10.6.1 Reference to Node 1.1.2 XX15 1.2.1.10.7 Diameter 2 cm 1400 1.2.1.10.7.1 Path POLYLINE 1400 1.2.1.10.7.1.1 Reference to Node 1.1.2 1400 1.2.1.10.8 [Observation Context content items] 4022 1.3 Anatomy/Pathology Interpretations XX00 1.3.1 Inferred Anatomy/Pathology Nodule XX02 1.3.1.1 Associated Chest Component Lungs XX02 1.3.1.2 Certainty of Inference 94% XX02 1.3.1.3 Probability of Pathology 86% XX02 1.3.1.4 Pathology Presence Clearly Present XX02 1.3.1.5 Algorithm Name “Nodule Interpreter” 4019 1.3.1.6 Algorithm Version “V0.9” 4019 1.3.1.7 Reference to Node 1.2.1 XX02 1.4 Summary of Detections Succeeded XX00 1.4.1 Successful Detections XX10 1.4.1.1 Detection Performed Nodule XX12 1.4.1.1.1 Algorithm Name “Lung Nodule Detector” 4019 1.4.1.1.2 Algorithm Version “V1.3” 4019 1.4.1.1.3 Reference to node 1.1.1 XX12



TID

1.5 Summary of Analyses Succeeded XX00 1.5.1 Successful Analyses XX11 1.5.1.1 Analysis Performed XX13 1.5.1.1.1 Algorithm Name “Nodule Change” 4019 1.5.1.1.2 Algorithm Version “V2.3” 4019 1.5.1.1.3 Reference to node 1.1.1 XX13 1.5.1.1.4 Reference to node 1.1.2 XX13 1.5.1.2 Analysis Performed XX13 1.5.1.2.1 Algorithm Name “Nodule Interpreter” 4019 1.5.1.2.2 Algorithm Version “V0.9” 4019 1.5.1.2.3 Reference to node 1.1.1 XX13

Example 4: Lung Nodule Detection in Chest Radiograph, Spatially Correlated with CT The patient in Example 3 is called back for CT to confirm the Lung Nodule found in Example 3. The patient undergoes CT of the Thorax and the initial chest radiograph and CT slices are sent to a more comprehensive CAD device for processing. Findings are detected and analyses are performed that correlate findings from the two data sets. Portions of the prior CAD report (Example 3) are incorporated into this report.

PROJECTION CHEST (PRIOR)

CT SLICES (CURRENT)


Figure x.x.x.13: Chest radiograph and CT slice as described in Example 3

Italicized entries (xxx) in the following table denote references to or by-value inclusion of content tree items reused from the prior Chest CAD SR instance (Example 3).

Node Code Meaning of Concept Name Code Meaning of Example Value

TID

1 Chest CAD Report XX00 1.1 Language of Content Item and

Descendants English 1204

1.1.1 Country of Language UNITED STATES 1204 1.2 Image Library XX00 1.3 CAD Processing and Findings Summary All algorithms succeeded;

with findings XX01

1.4 Anatomy/Pathology Interpretations XX00 1.5 Disease Interpretations XX00 1.6 Association of Inferred Diseases XX00 1.7 Summary of Detections XX00 1.8 Summary of Analyses XX00 While the Image Library contains references to content tree items reused from the prior Chest CAD SR instance, the images are actually used in the CAD analysis and are therefore not italicized as indicated above.


TID

1.2 Image Library XX00 1.2.1 IMAGE 1 XX14 1.2.1.1 Image View Code Sequence Antero-posterior XX14 1.2.1.2 Study Date 20000101 XX14 1.2.2 IMAGE 2 [CT slice 245] XX14 1.2.2.1 Study Date 20000201 XX14 1.2.3 IMAGE 3 [CT slice 246] XX14 1.2.3.1 Study Date 20000201 XX14 1.2.4 IMAGE 4 [CT slice 247] XX14 1.2.4.1 Study Date 20000201 XX14 Most recent examination content:


TID


XX01

1.3.1 Composite Feature Category Abnormal opacity XX05



TID

1.3.1 Composite Feature Category Abnormal opacity XX05 1.3.1.1 Rendering Intent Presentation Required XX05 1.3.1.2 Composite Feature Nodule XX05 1.3.1.3 Composite type Target content items are

related spatially XX06

1.3.1.4 Scope of Feature Feature detected on images from multiple modalities

XX06

1.3.1.5 Algorithm Name “Chest/CT Correlator” 4019 1.3.1.6 Algorithm Version “V2.1” 4019 1.3.1.7 Diameter 4 cm 1400 1.3.1.7.1 Path 1400 1.3.1.7.1.1 Reference to node 1.2.3 1400 1.3.1.8 Volume estimated from single 2D region 3.2 cm3 1402 1.3.1.8.1 Perimeter Outline 1402 1.3.1.8.1.1 Reference to node 1.2.3 1402 1.3.1.9 Size Modifier Small XX08 1.3.1.10 Border Shape Lobulated XX08 1.3.1.11 Location in Chest Mid lobe XX08 1.3.1.12 Side of Chest Right XX08 1.3.1.13 Composite Feature Category Abnormal opacity XX05 1.3.1.14 Single Image Finding Category Abnormal opacity XX07


TID

1.3.1.13 Composite Feature Category Abnormal opacity XX05 1.3.1.13.1 Rendering Intent Presentation Required XX05 1.3.1.13.2 Composite Feature Nodule XX05 1.3.1.13.3 Composite type Target content items are

related spatially XX06

1.3.1.13.4 Scope of Feature Feature detected on multiple images

XX06

1.3.1.13.5 Algorithm Name “Nodule Builder” 4019 1.3.1.13.6 Algorithm Version “V1.4” 4019 1.3.1.13.7 Diameter 4 cm 1400 1.3.1.13.8 Volume estimated from single 2D region 3.2 cm3 1402 1.3.1.13.9 Single Image Finding Category Abnormal opacity XX07 1.3.1.13.10 Single Image Finding Category Abnormal opacity XX07 1.3.1.13.11 Single Image Finding Category Abnormal opacity XX07



TID

1.3.1.13.9 Single Image Finding Category Abnormal opacity XX07 1.3.1.13.9.1 Rendering Intent Presentation Required XX07 1.3.1.13.9.2 Single Image Finding Nodule XX07 1.3.1.13.9.3 Algorithm Name “CT Nodule Detector” 4019 1.3.1.13.9.4 Algorithm Version “V2.5” 4019 1.3.1.13.9.5 Center POINT XX15 1.3.1.13.9.5.1 Reference to node 1.2.2 XX15 1.3.1.13.9.6 Outline POLYLINE XX15 1.3.1.13.9.6.1 Reference to node 1.2.2 XX15


TID



TID



TID

1.3.1.14 Single Image Finding Category Abnormal opacity XX07 1.3.1.14.1 Rendering Intent Presentation Required XX07 1.3.1.14.2 Single Image Finding Nodule XX07



TID

1.3.1.14.3 Algorithm Name “Lung Nodule Detector” 4019 1.3.1.14.4 Algorithm Version “V1.3” 4019 1.3.1.14.5 Center POINT XX15 1.3.1.14.5.1 Reference to node 1.2.1 XX15 1.3.1.14.6 Outline POLYLINE XX15 1.3.1.14.6.1 Reference to node 1.2.1 XX15 1.3.1.14.7 Diameter 4 cm 1400 1.3.1.14.7.1 Path POLYLINE 1400 1.3.1.14.7.1.1 Reference to Node 1.2.1 1400 1.3.1.14.8 [Observation Context content items] 4022


TID

1.4 Anatomy/Pathology Interpretations XX00 1.4.1 Inferred Anatomy/Pathology Nodule XX02 1.4.1.1 Associated Chest Component Lungs XX02 1.4.1.2 Certainty of Inference 94% XX02 1.4.1.3 Probability of Pathology 86% XX02 1.4.1.4 Pathology Presence Clearly Present XX02 1.4.1.5 Algorithm Name “Nodule Interpreter” 4019 1.4.1.6 Algorithm Version “V1.2” 4019 1.4.1.7 Composite Feature Reference to Node 1.3.1 XX02


TID

1.5 Disease Interpretations XX00 1.5.1 Inferred Disease Editor’s note: Add a

disease that matches 1.6.1

XX03

1.5.1.1 Inferred Disease Category Neoplastic XX03 1.5.1.2 Certainty of Inference 31% XX03 1.5.1.3 Disease Presence Clearly Present XX03 1.5.1.4 Algorithm Name “Disease Analyzer” 4019 1.5.1.5 Algorithm Version “V0.3” 4019 1.5.1.6 Reference to Node 1.3.1 XX03 1.5.1.7 Reference to Node 1.4.1 XX03



TID

1.5.2 Inferred Disease Pneumococcal XX03 1.5.2.1 Inferred Disease Category Infectious XX03 1.5.2.2 Certainty of Inference 36% XX03 1.5.2.3 Disease Presence Clearly Present XX03 1.5.2.4 Algorithm Name “Disease Analyzer” 4019 1.5.2.5 Algorithm Version “V0.3” 4019 1.5.2.6 Reference to Node 1.3.1 XX03 1.5.2.7 Reference to Node 1.4.1 XX03


TID

1.6 Association of Inferred Diseases XX00 1.6.1 Differential Diagnosis/Impression Editor’s Note: Add a type

of cancer XX04

1.6.1.1 Impression Description “Evidence of squamous cell carcinoma”

XX04

1.6.1.2 Algorithm Name “Differential Diagnoser” 4019 1.6.1.3 Algorithm Name “V6.6” 4019 1.6.1.4 Recommended Follow-up Interval 3 Months XX04 1.6.1.5 Likelihood of Related Disease 85% XX16 1.6.1.5.1 Reference to Node 1.5.1 XX16 1.6.1.6 Likelihood of Related Disease 15% XX16 1.6.1.6.1 Reference to Node 1.5.2 XX16


TID

1.7 Summary of Detections Succeeded XX00 1.7.1 Successful Detections XX10 1.7.1.1 Detection Performed Nodule XX12 1.7.1.1.1 Algorithm Name “Lung Nodule Detector” 4019 1.7.1.1.2 Algorithm Version “V1.3” 4019 1.7.1.1.3 Reference to node 1.2.1 XX12 1.7.1.2 Detection Performed Nodule XX12 1.7.1.2.1 Algorithm Name “CT Nodule Detector” 4019 1.7.1.2.2 Algorithm Version “V2.5” 4019 1.7.1.2.3 Reference to node 1.2.2 XX12 1.7.1.2.4 Reference to node 1.2.3 XX12



TID

1.7.1.2.5 Reference to node 1.2.4 XX12 1.8 Summary of Analyses Succeeded XX00 1.8.1 Successful Analyses XX11 1.8.1.1 Analysis Performed XX13 1.8.1.1.1 Algorithm Name “Chest/CT Correlator” 4019 1.8.1.1.2 Algorithm Version “V2.1” 4019 1.8.1.1.3 Reference to node 1.2.1 XX13 1.8.1.1.4 Reference to node 1.2.2 XX13 1.8.1.1.5 Reference to node 1.2.3 XX13 1.8.1.1.6 Reference to node 1.2.4 XX13 1.8.1.2 Analysis Performed XX13 1.8.1.2.1 Algorithm Name “Nodule Builder” 4019 1.8.1.2.2 Algorithm Version “V1.4” 4019 1.8.1.2.3 Reference to node 1.2.2 XX13 1.8.1.2.4 Reference to node 1.2.3 XX13 1.8.1.2.5 Reference to node 1.2.4 XX13 1.8.1.3 Analysis Performed XX13 1.8.1.3.1 Algorithm Name “Nodule Interpreter” 4019 1.8.1.3.2 Algorithm Version “V1.2” 4019 1.8.1.3.3 Reference to node 1.2.1 XX13 1.8.1.4 Analysis Performed XX13 1.8.1.4.1 Algorithm Name “Disease Analyzer” 4019 1.8.1.4.2 Algorithm Version “V0.3” 4019 1.8.1.4.3 Reference to node 1.2.1 XX13 1.8.1.5 Analysis Performed XX13 1.8.1.5.1 Algorithm Name “Differential Diagnoser” 4019 1.8.1.5.2 Algorithm Version “V6.6” 4019 1.8.1.5.3 Reference to node 1.2.1 XX13 1.8.1.5.4 Reference to node 1.2.2 XX13 1.8.1.5.5 Reference to node 1.2.3 XX13 1.8.1.5.6 Reference to node 1.2.4 XX13


Part 4 Addendum



Update Annex B and I SOP Class tables

Add Chest CAD SR Storage SOP Class to Table B.5-1

B.5 STANDARD SOP CLASSES

SOP Class Name SOP Class UID IOD (See PS 3.3) Chest CAD SR 1.2.840.10008.5.1.4.1.1.88.x Chest CAD SR IOD

B.5.1.5 Structured Reporting Storage SOP Classes For SOP classes Basic Text SR, Enhanced SR, Comprehensive SR, Mammography CAD SR, and Chest CAD SR, see Annex O.

Add Chest CAD SR Storage Media Storage SOP Classes to Table I.4-1

I.4 MEDIA STANDARD STORAGE SOP CLASSES

SOP Class Name SOP Class UID IOD (See PS 3.3) Chest CAD SR 1.2.840.10008.5.1.4.1.1.88.x Chest CAD SR IOD

Update Annex O

O.1 OVERVIEW

…

O.X BEHAVIOR OF AN SCU

O.X.y Chest CAD SR SOP Class Rendering Intent concept modifiers in the Chest CAD SR object shall be consistent. Content items marked “For Presentation” shall not be subordinate to content items marked “Not for Presentation” or “Presentation Optional” in the content tree. Similarly, content items marked “Presentation Optional” shall not be subordinate to content items marked “Not for Presentation” in the content tree.

Content items referenced from another SR object instance, such as a prior Chest CAD SR, shall be inserted by-value in the new SR object instance, with appropriate original source observation context. It is necessary to update Rendering Intent, and referenced content item identifiers for by-reference relationships, within content items paraphrased from another source.


O.2 BEHAVIOR OF AN SCP

…

O.2.x Chest CAD SR SOP Class The Chest CAD SR object contains data not only for presentation to the clinician, but also data solely for use in subsequent CAD analyses.

The SCU provides rendering guidelines via “Rendering Intent” concept modifiers associated with “Composite Feature” and “Single Image Finding” content items. The full meaning of the SR is provided if all content items marked “Presentation Required” are rendered down to the first instance of “Not for Presentation” or “Presentation Optional” for each branch of the tree. Use of the SCU’s Conformance Statement is recommended if further enhancement of the meaning of the SR can be accomplished by rendering some or all of the data marked “Presentation Optional”. Data marked “Not for Presentation” should not be rendered by the SCP; it is embedded in the SR content tree as input to subsequent Chest CAD analysis work steps.

O.4 CONFORMANCE

…

O.4.1 Conformance Statement for an SCU …

O.4.1.x Chest CAD SR SOP Class The following shall be documented in the Conformance Statement of any implementation claiming conformance to the Chest CAD SR SOP Class as an SCU:

• Which types of detections and/or analyses the device is capable of performing:

• From detections listed in Context Group YY35 Chest Single Image Finding

• From analyses listed in Context Group YY57 Types of Chest CAD Analysis

• Which optional content items are supported

• Conditions under which content items are assigned Rendering Intent of “Presentation Optional”

• Conditions under which content items are assigned Rendering Intent of “Not for Presentation”

O.4.2 Conformance Statement for an SCP …

O.4.2.x Chest CAD SR SOP Class The following shall be documented in the Conformance Statement of any implementation claiming conformance to the Chest CAD SR SOP Class as an SCP:

• Conditions under which the SCP will render content items with Rendering Intent concept modifier set to “Presentation Optional”


Part 6 Addendum

ANNEX A (NORMATIVE): REGISTRY OF DICOM UNIQUE IDENTIFIERS (UID)

Add the following UIDs to Part 6 Annex A:

UID Value UID NAME UID TYPE Part 1.2.840.10008.5.1.4.1.1.88.x Chest CAD SR SOP Class 3.4


Part 16 Addendum



Add the following Templates to Part 16 Annex A DCMR Templates (Normative):

Annex A DCMR Templates (Normative)

A.X: CHEST CAD SR IOD TEMPLATES The templates that comprise the Chest CAD SR IOD are interconnected as in Figure x.1-1:

• • •

TID XX00Chest CADDocument Root

TID XX10DetectionsPerformed

TID XX11AnalysesPerformed

TID XX01FindingsSummary

TID XX12DetectionPerformed

TID XX13AnalysisPerformed

TID XX02Inferred anatomy/pathology

TID XX05Compositefeature

TID XX07Single imagefinding

TID XX06Compositefeature body

TID XX05Compositefeature

TID XX07Single imagefinding

TID XX09Image quality

TID XX08Modifiers

• • •

TID XX15Geometry

TID XX14Image library

TID XX15Geometry

TID 1400,1401, 1402Measurement

TID 4019CAD AlgorithmIdentification




TID 4022CAD ObservationContext

TID 4022CAD ObservationContext

TID 1400, 1401Measurement

TID XX08Modifiers

TID XX03Inferred diseases

TID XX04DifferentialDiagnosis

TID XX08Modifiers

TID XX16Diseaserelationships

• • •

• • •


Figure x.1-1: Chest CAD SR IOD Template Structure

In Figure x.1-1, ‘• • • ’ indicates possible recursive application of subordinate templates.


TID XX00 Chest CAD Document Root Template This template forms the top of a content tree that allows a chest CAD device to describe the results of detection and analysis of Chest evidence. This template, together with its subordinate templates, describes both the results for presentation to radiologists and partial product results for consumption by chest CAD devices in subsequent chest CAD reports.

This template defines a Container that contains an Image Library, the CAD results, CAD interpretations of inferred anatomy, pathology, and diseases, associations between inferred diseases, and summaries of the detection and analysis algorithms performed. The Image Library contains the Image SOP Class and Instance UIDs, and selected attributes for each image referenced in either the algorithm summaries or chest CAD results.

The atomic CAD results of Single Image Findings and Composite Features are described in the Chest CAD Findings Summary sub-tree. The CAD interpretations of those results are stored in separate sub-trees, in the form of Inferred Anatomy/Pathology, Inferred Disease, and Associations of Inferred Diseases.

The Summary of Detections and Summary of Analyses sub-trees gather lists of algorithms attempted, grouped by success/failure status. Algorithms not attempted are not mentioned in these sub-trees. This information forms the basis for understanding why a chest CAD report may produce no (or fewer than anticipated) results. Chest CAD results are constructed bottom-up, starting from Single Image Findings (see TID XX07), associated as Composite Features (see TID XX05).

See the figure entitled “Top Levels of Chest CAD SR Content Tree” in the “Chest CAD SR Content Tree Structure” Annex of PS 3.3.

Note: This template is somewhat similar to TID 4000 Mammography CAD Document Root.

TID XX00 CHEST CAD DOCUMENT ROOT

NL Rel with Parent

VT Concept Name VM Req Type

Condition Value Set Constraint

1 CONTAINER (zzz001, DCM, “Chest CAD Report”)

1 M

2 > HAS CONCEPT MOD

INCLUDE ETID (1204) “Language of Content Item and Descendants”

1 M

3 > CONTAINS CONTAINER (111028, DCM, “Image Library”)

1 M

4 >> CONTAINS INCLUDE ETID (XX14) “Chest CAD Image Library Entry”

1-n M

5 > CONTAINS INCLUDE ETID (XX01) “Chest CAD Findings Summary”

1 M

6 > CONTAINS CONTAINER (zzz020, DCM, “Anatomy/Pathology Interpretations”)

1 U

7 >> CONTAINS INCLUDE ETID (XX02) “Chest CAD Inferred Anatomy/Pathology”

1-n U

8 > CONTAINS CONTAINER (zzz044, DCM, “Disease Interpretations”)

1 U

9 >> CONTAINS INCLUDE ETID (XX03) “Chest CAD Inferred Diseases”

1-n U

10 > CONTAINS CONTAINER (zzz045, DCM, “Association of Inferred Diseases”)

1 U

11 >> CONTAINS INCLUDE ETID (XX04) “Chest CAD Differential Diagnosis”

1-n U


NL Rel with Parent



12 > CONTAINS CODE (111064, DCM, “Summary of Detections”)

1 M ECID (6042) “Status of Results”

13 >> INFERRED FROM

INCLUDE ETID (XX10) “Chest CAD Detections Performed”

1 MC Shall be present unless the value of (111064, DCM, “Summary of Detections”) is (111225, DCM, “Not Attempted”)

14 > CONTAINS CODE (111065, DCM, “Summary of Analyses”)

1 M ECID (6042) “Status of Results”

15 >> INFERRED FROM

INCLUDE ETID (XX11) “Chest CAD Analyses Performed”

1 MC Shall be present unless the value of (111065, DCM, “Summary of Analyses”) is (111225, DCM, “Not Attempted”)

Content Item Descriptions

Image Library The “Image Library” section of the Content Tree (TID XX00, row 3) shall include all Image SOP Instances from the Current Requested Procedure Evidence Sequence (0040,A375) attribute of the SR Document General module. If a portion of another instance of a Chest CAD SR IOD is duplicated in the “Chest CAD Findings Summary” section of the Content Tree, the “Image Library” shall also include all Image Library Entries referenced from the duplicated portions of the Chest CAD SR.

Detections Performed

Analyses Performed

The “Detections Performed” and “Analyses Performed” sections of the Content Tree (TID XX00, rows 13 and 15) together shall reference all Image SOP Instances included in the Current Requested Procedure Evidence Sequence (0040,A375) attribute of the SR Document General module.


TID XX01 Chest CAD Findings Summary Template The contents of this template describe the findings and aggregate features that the chest CAD device had for the Chest evidence presented. This template forms the chest CAD results sub-tree of the Chest CAD Document Root (TID XX00). The data from which the details are inferred are expressed in the Composite Features (see TID XX05) and/or Single Image Findings (see TID XX07), of which there may be several.

The sub-tree headed by this template is illustrated in the figure entitled “Example of CAD Processing and Findings Summary sub-tree of Chest CAD SR Content Tree” in the “Chest CAD SR Content Tree Structure” Annex of PS 3.3.

TID XX01 CHEST CAD FINDINGS SUMMARY

NL Rel with Parent



1 CODE (111017, DCM, “CAD Processing and Findings Summary”)

1 M ECID (6047) “CAD Processing and Findings Summary”

2 > INFERRED FROM

INCLUDE ETID (XX05) “Chest CAD Composite Feature”

1-n U

3 > INFERRED FROM

INCLUDE ETID (XX07) “Chest CAD Single Image Finding”

1-n U


CAD Processing and Findings Summary

This code value is used to express if and why the Chest CAD Findings Summary sub-tree is empty. The Summary of Detections and Summary of Analyses sub-trees of the Document Root node contain detail about which (if any) algorithms succeeded or failed.

If the code value indicates that there were no findings, then the code value can be used to determine whether chest CAD processing occurred successfully, without parsing the Summary of Detections and Summary of Analyses sub-trees.


TID XX02 Chest CAD Inferred Anatomy/Pathology Template The anatomy and pathology inferred from the chest CAD results sub-tree are expressed in this template. Items in this template form the Anatomy/Pathology Interpretations sub-tree of the Chest CAD Document Root (TID XX00). Inferred Anatomy/Pathology content items are inferred by-reference from single image finding and composite feature content items located in the chest CAD results sub-tree.

These by-reference inferences are illustrated in the figure entitled “Example of Sub-tree Relationships within Chest CAD SR Content Tree” in the “Chest CAD SR Content Tree Structure” Annex of PS 3.3.

TID XX02 CHEST CAD INFERRED ANATOMY/PATHOLOGY

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1 CODE (zzz002, DCM, “Inferred Anatomy/Pathology”)

1 M DCID (YY01) “Chest Inferred Anatomy” or DCID (YY08) “Chest Inferred Pathology”

2 > HAS CONCEPT MOD

CODE (zzz006, DCM, “Associated Chest Component”)

1 M DCID (YY00) “Chest Component Categories”

3 > HAS PROP NUM (zzz021, DCM, “Certainty of inference”)

1 U UNITS = (%, UCUM, “Percent”)Values = 0 – 100

4 > HAS PROP NUM (zzz022, DCM, “Probability of pathology”)


5 > HAS PROP CODE (zzz023, DCM, “Pathology presence”)

1 U ECID (YY15) “Pathology or Disease Presence”

6 > HAS PROP INCLUDE ETID (4019) “CAD Algorithm Identification”

1 U

7 > INCLUDE ETID (XX08) “Chest CAD Modifiers”

1 U

8 > R-INFERRED FROM

CODE (111015, DCM, “Composite Feature”)

1-n U

9 > R-INFERRED FROM

CODE (111059, DCM, “Single Image Finding”)

1-n U

10 > INFERRED FROM

INCLUDE ETID (XX02) “Chest CAD Inferred Anatomy/Pathology”

1-n U


Certainty of Inference The certainty that the device populating the Chest CAD SR report places on this inferred anatomy or pathology, where 0 equals no certainty and 100 equals certainty.


TID XX03 Chest CAD Inferred Diseases Template The diseases inferred from the chest CAD results and anatomy/pathology interpretations sub-trees are expressed in this template. Items in this template form the disease interpretations sub-tree of the Chest CAD Document Root (TID XX00). Inferred Disease content items are inferred by-reference from single image finding and composite feature content items located in the chest CAD results sub-tree, and/or inferred anatomy/pathology content items located in the anatomy/pathology interpretations sub-tree.

These by-reference inferences are illustrated in the figure entitled “Example of Sub-tree Relationships within Chest CAD SR Content Tree” in the “Chest CAD SR Content Tree Structure” Annex of PS 3.3.

TID XX03 CHEST CAD INFERRED DISEASES

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1 CODE (zzz014, DCM, “Inferred Disease”)

1 M BCID (YY17) “Chest Inferred Diseases”

2 > HAS CONCEPT MOD

CODE (zzz015, DCM, “Inferred Disease Category”)

1 M DCID (YY16) “Chest Disease Categories”

3 > HAS PROP NUM (zzz021, DCM, “Certainty of inference”)


4 > HAS PROP CODE (zzz030, DCM, “Disease presence”)

1 U ECID (YY15) “Pathology or Disease Presence”


1 U

6 > R-INFERRED FROM


1-n U

7 > R-INFERRED FROM


1-n U

8 > R-INFERRED FROM

CODE (zzz002, DCM, “Inferred Anatomy/Pathology”)

1-n U


Certainty of Inference The certainty that the device populating the Chest CAD SR report places on this inferred disease, where 0 equals no certainty and 100 equals certainty.

Impression Description Free-form text describing the impression of inferred disease.


TID XX04 Chest CAD Differential Diagnosis Template Differential diagnosis and interpretations of relationships between inferred diseases are expressed in this template. Items in this template form the associations of inferred diseases sub-tree of the Chest CAD Document Root (TID XX00).

See the figure entitled “Example of Disease Interpretations and Association of Inferred Diseases sub-trees of Chest CAD SR Content Tree” in the “Chest CAD SR Content Tree Structure” Annex of PS 3.3.

TID XX04 CHEST CAD DIFFERENTIAL DIAGNOSIS

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1 CODE (111023, DCM, “Differential Diagnosis/Impression”)

1 M CID to be determined

2 > HAS PROP TEXT (111033, DCM, “Impression Description”)

1 U


1 U

4 > HAS PROP CODE (111053, DCM, “Recommended Follow-up”)

1-n U DCID (YY19) “Chest Recommended Follow-up”

5 > HAS PROP NUM (111055, DCM, “Recommended Follow-up Interval”)

1 U XOR row 11 UNITS = DCID (6064) “Units of Follow-up Interval”; Values = Integer ≥ 0, where 0 = immediate follow-up

6 > HAS PROP DATE (111054, DCM, “Recommended Follow-up Date”)

1 U XOR row 10 Shall be later than date of exam

7 > HAS PROP INCLUDE ETID (XX16) “Chest CAD Disease Relationships”

1-n M


Row 7 It is recommended that the sum of the values of the “Likelihood of Related Disease” content items be 100%.


TID XX05 Chest CAD Composite Feature Template This template collects a composite feature for a lesion, anatomy, non-lesion object, or correlation of related objects (see TID XX01). The details of the composition are expressed in the Chest CAD Composite Feature Body (see TID XX06). The data from which the details are inferred, are expressed in the Composite Features (see TID XX05) and/or Single Image Findings (see TID XX07), of which there may be several.

A Composite Feature shall be INFERRED FROM any combination of two or more Composite Features or Single Image Findings or mixture thereof.

Note: This template is similar to TID 4004 Mammography CAD Composite Feature.

TID XX05 CHEST CAD COMPOSITE FEATURE

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1 CODE (zzz033, DCM, “Composite Feature Category”)

1 M DCID (YY20) “Chest Finding or Feature Category”

2 > HAS CONCEPT MOD

CODE (111056, DCM, “Rendering Intent”)

1 M ECID (6034) “Intended Use of CAD Output”

3 > HAS CONCEPT MOD


1 U DCID (YY21) “Chest Composite Feature”

4 > HAS CONCEPT MOD


1 MC Shall be present IFF parent value is (zzz008, DCM, “Radiographic anatomy”)

DCID (YY00) “Chest Component Categories”

5 > HAS PROP INCLUDE ETID (XX06) “Chest CAD Composite Feature Body”

1 M

6 > INFERRED FROM

INCLUDE ETID (XX05) “Chest CAD Composite Feature”

1-n MC At least two items shall be present: two of row 6, two of row 7, or one of each.

7 > INFERRED FROM

INCLUDE ETID (XX07) “Chest CAD Single Image Finding”

1-n MC At least two items shall be present: two of row 6, two of row 7, or one of each.

8 > HAS OBS CONTEXT

INCLUDE ETID (4022) “CAD Observation Context”

1 MC Shall be present only if this feature is duplicated from a different report than its parent.


Rendering Intent This content item constrains the SCP receiving the Chest CAD SR IOD in its use of the contents of this template and its target content items. Chest CAD devices may opt to use data marked “Not for Presentation” or “Presentation Optional” as input to subsequent chest CAD processing steps. Refer to PS 3.4, Annex O Structured Reporting Standard SOP Classes for SCU and SCP Behavior.


TID XX06 Chest CAD Composite Feature Body Template The details of a composite feature are expressed in this template. It is applied to Chest CAD Composite Feature (TID XX05).

Note: This template is similar to TID 4005 Mammography CAD Composite Feature Body.

TID XX06 CHEST CAD COMPOSITE FEATURE BODY

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1 CODE (111016, DCM, “Composite type”)

1 M ECID (6035) “Composite Feature Relations “

2 CODE (111057, DCM, “Scope of Feature”)

1 M ECID (6036) “Scope of Feature”

3 INCLUDE ETID (4019) “CAD Algorithm Identification”

1 M

4 NUM (111011, DCM, “Certainty of feature”)

1 U UNITS = (%, UCUM, “Percent”)Value = 0 – 100

5 INCLUDE ETID (XX15) “Chest CAD Geometry”

1-n U

6 INCLUDE DTID (1400) “Linear Measurement”

1-n U The by-reference relationship to the IMAGE in TID (1400) “Linear Measurement” shall be used.

7 INCLUDE DTID (1401) “Area Measurement”

1-n U The by-reference relationship to the IMAGE in TID (1401) “Area Measurement” shall be used.

8 INCLUDE DTID (1402) “Volume Measurement”

1-n U The by-reference relationship to the IMAGE in TID (1402) “Volume Measurement” shall be used.

9 INCLUDE ETID (XX08) “Chest CAD Modifiers”

1 U

10 NUM DCID (YY53) “Chest Quantitative Temporal Difference Type”

1-n UC May be present only if the value of (111016, DCM, “Composite type”) is (111153, DCM, “Target content items are related temporally”)

UNITS = DCID (7460) “Units of Linear Measurement”, DCID (7461) “Units of Area Measurement”, DCID (7462) “Units of Volume Measurement or (1, UCUM, “Unity”)

11 > R-INFERRED FROM

NUM 2 U The referenced numeric values shall have the same Concept Name. Their UNITS shall be the same as row 10

12 CODE (111049, DCM, “Qualitative Difference”)

1-n UC May be present only if the value of (111016, DCM, “Composite type”) is (111153, DCM, “Target content items are related temporally”)

DCID (YY54) “Chest Qualitative Temporal Difference Type”

13 > HAS PROP TEXT (111021, DCM, “Description of Change”)

1 U

14 > R-INFERRED FROM

CODE 2 M The referenced code values shall have the same Concept Name and be from the same context group.



Certainty of Feature The likelihood that the feature analyzed, and classified by the CODE specified in the Composite Feature parent template, is in fact that type of feature.

Volume Measurement If dimensions for a volume are to be stated in terms of length, width, and depth, then one shall use 3 instances of TID (1400) Linear Measurement.

Row 10 Values ≤ 0 are allowed. The two referenced numeric values are target content items of the first generation Composite Feature or Single Image Finding children of this composite feature. Given the equation, A – B, the value representing A shall be referenced first.

Qualitative Difference The two referenced code values are target content items of the first generation Composite Feature or Single Image Finding children of this composite feature.


TID XX07 Chest CAD Single Image Finding Template This template describes a single image finding for a lesion or other object. The details of the finding are expressed in this template and/or more specific templates.

Note: This template is similar to TID 4006 Mammography CAD Single Image Finding.

TID XX07 CHEST CAD SINGLE IMAGE FINDING

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1 CODE (zzz034, DCM, “Single Image Finding Category”)

1 M DCID (YY20) “Chest Finding or Feature Category”

2 > HAS CONCEPT MOD

CODE (111056, DCM, “Rendering Intent”)

1 M ECID (6034) “Intended Use of CAD Output”

3 > HAS CONCEPT MOD


1 U DCID (YY35) “Chest Single Image Finding”

4 > HAS CONCEPT MOD


1 MC Shall be present IFF parent value is (zzz008, DCM, “Radiographic anatomy”)

DCID (YY00) “Chest Component Categories”


1 M

6 > HAS PROP NUM (111012, DCM, “Certainty of Finding”)


7 > HAS PROP TEXT (111058, DCM, “Selected Region Description”)

1 MC Shall be present only if value of parent is (111099, DCM, “Selected region”)

8 > HAS PROP INCLUDE ETID (XX15) “Chest CAD Geometry”

1 MC Shall be present unless value of parent is (111101, DCM, “Image quality”)

9 > HAS PROP INCLUDE DTID (1400) “Linear Measurement”

1-n U The by-reference relationship to the IMAGE in TID (1400) “Linear Measurement” shall be used.

10 > HAS PROP INCLUDE DTID (1401) “Area Measurement”

1-n U The by-reference relationship to the IMAGE in TID (1401) “Area Measurement” shall be used.

11 > HAS PROP INCLUDE ETID (XX08) “Chest CAD Modifiers”

1 U

12 > R-HAS PROP

IMAGE 1 MC Shall be present only if value of parent is (111101, DCM, “Image quality”) and row 13 is not present

Shall reference an IMAGE content item in the (111028, DCM, “Image Library”)

13 > R-HAS PROP

SCOORD (111030, DCM, “Image Region”)

1-n MC Shall be present only if value of parent is (111101, DCM, “Image quality”) and row 12 is not present

14 >> R-SELECTED FROM

IMAGE 1 M All the (111030, DCM, “Image Region”) content items in a single invocation of this template shall reference the same IMAGE content item in the (111028, DCM, “Image Library”)


NL Rel with Parent



15 > HAS PROP INCLUDE ETID (XX09) “Chest CAD Image Quality”

1 MC Shall be present only if value of parent is (111101, DCM, “Image quality”)

16 > HAS OBS CONTEXT

INCLUDE ETID (4022) “CAD Observation Context”

1 MC Shall be present only if this finding is duplicated from a different report than its parent.


Rendering Intent This content item constrains the SCP receiving the Chest CAD SR IOD in its use of the contents of this template and its target content items. Chest CAD devices may opt to use data marked “Not for Presentation” or “Presentation Optional” as input to subsequent chest CAD processing steps. Refer to PS 3.4, Annex O Structured Reporting Storage SOP Classes for SCU and SCP Behavior.

Certainty of Finding The likelihood that the finding detected, and classified by the Single Image Finding Category CODE specified, is in fact that type of finding.


TID XX08 Chest CAD Modifiers This template provides qualitative detail for a Single Image Finding, Composite Feature, or Inferred Anatomy/Pathology. It is applied to Chest CAD Inferred Anatomy/Pathology (TID XX02), Chest CAD Composite Feature (TID XX05) and Chest CAD Single Image Finding (TID XX07).

TID XX08 CHEST CAD MODIFIERS

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1 CODE (zzz035, DCM, “Size Modifier”)

1 U DCID (YY39) “Size Modifier”

2 CODE (zzz036, DCM, “Width Modifier”)

1 U DCID (YY26) “Width Modifier”

3 CODE (zzz018, DCM, “Border shape”)

1 U DCID (YY40) “Chest Border Shape”

4 CODE (zzz010, DCM, “Border definition”)

1 U DCID (YY41) “Chest Border Definition”

5 CODE (zzz017, DCM, “Orientation Modifier”)

1 U DCID (YY42) “Chest Orientation Modifier”

6 CODE (zzz012, DCM, “Type of Content”)

1-n U DCID (YY43) “Chest Content Modifier”

7 CODE (zzz037, DCM, “Opacity Modifier”)

1 U DCID (YY44) “Chest Opacity Modifier”

8 CODE (zzz016, DCM, “Location in Chest”)

1 U DCID (YY45) “Chest Location Modifier”

9 CODE (zzz027, DCM, “Side of Chest”)

1 U ECID (YY47) “Side Modifier”

10 CODE (zzz009, DCM, “Distribution Modifier”)

1-n U DCID (YY48) “Chest Distribution Modifier”

11 CODE (zzz038, DCM, “Abnormal Distribution of Anatomic Structure”

1 U DCID (YY27) “Chest Anatomic Structure Abnormal Distribution”

12 CODE (zzz011, DCM, “Site involvement”)

1-n U DCID (YY49) “Chest Site Involvement”

13 CODE (zzz039, DCM, “Severity Modifier”)

1 U DCID (YY50) “Severity Modifier”

14 CODE (zzz013, DCM, “Texture Modifier”)

1 U DCID (YY51) “Chest Texture Modifier”

15 NUM (zzz028, DCM, “Calcification extent as percent of surface”)


16 CODE (zzz040, DCM, “Calcification Modifier”)

1 U DCID (YY52) “Chest Calcification Modifier”

17 NUM (zzz041, DCM, “CT Number”) 1 U UNITS = Hounsfield (HU)


TID XX09 Chest CAD Image Quality Template This template provides the detail specific to an image quality finding (see TID XX07). It allows the encoding of descriptors of image quality (CID YY55) for a given image or region of an image. For instance, images with partial motion blur can be identified with the region noted.

Note: This template is the same as TID 4014 Mammography CAD Image Quality, with the exception of the defined context groups identified in the Value Set Constraint for content items of Value Type CODE. If CP-274 is approved, TID 4014 will be used in place of TID XX09, and modified to include parameters for the context groups identified in rows 1 and 3. DCID (YY55) and DCID (YY56) will be assigned in TID XX07 where TID 4014 is invoked.

TID XX09 CHEST CAD IMAGE QUALITY

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1 CODE (111052, DCM, “Quality Finding”)

1 M DCID (YY55) “Chest Image Quality Finding”

2 CODE (111050, DCM, “Quality Assessment”)

1 U DCID (6044) “Types of Image Quality Assessment”

3 CODE (111051, DCM, “Quality Control Standard”)

1 UC Shall be present if row 2 is present.

DCID (YY56) “Chest Types of Quality Control Standard”

4 NUM (111029, DCM, “Image Quality Rating”)

1 U UNITS = (1, UCUM, “Unity”) Value = 0 – 100


Image Quality Rating A numeric value in the range 0 to 100, inclusive, where 0 is worst quality and 100 is best quality.


TID XX10 Chest CAD Detections Performed Template This template gathers two lists of detection algorithms attempted, grouped by success/failure status. Algorithms not attempted are not mentioned in this sub-tree of the Document Root (TID XX00). This information forms the basis for understanding why a chest CAD report may produce no (or fewer than anticipated) detection results.

The sub-tree formed by this template is illustrated in the figure entitled “Summary of Detections and Analyses Levels of Chest CAD SR Content Tree” in the “Chest CAD SR Content Tree Structure” Annex of PS 3.3.

Note: This template is the same as TID 4015 Mammography CAD Detections Performed, with the exception of the identified included templates. If CP-274 is approved, TID 4015 will be used in place of TID XX10, with slight modifications, removing mammography specifics from the template names.

TID XX10 CHEST CAD SR IOD DETECTIONS PERFORMED

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1 CONTAINER (111063, DCM, “Successful Detections”)

1 MC Shall be present only if value of parent is (111222, DCM, “Succeeded”) or (111223, DCM, “Partially Succeeded”)

2 > CONTAINS INCLUDE ETID (XX12) “Chest CAD Detection Performed”

1-n M

3 CONTAINER (111025, DCM, “Failed Detections”)

1 MC Shall be present only if value of parent is (111224, DCM, “Failed”) or (111223, DCM, “Partially Succeeded”)

4 > CONTAINS INCLUDE ETID (XX12) “Chest CAD Detection Performed”

1-n M


TID XX11 Chest CAD Analyses Performed Template This template gathers two lists of analysis algorithms attempted, grouped by success/failure status. Algorithms not attempted are not mentioned in this sub-tree of the Document Root (TID XX00). This information forms the basis for understanding why a chest CAD report may produce no (or fewer than anticipated) analysis results.

The sub-tree formed by this template is illustrated in the figure entitled “Summary of Detections and Analyses Levels of Chest CAD SR Content Tree” in the “Chest CAD SR Content Tree Structure” Annex of PS 3.3.

Note: This template is the same as TID 4016 Mammography CAD Analyses Performed, with the exception of the identified included templates. If CP-274 is approved, TID 4016 will be used in place of TID XX11, with slight modifications, removing mammography specifics from the template names.

TID XX11 CHEST CAD ANALYSES PERFORMED

NL Rel with Parent



1 CONTAINER (111062, DCM, “Successful Analyses”)

1 MC Shall be present only if value of parent is (111222, DCM, “Succeeded”) or (111223, DCM, “Partially Succeeded”)

2 > CONTAINS INCLUDE ETID (XX13) “Chest CAD Analysis Performed”

1-n M

3 CONTAINER (111024, DCM, “Failed Analyses”)

1 MC Shall be present only if value of parent is (111224, DCM, “Failed”) or (111223, DCM, “Partially Succeeded”)

4 > CONTAINS INCLUDE ETID (XX13) “Chest CAD Analysis Performed”

1-n M


TID XX12 Chest CAD Detection Performed Template This template fully identifies a detection algorithm and the images and/or image regions on which it operated (see TID XX10).

Note: This template is the same as TID 4017 Mammography CAD Detection Performed, with the exception of the defined context group identified in the Value Set Constraint for the content item of Value Type CODE. If CP-274 is approved, TID 4017 will be used in place of TID XX12, and modified to include a parameter for the context group identified in rows 1. DCID (YY35) will be assigned in TID XX00 where TID 4015, which invokes TID 4017, is invoked.

TID XX12 CHEST CAD DETECTION PERFORMED

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1 CODE (111022, DCM, “Detection Performed”)

1 M DCID (YY35) “Chest Single Image Finding”


1 M

3 > R-HAS PROP

IMAGE 1-n MC At least one of row 3 or 4 shall be present

Shall reference IMAGE content item(s) in the (111028, DCM, “Image Library”)

4 > HAS PROP SCOORD (111030, DCM, “Image Region”)

1-n MC At least one of row 3 or 4 shall be present


IMAGE 1 M Shall reference an IMAGE content item in the (111028, DCM, “Image Library”)


CAD Algorithm Identification

If more than one detection algorithm has the same “Detection Performed” code value (CID YY35) then the “CAD Algorithm Identification” shall unambiguously distinguish between algorithms.


TID XX13 Chest CAD Analysis Performed Template This template fully identifies an analysis algorithm and the images and/or image regions on which it operated (see TID XX11).

Note: This template is the same as TID 4018 Mammography CAD Analysis Performed, with the exception of the defined context group identified in the Value Set Constraint for the content item of Value Type CODE. If CP-274 is approved, TID 4018 will be used in place of TID XX13, and modified to include a parameter for the context group identified in rows 1. DCID (YY57) will be assigned in TID XX00 where TID 4016, which invokes TID 4018, is invoked.

TID XX13 CHEST CAD ANALYSIS PERFORMED

NL Rel with Parent



1 CODE (111004, DCM, “Analysis Performed”)

1 M DCID (YY57) “Types of Chest CAD Analysis”


1 M

3 > R-HAS PROP

IMAGE 1-n MC A total of at least two instances of row 3 or 4 shall be present

Shall reference IMAGE content item(s) in the (111028, DCM, “Image Library”)

4 > HAS PROP SCOORD (111030, DCM, “Image Region”)

1-n MC At total of at least two instances of row 3 or 4 shall be present




CAD Algorithm Identification

If more than one analysis algorithm has the same “Analysis Performed” code value (CID YY57) then the “CAD Algorithm Identification” shall unambiguously distinguish between algorithms.


TID XX14 Chest CAD Image Library Entry Template Each instance of the Image Library Entry template contains the Image SOP Class and Instance UIDs, and selected attributes for an image. Content items from this template form the image library sub-tree of the Chest CAD Document Root (TID XX00). If the Image SOP Class is other than Computed Radiography or Digital X-Ray Image Storage then as many of the attributes as possible should be derived.

Note: This template is the same as TID 4020 Mammography CAD Image Library, with the exception of the defined context groups identified in the Value Set Constraint for content items of Value Type CODE. If CP-274 is approved, TID 4020 will be used in place of TID XX14, and modified to include a parameter for the context groups identified in rows 2, 3 and 4. ECID (YY58), DCID (4010) and DCID (4011) will be assigned in TID XX00 where TID 4020 is invoked.

TID XX14 CHEST CAD IMAGE LIBRARY ENTRY

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1 IMAGE 1 M 2 > HAS ACQ

CONTEXT CODE (111027, DCM, “Image

Laterality”) 1 MC Shall be present if (0020,0062)

is in the Image IOD ECID (YY58) “Image Laterality”

3 > HAS ACQ CONTEXT

CODE (111031, DCM, “Image View”) 1 MC Shall be present if (0054,0220) or (0018,5101) is in the Image IOD

DCID (4010) “DX View”

4 > HAS ACQ CONTEXT

CODE (111032, DCM, “Image View Modifier”)

1 MC Shall be present if (0054,0222) is in the Image IOD

DCID (4011) “DX View Modifier”

5 > HAS ACQ CONTEXT

TEXT (111044, DCM, “Patient Orientation Row”)


6 > HAS ACQ CONTEXT

TEXT (111043, DCM, “Patient Orientation Column”)


7 > HAS ACQ CONTEXT

DATE (111060, DCM, “Study Date”) 1 MC Shall be present if (0008,0020) is in the Image IOD

8 > HAS ACQ CONTEXT

TIME (111061, DCM, “Study Time”) 1 MC Shall be present if (0008,0030) is in the Image IOD

9 > HAS ACQ CONTEXT

DATE (111018, DCM, “Content Date”)


10 > HAS ACQ CONTEXT

TIME (111019, DCM, “Content Time”)



NUM (111026, DCM, “Horizontal Imager Pixel Spacing”)


UNITS = EV (um, UCUM, “micrometer”)


NUM (111066, DCM, “Vertical Imager Pixel Spacing”)


UNITS = EV (um, UCUM, “micrometer”)


Patient Orientation Row

Patient Orientation Column

First (row) and Second (column) components of Patient Orientation (0020,0020) in the Image IOD. See PS 3, C.7.6.1.1.1.

Horizontal Imager Pixel Spacing

The row (first) component of Imager Pixel Spacing (0018,1164) in the Image IOD. See PS 3, C.8.11.4. Convert the source spacing to micrometers.


Vertical Imager Pixel Spacing

The column (second) component of Imager Pixel Spacing (0018,1164) in the Image IOD. See PS 3, C.8.11.4. Convert the source spacing to micrometers.

TID XX15 Chest CAD Geometry Template All geometry template invocations require specification of either the location of the center of the object, the outline, or both. Geometry is a property of single image findings (see TID XX07) and composite features (see TID XX06).

Note: This template is the same as TID 4021 Mammography CAD Geometry, with the exception of the Requirement Type for the content items of Value Type SCOORD. Even if CP-274 is approved, this will remain a separate template.

TID XX15 CHEST CAD GEOMETRY

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1 SCOORD (111010, DCM, “Center”) 1 MC At least one of rows 1,3 shall be present.

Graphic Data Type = POINT

2 > R-SELECTED FROM


3 SCOORD (111041, DCM, “Outline”) 1 MC At least one of rows 1,3 shall be present.

4 > R-SELECTED FROM

IMAGE 1 M Shall reference the same content item as row 2

TID XX16 Chest CAD Disease Relationships Template This template is invoked by the Chest CAD Differential Diagnosis template (TID XX04). The purpose of this template is to convey the percent likelihood of each inferred disease that led to the differential diagnosis. This sub-tree includes by-reference HAS PROPERTIES relationships to inferred disease content items located in the disease interpretations sub-tree.

TID XX16 CHEST CAD DISEASE RELATIONSHIPS

NL Rel with Parent



1 HAS PROP NUM (zzz032, DCM, “Likelihood of Related Disease”)

1 M UNITS = (%, UCUM, “Percent”)Values = 0 – 100

2 > R-HAS PROP

CODE (zzz014, DCM, “Inferred Disease”)

1 M

3 > HAS PROP INCLUDE ETID (XX16) “Chest CAD Disease Relationships”

1-n U


Row 3 It is recommended that the sum of the values of the “Likelihood of Related Disease” content items be 100%.


TID 4019 CAD Algorithm Identification Template This template details the algorithm unambiguously. Re-state the software identification from the General Equipment Module of the CAD SR IOD if all algorithms are unambiguously defined by that module.

Note: Duplicate of Template defined in Supplement 50 (Mammography CAD SR), Final Text - reuse

TID 4019 CAD ALGORITHM IDENTIFICATION

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1 TEXT (111001, DCM, “Algorithm Name”)

1 M

2 TEXT (111003, DCM, “Algorithm Version”)

1 M

3 TEXT (111002, DCM, “Algorithm Parameters”)

1-n U

TID 4022 CAD Observation Context Template This template is invoked when a content item, which may be the “root” of a sub-tree, is paraphrased from a prior SR document.

Note: Duplicate of Template defined in Supplement 50 (Mammography CAD SR), Final Text - reuse

TID 4022 CAD OBSERVATION CONTEXT

NL Rel with Parent



1 COMPOSITE

(111040, DCM, “Original Source”)

1 MC Shall be present if the original source is a DICOM object.

2 > HAS CONCEPT MOD

INCLUDE ETID (1204) “Language of Content Item and Descendants”

1 M

3 INCLUDE ETID (1001) “Observation Context”

1 M


TID 1400 Linear Measurement Template Note: Duplicate of Template defined in Supplement 53 (DICOM Content Mapping Resource), Final Text, with Row 2 Req Type modified and Rows 5, 6 added, pending CP-265 – reuse

TID 1400 LINEAR MEASUREMENT

NL Rel with Parent



1 NUM DCID (7470) “Linear Measurements”

1 M UNITS = DCID (7460) “Units of Linear Measurement”

2 > INFERRED FROM

SCOORD (121055, DCM, “Path”) 1 MUC XOR Rows 5, 6


IMAGE 1 MC XOR Row 4

4 >> SELECTED FROM


5 > INFERRED FROM

IMAGE 1-n UC XOR Rows 2, 6

6 > R-INFERRED FROM



Path Path can be:

• an open POLYLINE with two different points (to measure length, diameter, distance, proximity, etc),

• a CIRCLE or ELLIPSE (to measure circumference) or

• an open or closed POLYLINE (closed polygon) to measure path length (open) or perimeter (closed).


TID 1401 Area Measurement Template Note: Duplicate of Template defined in Supplement 53 (DICOM Content Mapping Resource), Final Text, with Rows 5,6 added, pending CP-265 – reuse

TID 1401 AREA MEASUREMENT

NL Rel with Parent



1 NUM DCID (7471) “Area Measurements”

1 M Area shall be > 0 UNITS = DCID (7461) “Units of Area Measurement”

2 > INFERRED FROM

SCOORD (121056, DCM, “Area Outline”)1 MC XOR Rows 5, 6 Shall be present if the concept name of Row 1 is (121202, DCM, "Area of Defined Region"). May be present otherwise.

Graphic data type shall not be MULTIPOINT



4 >> SELECTED FROM


5 > INFERRED FROM

IMAGE 1-n UC XOR Rows 2, 6 Shall not be present if concept name of Row 1 is (121202,DCM, “Area of Defined Region”).

6 > INFERRED FROM

IMAGE 1-n UC XOR Rows 2, 5 Shall not be present if concept name of Row 1 is (121202,DCM, “Area of Defined Region”).


Area Outline A Graphic Data Type of POINT implies that the object is a single pixel and the object’s area is the area of the pixel. Otherwise the type shall be a closed POLYLINE (start and end point the same) or a CIRCLE or an ELLIPSE.


TID 1402 Volume Measurement Template Note: Duplicate of Template defined in Supplement 53 (DICOM Content Mapping Resource), Final Text, with Rows 5, 6 added, pending CP-265 – reuse

TID 1402 VOLUME MEASUREMENT

NL Rel with Parent



1 NUM DCID(CID 7472) “Volume Measurements”

1 M Volume shall be > 0 UNITS = DCID (7462) “Units of Volume Measurement”

2 > INFERRED FROM

SCOORD (121057,DCM, “Perimeter Outline”)

1-n UC XOR Rows 5, 6 Graphic data type shall not be MULTIPOINT



4 >> SELECTED FROM


5 > INFERRED FROM


6 > R-INFERRED FROM



Perimeter Outline The two dimensional perimeter of the volume’s intersection with or projection into the image. A Graphic Data Type of POINT implies that the volume’s intersection or projection in a plane is a single pixel. A single pixel projection perimeter cannot cause a volume calculation to become 0.

Otherwise the type shall be a closed POLYLINE (start and end point the same) or a CIRCLE or an ELLIPSE.


Add the following Context Groups to Part 16 Annex B DCMR Context Groups (Normative):

Annex B DCMR Context Groups (Normative)

CONTEXT ID YY00 Chest Component Categories

(Most Restrictive Use: Defined) Coding Scheme

Designator (0008,0102)

Coding Scheme Version

(0008,0103)

Code Value (0008,0100)

Code Meaning (0008,0104)

Lungs Bronchovascular Pleura Mediastinum Heart Osseous

CONTEXT ID YY01

Chest Inferred Anatomy (Most Restrictive Use: Defined)

Coding Scheme



(0008,0103)



Include Context ID YY02 Include Context ID YY03 Include Context ID YY04 Include Context ID YY05 Include Context ID YY06 Include Context ID YY07 Hemithorax


CONTEXT ID YY02 Lung Inferred Anatomy

(Most Restrictive Use: Defined) Note: Original sources are “Terms Used in Chest Radiology” and “Terms For CT of the Lungs”, from Fraser and Pare’s Diagnosis of Diseases of the Chest, Fourth Edition, Volume I, pp. xvii-xxxi and pp. xxxiii-xxxvi, respectively.

Coding Scheme



(0008,0103)



Interstitium Lobe Parenchyma Secondary pulmonary lobule Segment

CONTEXT ID YY03

Bronchovascular Inferred Anatomy (Most Restrictive Use: Defined)

Note: Original sources are “Terms Used in Chest Radiology” and “Terms For CT of the Lungs”, from Fraser and Pare’s Diagnosis of Diseases of the Chest, Fourth Edition, Volume I, pp. xvii-xxxi and pp. xxxiii-xxxvi, respectively.

Coding Scheme



(0008,0103)



Airway Bronchus Carina Hilum Perfusion

CONTEXT ID YY04

Pleura Inferred Anatomy (Most Restrictive Use: Defined)


Coding Scheme



(0008,0103)



Fissure


CONTEXT ID YY05

Mediastinum Inferred Anatomy (Most Restrictive Use: Defined)


Coding Scheme



(0008,0103)



Aortopulmonary window Azygoesophageal recess

CONTEXT ID YY06

Heart Inferred Anatomy (Most Restrictive Use: Defined)

Coding Scheme



(0008,0103)



CONTEXT ID YY07

Osseous Inferred Anatomy (Most Restrictive Use: Defined)

Coding Scheme



(0008,0103)



CONTEXT ID YY08

Chest Inferred Pathology (Most Restrictive Use: Defined)

Coding Scheme



(0008,0103)



Include Context ID YY09 Include Context ID YY10 Include Context ID YY11 Include Context ID YY12


Coding Scheme



(0008,0103)



Include Context ID YY13 Include Context ID YY14

CONTEXT ID YY09

Lung Inferred Pathology (Most Restrictive Use: Defined)


Coding Scheme



(0008,0103)



Abscess Air-trapping Atelectasis Bleb Bulla Bullous emphysema Cavity Centrilobular emphysema Coin lesion Collapse Collateral ventilation Consolidation Cyst Cystic air space Distal acinar emphysema Emphysema Fibrosis Fungus ball Hyperventilation Hypoventilation Mass

DCM zzz003 Nodule Panlobular emphysema Platelike atelectasis Pneumatocele Primary complex


Coding Scheme



(0008,0103)



Pseudocavity Pulmonary edema Traction bronchioectasis Traction bronchilectasis

CONTEXT ID YY10

Bronchovascular Inferred Pathology (Most Restrictive Use: Defined)


Coding Scheme



(0008,0103)



Bronchiectasis Bronchocele Clot Cor pulmonale Embolus Hypertension Mucoid impaction Oligemia Thromboembolism Thrombosis Thrombus

CONTEXT ID YY11

Pleura Inferred Pathology (Most Restrictive Use: Defined)


Coding Scheme



(0008,0103)



Fibrosis Mass Pleural thickening Pneumothorax


Coding Scheme



(0008,0103)



Tension

CONTEXT ID YY12 Mediastinum Inferred Pathology (Most Restrictive Use: Defined)


Coding Scheme



(0008,0103)



Abscess Fibrosis Hernia Lymphadenopathy Mass Pneumomediastinum

CONTEXT ID YY13

Heart Inferred Pathology (Most Restrictive Use: Defined)


Coding Scheme



(0008,0103)



Cor pulmonale Thrombosis

CONTEXT ID YY14

Osseous Inferred Pathology (Most Restrictive Use: Defined)

Coding Scheme



(0008,0103)




CONTEXT ID YY15

Pathology or Disease Presence (Most Restrictive Use: Enumerated)

Coding Scheme



(0008,0103)



DCM zzz024 No evidence of presence DCM zzz025 Clearly present DCM zzz026 Inconclusive evidence of presence

CONTEXT ID YY16

Chest Disease Categories (Most Restrictive Use: Defined)

Coding Scheme



(0008,0103)



Infectious Neoplastic Autoimmune

CONTEXT ID YY17

Chest Inferred Diseases (Most Restrictive Use: Baseline)

Coding Scheme



(0008,0103)



CONTEXT ID YY18

Change Since Last Chest Radiograph or Prior Surgery (Most Restrictive Use: Defined)

Coding Scheme



(0008,0103)



SRT 1.1 F-01721 New finding SRT 1.1 F-01722 Finding partially removed SRT 1.1 F-01723 No significant changes in the finding SRT 1.1 M-02520 Increase in size


Coding Scheme



(0008,0103)



SRT 1.1 M-02530 Decrease in size SRT 1.1 F-01728 Less defined SRT 1.1 F-01729 More defined

CONTEXT ID YY19 Chest Recommended Follow-up (Most Restrictive Use: Defined)

Coding Scheme



(0008,0103)



DCM 111135 Additional projections DCM zzz042 Computed Tomography (CT) DCM 111138 Old films/images for comparison DCM 111140 Normal interval follow-up DCM 111141 Any decision to biopsy should be based on clinical

assessment DCM 111142 Follow-up at short interval (1-11 months) DCM 111143 Biopsy should be considered DCM 111146 Suggestive of malignancy – take appropriate action DCM 111147 Cytologic analysis

CONTEXT ID YY20 Chest Finding or Feature Category




(0008,0103)



Abnormal lines (1D) DCM zzz043 Abnormal opacity

Abnormal lucency Abnormal calcifications Abnormal texture

DCM zzz008 Radiographic anatomy DCM 111102 Non-lesion DCM 111101 Image quality DCM 111099 Selected region


CONTEXT ID YY21 Chest Composite Feature




(0008,0103)



Include Context ID YY22 Include Context ID YY23 Include Context ID YY24 Include Context ID YY25 Include Context ID YY28 Include Context ID 6040

CONTEXT ID YY22 Abnormal Lines Composite Feature


Coding Scheme



(0008,0103)



Include Context ID YY36 Reticulonodular pattern

CONTEXT ID YY23 Abnormal Opacity Composite Feature


Coding Scheme



(0008,0103)



Include Context ID YY37 Beaded septum sign Nodular pattern Primary complex Pseudoplaque Reticulonodular pattern Signet-ring sign


CONTEXT ID YY24 Abnormal Lucency Finding or Feature


Coding Scheme



(0008,0103)



Air bronchiologram Air bronchogram Air crescent Air-trapping Halo sign Pneumomediastinum Pneumothorax

CONTEXT ID YY25 Abnormal Texture Composite Feature


Coding Scheme



(0008,0103)



Include Context ID YY38 Nodular pattern Reticulonodular pattern


CONTEXT ID YY26 Width Modifier


Coding Scheme



(0008,0103)



Enlarged Too narrow Vasoconstriction Vasodilation

CONTEXT ID YY27 Chest Anatomic Structure Abnormal Distribution


Coding Scheme



(0008,0103)



Air-trapping Architectural distortion Mosaic perfusion Oligemia Pleonemia

CONTEXT ID YY28 Radiographic Anatomy Finding or Feature


Coding Scheme



(0008,0103)



Include Context ID YY29 Include Context ID YY30 Include Context ID YY31 Include Context ID YY32


Coding Scheme



(0008,0103)



Include Context ID YY33 Include Context ID YY34 Interface Line Lucency

CONTEXT ID YY29 Lung Anatomy Finding or Feature


Coding Scheme



(0008,0103)



Lobe Midlung window Secondary pulmonary lobule Segment

CONTEXT ID YY30 Bronchovascular Anatomy Finding or Feature


Coding Scheme



(0008,0103)



Airway Bronchus Carina Carina angle Centrilobular structures Hilum


CONTEXT ID YY31 Pleura Anatomy Finding or Feature


Coding Scheme



(0008,0103)



Anterior junction line Fissure Posterior junction line

CONTEXT ID YY32 Mediastinum Anatomy Finding or Feature


Coding Scheme



(0008,0103)



Azygoesophageal recess interface Paraspinal line Posterior tracheal stripe Right tracheal stripe Stripe

CONTEXT ID YY33 Heart Anatomy Finding or Feature




(0008,0103)




CONTEXT ID YY34 Osseous Anatomy Finding or Feature




(0008,0103)



Rib Clavicle Spine

CONTEXT ID YY35 Chest Single Image Finding




(0008,0103)



Include Context ID YY36 Include Context ID YY37 Include Context ID YY24 Include Context ID YY38 Include Context ID YY28 Include Context ID 6040

CONTEXT ID YY36

Abnormal Lines Single Image Finding (Most Restrictive Use: Defined)


Coding Scheme



(0008,0103)



Air-fluid level Corona radiata Honeycomb pattern Fleischner’s line(s) Intralobular lines Kerley A line Kerley B line Kerley C lines Parenchymal band


Coding Scheme



(0008,0103)



Platelike atelectasis Reticular pattern Septal line(s) Subpleural line Tramline shadow Tubular shadow

CONTEXT ID YY37 Abnormal Opacity Single Image Finding


Coding Scheme



(0008,0103)



DCM zzz007 Abnormal interstitial pattern Coin lesion Density Dependent opacity Infiltrate Mass Micronodule

DCM zzz003 Nodule DCM zzz004 Opacity

Phantom tumor (pseudotumor) Shadow Small irregular opacities Small rounded opacities Tree-in-bud sign


CONTEXT ID YY38 Abnormal Texture Single Image Finding


Coding Scheme



(0008,0103)



DCM zzz007 Abnormal interstitial pattern Granular pattern Honeycomb pattern Miliary pattern Reticular pattern Small irregular opacities

CONTEXT ID YY39 Size Modifier




(0008,0103)



Extremely small Very small Small Medium Large Enlarged Too small


CONTEXT ID YY40 Chest Border Shape


Coding Scheme



(0008,0103)



SNM3 3.4 M-02100 Round shape Elliptic

SNM3 3.4 G-A402 Irregular Lobulated Spiculated

CONTEXT ID YY41 Chest Border Definition


Coding Scheme



(0008,0103)



Defined well Defined sharply Defined poorly Defined distinctly Demarcated well Demarcated sharply Demarcated poorly Circumscribed


CONTEXT ID YY42 Chest Orientation Modifier




(0008,0103)



Horizontal Vertical Oblique

CONTEXT ID YY43 Chest Content Modifier


Coding Scheme



(0008,0103)



Air Fat Soft tissue Calcium Foreign material (iodized oil, mercury, talc)

CONTEXT ID YY44 Chest Opacity Modifier


Coding Scheme



(0008,0103)



Acinar Air space Fibronodular Fluffy Linear Profusion Silhouette sign


CONTEXT ID YY45 Chest Location Modifier




(0008,0103)



Include CONTEXT ID YY46

CONTEXT ID YY46 Lung Location Modifier




(0008,0103)



Upper zone Mid zone Lower zone Upper lobe Mid lobe Lower lobe Apical Basilar Central Peripheral Anterior segment Posterior segment

CONTEXT ID YY47 Side Modifier




(0008,0103)



SNM3 G-A101 Left SNM3 G-A100 Right SNM3 G-A102 Right and left


CONTEXT ID YY48 Chest Distribution Modifier


Coding Scheme



(0008,0103)



Bat’s wing Butterfly distribution Centrilobular Coalescent

SNM3 G-A321 Diffuse Discoid Disseminated Focal Generalized Lobar Multifocal Segmental Systemic

CONTEXT ID YY49 Chest Site Involvement


Coding Scheme



(0008,0103)



Lung (Alveolar) Mediastinum (Airways) Lobar Interstitial Bronchial Hilum or Hila Aorta Pleura Chest wall Upper Abdomen


CONTEXT ID YY50 Severity Modifier




(0008,0103)



Mild Moderate Severe

CONTEXT ID YY51 Chest Texture Modifier


Coding Scheme



(0008,0103)



Homogeneous (uniform opacity) Inhomogeneous

CONTEXT ID YY52 Chest Calcification Modifier


Coding Scheme



(0008,0103)



SRT 1.1 F-01763 Eggshell calcification SRT 1.1 F-01761 Coarse (popcorn-like) calcification

Target Laminated Fibrocalcific Flocculent Nodular Ossification


CONTEXT ID YY53 Chest Quantitative Temporal Difference Type




(0008,0103)



SRT 1.1 F-017B1 Difference in size SRT 1.1 F-017B3 Difference in location

CONTEXT ID YY54 Chest Qualitative Temporal Difference Type




(0008,0103)



Difference in border shape Difference in border definition Difference in distribution Difference in site involvement Difference in Type of Content Difference in Texture

CONTEXT ID YY55 Chest Image Quality Finding




(0008,0103)



DCM 111208 Grid artifact(s) DCM 111209 Positioning DCM 111210 Motion blur DCM 111211 Under exposed DCM 111212 Over exposed DCM 111213 No image DCM 111214 Detector artifact(s) DCM 111215 Artifact(s) other than grid or detector artifact DCM 111216 Mechanical failure DCM 111217 Electrical failure DCM 111218 Software failure


Coding Scheme



(0008,0103)



DCM 111219 Inappropriate mage processing DCM 111220 Other failure DCM 111221 Unknown failure

CONTEXT ID YY56 Chest Types of Quality Control Standard




(0008,0103)



(Editor’s note: Are there established quality control standards for Chest?)

CONTEXT ID YY57 Types of Chest CAD Analysis




(0008,0103)



SRT 1.1 P5-B3402 Spatial colocation analysis1 SRT 1.1 P5-B3404 Spatial proximity analysis2 SRT 1.1 P5-B3406 Temporal correlation SRT 1.1 P5-B3408 Image quality analysis

Inferred anatomy analysis Inferred pathology analysis

DCM zzz019 Inferred disease analysis Disease relationship analysis

1 Spatial Co-location Analysis is used to identify features that are the same or located in the same place. 2 Spatial Proximity Analysis is used to identify different features that are related spatially.


CONTEXT ID YY58 Image Laterality

(Most Restrictive Use: Defined) Note: From DICOM 1999, PS 3.3, C.8.11.2 DX Anatomy Imaged Module; Enumerated Values for Image Laterality (0020,0062) Attribute.

Coding Scheme



(0008,0103)



SNM3 G-A101 Left SNM3 G-A100 Right DCM zzz005 Unpaired SNM3 G-A102 Right and left

CONTEXT ID 6034

Intended Use of CAD Output (Most Restrictive Use: Enumerated)

Note: Duplicate of Context Group defined in Supplement 50 (Mammography CAD SR), Final Text - reuse

Coding Scheme



(0008,0103)



DCM 111150 Presentation Required: Rendering device is expected to present

DCM 111151 Presentation Optional: Rendering device may present

DCM 111152 Not for Presentation: Rendering device expected not to present

CONTEXT ID 6035 Composite Feature Relations

(Most Restrictive Use: Enumerated) Note: Duplicate of Context Group defined in Supplement 50 (Mammography CAD SR), Final Text – reuse

Coding Scheme



(0008,0103)



DCM 111153 Target content items are related temporally DCM 111154 Target content items are related spatially DCM 111155 Target content items are related contra-laterally


Context ID 6036 Scope of Feature

(Most Restrictive Use: Enumerated) Note: Duplicate of Context Group defined in Supplement 50 (Mammography CAD SR), Final Text - reuse

Coding Scheme



(0008,0103)



DCM 111156 Feature detected on the only image DCM 111157 Feature detected on only one of the images DCM 111158 Feature detected on multiple images DCM 111159 Feature detected on images from multiple

modalities

Context ID 6040 Non-Lesion Object Type

(Most Restrictive Use: Defined) Note: Duplicate of Context Group defined in Supplement 50 (Mammography CAD SR), Final Text - reuse

Coding Scheme



(0008,0103)



SNM3 A-04010 Implant DCM 111168 Scar Tissue SNM3 A-32475 BB shot (Lead Pellet) SNM3 J-83250 Metal (Lead) Marker SNM3 A-32110 Bullet DCM 111170 J Wire SNM3 A-13600 Staple SNM3 A-13510 Suture material SNM3 A-12062 Clip DCM 111171 Pacemaker SNM3 A-26800 Catheter DCM 111172 Paddle DCM 111173 Collimator DCM 111174 ID Plate SNM3 C-B0300 Contrast agent NOS DCM 111175 Other Marker DCM 111176 Unspecified


Context ID 6042 Status of Results


Coding Scheme



(0008,0103)



DCM 111222 Succeeded DCM 111223 Partially Succeeded DCM 111224 Failed DCM 111225 Not Attempted

Context ID 6044 Types of Image Quality Assessment


Coding Scheme



(0008,0103)



DCM 111235 Unusable Quality renders image unusable DCM 111236 Usable Does not meet the quality control

standard DCM 111237 Usable Meets the quality control standard

Context ID 6046 Units of Follow-up Interval


Coding Scheme



(0008,0103)



UCUM 1.4 d Day UCUM 1.4 wk Week UCUM 1.4 mo Month UCUM 1.4 a Year


Context ID 6047 CAD Processing and Findings Summary


Coding Scheme



(0008,0103)



DCM 111241 All algorithms succeeded; without findings DCM 111242 All algorithms succeeded; with findings DCM 111243 Not all algorithms succeeded; without findings DCM 111244 Not all algorithms succeeded; with findings DCM 111245 No algorithms succeeded; without findings

CONTEXT GROUP 7460 Units of Linear Measurement

(Most Restrictive Use: Defined) Note: Duplicate of Template defined in Supplement 53 (DICOM Content Mapping Resource), Final Text – reuse

Coding Scheme



(0008,0103)



UCUM 1.4 cm centimeter UCUM 1.4 mm millimeter UCUM 1.4 um micrometer

CONTEXT GROUP 7461 Units of Area Measurement


Coding Scheme



(0008,0103)



UCUM 1.4 cm2 Square centimeter UCUM 1.4 mm2 Square millimeter UCUM 1.4 um2 Square micrometer


CONTEXT GROUP 7462 Units of Volume Measurement (Most Restrictive Use: Defined)

Note: Duplicate of Template defined in Supplement 53 (DICOM Content Mapping Resource), Final Text – reuse

Coding Scheme



(0008,0103)



UCUM 1.4 dm3 Cubic decimeter UCUM 1.4 cm3 Cubic centimeter UCUM 1.4 mm3 Cubic millimeter UCUM 1.4 um3 Cubic micrometer

Note: A “cubic decimeter” is a “liter”, just as a “cubic centimeter” is a “milliliter” (of water). Though there are specific units “l” and “ml” in UCUM, only one form is included here, since this context group is intended for use for volume measurements of a physical object derived from one or more images, rather than of fluid volume.

CONTEXT GROUP 7470 Linear Measurements


Coding Scheme



(0008,0103)



SRT 1.1 G-A22A Length DCM 121211 Path length DCM 121206 Distance SNM3 G-A220 Width SRT 1.1 G-D785 Depth

SNM3 M-02550 Diameter SNM3 G-A185 Long Axis SNM3 G-A186 Short Axis SRT 1.1 G-A193 Major Axis SRT 1.1 G-A194 Minor Axis SRT 1.1 G-A195 Perpendicular Axis

SNM3 G-A196 Radius SRT 1.1 G-A197 Perimeter

SNM3 M-02560 Circumference


Coding Scheme



(0008,0103)



SRT 1.1 G-A198 Diameter of circumscribed circle

CONTEXT GROUP 7471 Area Measurements


Coding Scheme



(0008,0103)



SNM3 G-A166 Area SRT 1.1 G-A167 Area of defined region

CONTEXT GROUP 7472 Volume Measurements


Coding Scheme



(0008,0103)



SNM3 G-D705 Volume DCM 121216 Volume estimated from single 2D region DCM 121218 Volume estimated from two non-coplanar 2D

regions DCM 121217 Volume estimated from three or more non-coplanar

2D regions DCM 121222 Volume of sphere DCM 121221 Volume of ellipsoid DCM 121220 Volume of circumscribed sphere DCM 121219 Volume of bounding three dimensional region


Add the following definitions to Part 16 Annex D DICOM Controlled Terminology Definitions (Normative):

Annex D DICOM Controlled Terminology Definitions (Normative)

This Annex specifies the meanings of codes defined in DICOM, either explicitly or by reference to another part of DICOM or an external reference document or standard.

DICOM Code Definitions (Coding Scheme Designator “DCM” Coding Scheme Version “01”)

Code Value

Code Meaning Definition

zzz001 Chest CAD Report A structured report containing the results of computer-aided detection or diagnosis applied to chest imaging and associated clinical information

zzz002 Inferred Anatomy/Pathology An anatomy or pathology that is inferred from interpretation of the findings or features detected on one or more images and associated clinical information.

zzz003 Nodule Any pulmonary or pleural lesion represented in a radiograph by a sharply defined, discrete, approximately circular opacity 2-30 mm in diameter [Fraser & Pare].

zzz004 Opacity The shadow of an absorber that attenuates the x-ray beam more effectively than do surrounding absorbers. In a radiograph, any circumscribed area that appears more nearly white (of lesser photometric density) than its surround [Fraser & Pare].

zzz005 Unpaired A single entity that occurs only once, such as the heart or head in human anatomy.

zzz006 Associated Chest Component A named anatomic region within the chest cavity. zzz007 Abnormal interstitial pattern A collection of opacities detected within the

continuum of loose connective tissue throughout the lung, that is not expected in a diagnostically normal radiograph.

zzz008 Radiographic anatomy A type of anatomy that is expected to be detectable on a radiographic (x-ray based) image.

zzz009 Distribution Modifier Characteristic of the extent of spreading of a finding or feature.

zzz010 Border definition Characteristic of the clarity of the boundary or edges of a finding or feature.

zzz011 Site involvement The part(s) of the anatomy affected or encompassed by a finding or feature.

zzz012 Type of Content Characteristic of the matter or substance within a finding or feature


Code Value


zzz013 Texture Modifier Characteristic of the surface or consistency of a finding or feature.

zzz014 Inferred Disease A disease that is inferred from interpretation of the findings or features detected, and/or pathology inferred on one or more images and associated clinical information.

zzz015 Inferred Disease Category The class of disease to which an inferred disease belongs.

zzz016 Location in Chest The zone, lobe or segment within the chest cavity in which a finding or feature is situated.

zzz017 Orientation Modifier Editor’s note: Need to obtain definition from clinical radiologist.

zzz018 Border shape Characteristic of the shape formed by the boundary or edges of a finding or feature.

zzz019 Inferred disease analysis Analysis of a related group of findings, features or pathology, detected or inferred during image data inspection, to produce an inference of a particular disease.

zzz020 Anatomy/Pathology Interpretations A container for the inferences regarding anatomy and pathology, resulting from interpretation of one or more images and associated clinical information.

zzz021 Certainty of inference The certainty that a device places on an inference, where 0 equals no certainty and 100 equals certainty.

zzz022 Probability of pathology The likelihood that an inferred pathology is in fact the type of pathology identified.

zzz023 Pathology presence A qualitative descriptor of the degree to which an inferred pathology is evident.

zzz024 No evidence of presence zzz025 Clearly present zzz026 Inconclusive evidence of presence zzz027 Side of Chest An indication of whether the location of a finding

or feature is in the left, right, or both sides of the chest cavity.

zzz028 Calcification extent as percent of surface

The extent of a detected calcification, represented as the percent of the surrounding surface that it occupies.

zzz030 Disease presence A qualitative descriptor of the degree to which an inferred disease is evident.

zzz032 Likelihood of Related Disease Within a differential diagnosis, the percent likelihood that one disease is present versus another.


Code Value


zzz033 Composite Feature Category The named group in which an item that is an inferred correlation relating two or more individual findings or features belongs

zzz034 Single Image Finding Category The named group in which an item that was detected on one image belongs

zzz035 Size Modifier A qualitative descriptor for the extent of a finding or feature

zzz036 Width Modifier A qualitative descriptor for the thickness of tubular structures, such as pulmonary vessels.

zzz037 Opacity Modifier A characteristic that further describes the nature of an opacity.

zzz038 Abnormal Distribution of Anatomic Structure

The type of adverse affect that a finding or feature is having on the surrounding anatomy.

zzz039 Severity Modifier The level of acuteness of a finding or feature. zzz040 Calcification Modifier Identification of the morphology of detected

calcifications. zzz041 CT Number A quantitative numerical statement of the relative

attenuation of the x-ray beam at a specified point; expressed in Hounsfield units [Fraser & Pare]

zzz042 Computed Tomography (CT) A medical imaging procedure or piece of equipment in which the x-ray source is rotated mechanically around the patient to produce multiple projections, for mathematical reconstruction of the cross-sectional image [Fraser & Pare].

zzz043 Abnormal opacity An opacity that is not expected in a diagnostically normal radiograph.

zzz044 Disease Interpretations A container for the inferences regarding disease, resulting from interpretation of one or more images and associated clinical information.

zzz045 Association of Inferred Diseases A container for the differential diagnoses of inferred diseases, resulting from interpretation of one or more images and associated clinical information.

Digital Imaging and Communications in Medicine (DICOM)dicom.nema.org/dicom/supps/Sup65_pc.pdf ·...

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