The templates that comprise the Chest CAD SR IOD are interconnected as in Figure A-9.
In Figure A-9, '···' indicates possible recursive application of subordinate templates.
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, 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 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 4104 “Chest CAD Single Image Finding”), associated as Composite Features (see TID 4102 “Chest CAD Composite Feature”).
See Figure F.1-1 “Top Levels of Chest CAD SR Content Tree” in PS3.17 .
Non-Extensible
Significant
Yes
Table TID 4100. Chest CAD Document Root
NL |
Rel with Parent |
VT |
Concept Name |
VM |
Req Type |
Condition |
Value Set Constraint |
|
---|---|---|---|---|---|---|---|---|
1 |
CONTAINER |
1 |
M |
Root node |
||||
2 |
> |
HAS CONCEPT MOD |
INCLUDE |
1 |
M |
|||
3 |
> |
CONTAINS |
CONTAINER |
1 |
U |
|||
4 |
>> |
CONTAINS |
INCLUDE |
1-n |
M |
$ImageLaterality = DCID 244 "Laterality" $ImageView = DCID 4010 “DX View” $ImageViewMod = DCID 4011 “DX View Modifier” |
||
5 |
> |
CONTAINS |
INCLUDE |
1 |
M |
|||
6 |
> |
CONTAINS |
CODE |
1 |
M |
|||
7 |
>> |
INFERRED FROM |
INCLUDE |
1 |
MC |
Shall be present unless the value of row 6 is (111225, DCM, "Not Attempted") |
$DetectionCode = DCID 6101 “Chest Finding Or Feature”, DCID 6102 “Chest Finding Or Feature Modifier” |
|
8 |
> |
CONTAINS |
CODE |
1 |
M |
|||
9 |
>> |
INFERRED FROM |
INCLUDE |
1 |
MC |
Shall be present unless the value of row 8 is (111225, DCM, "Not Attempted") |
$AnalysisCode = DCID 6137 “Types of CAD Analysis” |
Content Item Descriptions
Image Library |
The "Image Library" section of the Content Tree (TID 4100 “Chest CAD Document Root”, row 3) may 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" may also include all Image Library Entries referenced from the duplicated portions of the Chest CAD SR. The Image Library is intended to be used in cases where the acquisition context content items differ from image to image, such as different views and/or laterality in projection X-Ray. |
Detections Performed |
The "Detections Performed" and "Analyses Performed" sections of the Content Tree (TID 4100 “Chest CAD Document Root”, rows 7 and 9) together shall reference all Image SOP Instances included in the Current Requested Procedure Evidence Sequence (0040,A375) attribute of the SR Document General module. |
Analyses Performed |
The contents of this template describe the findings and aggregate features that the chest CAD device detected for the chest evidence presented. This template forms the chest CAD results sub-tree of the Chest CAD Document Root (TID 4100 “Chest CAD Document Root”). The data from which the details are inferred are expressed in the Composite Features (see TID 4102 “Chest CAD Composite Feature”) and/or Single Image Findings (see TID 4104 “Chest CAD Single Image Finding”), of which there may be several.
The sub-tree headed by this template is illustrated in Figure F.1-2 “Example of CAD Processing and Findings Summary Sub-Tree of Chest CAD SR Content Tree” in PS3.17 .
Non-Extensible
Significant
Table TID 4101. Chest CAD Findings Summary
NL |
Rel with Parent |
VT |
Concept Name |
VM |
Req Type |
Condition |
Value Set Constraint |
|
---|---|---|---|---|---|---|---|---|
1 |
CODE |
1 |
M |
|||||
2 |
> |
INFERRED FROM |
INCLUDE |
1-n |
U |
|||
3 |
> |
INFERRED FROM |
INCLUDE |
1-n |
U |
|||
4 |
> |
HAS PROPERTIES |
INCLUDE |
1-n |
U |
Content Item Descriptions
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. |
This template collects a composite feature for a lesion, anatomy, non-lesion object, or correlation of related objects (see TID 4101 “Chest CAD Findings Summary”). The details of the composition are expressed in the Chest CAD Composite Feature Body (see TID 4103 “Chest CAD Composite Feature Body”). The data from which the details are inferred, are expressed in the Composite Features (see TID 4102 “Chest CAD Composite Feature”) and/or Single Image Findings (see TID 4104 “Chest CAD Single Image Finding”), 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.
Non-Extensible
Significant
Table TID 4102. Chest CAD Composite Feature
NL |
Rel with Parent |
VT |
Concept Name |
VM |
Req Type |
Condition |
Value Set Constraint |
|
---|---|---|---|---|---|---|---|---|
1 |
CODE |
1 |
M |
|||||
2 |
> |
HAS CONCEPT MOD |
CODE |
1 |
U |
|||
3 |
> |
HAS CONCEPT MOD |
TEXT |
1 |
U |
|||
4 |
> |
HAS CONCEPT MOD |
CODE |
1 |
MC |
Shall be present IFF value of row 1 is (112005, DCM, "Radiographic anatomy") |
||
5 |
> |
HAS CONCEPT MOD |
CODE |
1 |
UC |
May be present IFF value of row 1 is (111102, DCM, "Non-lesion") |
||
6 |
> |
HAS CONCEPT MOD |
CODE |
1 |
UC |
May be present IFF value of row 2 is from DCID 6114 “Osseous Anatomy Finding Or Feature” |
||
7 |
> |
HAS CONCEPT MOD |
CODE |
1 |
M |
|||
8 |
> |
HAS OBS CONTEXT |
INCLUDE |
1 |
U |
|||
9 |
> |
HAS OBS CONTEXT |
CODE |
1 |
U |
|||
10 |
> |
HAS OBS CONTEXT |
INCLUDE |
1 |
MC |
Shall be present IFF this feature is duplicated from a different report than its parent. |
||
11 |
> |
HAS OBS CONTEXT |
INCLUDE |
1 |
M |
|||
12 |
> |
HAS PROPERTIES |
INCLUDE |
1 |
M |
|||
13 |
> |
INFERRED FROM |
INCLUDE |
1-n |
MC |
At least two items shall be present: two of row 13, two of row 14, or one of each. |
||
14 |
> |
INFERRED FROM |
INCLUDE |
1-n |
MC |
At least two items shall be present: two of row 13, two of row 14, or one of each. |
Content Item Descriptions
Anatomic Identifier |
An identifier of an anatomic feature when a multiplicity of features of that type may be present, such as "Rib 1", "Rib 2" or thoracic vertebrae "T1" or "T2". |
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 Section O.2 “Structured Reporting Storage SOP Class SCU and SCP Behavior” in PS3.4 . |
The details of a composite feature are expressed in this template. It is applied to Chest CAD Composite Feature (TID 4102 “Chest CAD Composite Feature”).
Non-Extensible
Significant
Table TID 4103. Chest CAD Composite Feature Body
NL |
Rel with Parent |
VT |
Concept Name |
VM |
Req Type |
Condition |
Value Set Constraint |
|
---|---|---|---|---|---|---|---|---|
1 |
CODE |
1 |
M |
|||||
2 |
CODE |
1 |
M |
|||||
3 |
NUM |
1 |
U |
UNITS = EV (%, UCUM, "Percent") Value = 0 - 100 |
||||
4 |
INCLUDE |
1 |
U |
|||||
5 |
INCLUDE |
1-n |
U |
|||||
6 |
INCLUDE |
1-n |
U |
|||||
7 |
INCLUDE |
1-n |
U |
|||||
8 |
INCLUDE |
1 |
U |
|||||
9 |
NUM |
1-n |
UC |
May be present IFF the value of row 1 is (111153, DCM, "Target content items are related temporally") |
||||
10 |
> |
R-INFERRED FROM |
NUM |
2 |
U |
The referenced numeric values shall have the same Concept Name. Their UNITS shall be the same as row 9 |
||
11 |
CODE |
1-n |
UC |
May be present only if the value of row 1 is (111153, DCM, "Target content items are related temporally") |
||||
12 |
> |
HAS PROPERTIES |
TEXT |
1 |
U |
|||
13 |
> |
R-INFERRED FROM |
CODE |
2 |
M |
The referenced content items shall have the same Concept Name and their code values shall be from the same context group. |
Content Item Descriptions
Certainty of Feature |
The certainty of the CAD device that the feature analyzed and classified by the CODE, as 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 9 |
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. |
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.
Non-Extensible
Significant
Table TID 4104. Chest CAD Single Image Finding
NL |
Rel with Parent |
VT |
Concept Name |
VM |
Req Type |
Condition |
Value Set Constraint |
|
---|---|---|---|---|---|---|---|---|
1 |
CODE |
1 |
M |
|||||
2 |
> |
HAS CONCEPT MOD |
CODE |
1 |
U |
|||
3 |
> |
HAS CONCEPT MOD |
TEXT |
1 |
U |
|||
4 |
> |
HAS CONCEPT MOD |
CODE |
1 |
MC |
Shall be present IFF value of row 1 is (112005, DCM, "Radiographic anatomy") |
||
5 |
> |
HAS CONCEPT MOD |
CODE |
1 |
UC |
May be present IFF value of row 1 is (111102, DCM, "Non-lesion") |
||
6 |
> |
HAS CONCEPT MOD |
CODE |
1 |
M |
|||
7 |
>> |
HAS PROPERTIES |
NUM |
1 |
UC |
IFF value of row 6 is (111151, DCM, "Presentation Optional") and row 1 of TID 4023 “CAD Operating Points” is present for the finding identified in row 1 |
UNITS = DT ({1:n}, UCUM, "range: 1:n"), where n is the maximum specified in Row 1 of TID 4023 “CAD Operating Points” for the finding identified in row 1. Value is restricted to being an integer |
|
8 |
> |
HAS OBS CONTEXT |
INCLUDE |
1 |
U |
|||
9 |
> |
HAS OBS CONTEXT |
CODE |
1 |
U |
|||
10 |
> |
HAS OBS CONTEXT |
INCLUDE |
1 |
MC |
Shall be present IFF this finding is duplicated from a different report than its parent. |
||
11 |
> |
HAS OBS CONTEXT |
INCLUDE |
1 |
M |
|||
12 |
> |
HAS PROPERTIES |
NUM |
1 |
U |
UNITS = EV (%, UCUM, "Percent") Value = 0 - 100 |
||
13 |
> |
HAS PROPERTIES |
TEXT |
1 |
MC |
Shall be present IFF value of row 1 is (111099, DCM, "Selected region") |
||
14 |
> |
HAS PROPERTIES |
INCLUDE |
1 |
MC |
Shall be present unless value of row 1 is (111101, DCM, "Image quality") |
||
15 |
> |
HAS PROPERTIES |
INCLUDE |
1-n |
U |
|||
16 |
> |
HAS PROPERTIES |
INCLUDE |
1-n |
U |
|||
17 |
> |
HAS PROPERTIES |
INCLUDE |
1-n |
U |
|||
18 |
> |
HAS PROPERTIES |
INCLUDE |
1 |
U |
|||
19 |
> |
INFERRED FROM |
IMAGE |
1 |
MC |
Shall be present IFF value of row 1 is (111101, DCM, "Image quality") and rows 20 and 21 are not present |
||
20 |
> |
R-INFERRED FROM |
IMAGE |
1 |
MC |
Shall be present IFF value of row 1 is (111101, DCM, "Image quality") and rows 19 and 21 are not present |
Shall reference an IMAGE content item in the (111028, DCM, "Image Library") |
|
21 |
> |
INFERRED FROM |
SCOORD |
1-n |
MC |
Shall be present IFF value of row 1 is (111101, DCM, "Image quality") and rows 19 and 20 are not present |
||
22 |
>> |
SELECTED FROM |
IMAGE |
1 |
MC |
XOR row 23 |
All the row 21 content items in a single invocation of this template shall reference the same IMAGE |
|
23 |
>> |
R-SELECTED FROM |
IMAGE |
1 |
MC |
XOR row 22 |
All the row 21 content items in a single invocation of this template shall reference the same IMAGE content item in the (111028, DCM, "Image Library") |
|
24 |
> |
HAS PROPERTIES |
INCLUDE |
1 |
MC |
Shall be present IFF value of row 1 is (111101, DCM, "Image quality") |
$QualityFinding = DCID 6135 “Image Quality Finding” $QualityStandard = DCID 6136 “Chest Types of Quality Control Standard” |
Content Item Descriptions
Anatomic Identifier |
An identifier of an anatomic feature when a multiplicity of features of that type may be present, such as "Rib 1", "Rib 2" or thoracic vertebrae "T1" or "T2". |
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 Section O.2 “Structured Reporting Storage SOP Class SCU and SCP Behavior” in PS3.4 . |
CAD Operating Point |
Additional information to use when Rendering Intent is "Presentation Optional". A CAD Operating Point of zero is not sent, and is encoded as a Rendering Intent of "Presentation Required". See Section O.2 “Structured Reporting Storage SOP Class SCU and SCP Behavior” in PS3.4 and Section E.4 “CAD Operating Point” in PS3.17 . |
Certainty of Finding |
The certainty of the CAD device that the finding detected and classified by the Single Image Finding CODE specified is in fact that type of finding. |
This template provides qualitative detail for a Single Image Finding or Composite Feature. It is applied to Chest CAD Composite Feature (TID 4102 “Chest CAD Composite Feature”) and Chest CAD Single Image Finding (TID 4104 “Chest CAD Single Image Finding”).
Non-Extensible
Significant
Table TID 4105. Chest CAD Descriptors
NL |
Rel with Parent |
VT |
Concept Name |
VM |
Req Type |
Condition |
Value Set Constraint |
|
---|---|---|---|---|---|---|---|---|
1 |
CODE |
1 |
U |
|||||
2 |
CODE |
1 |
U |
|||||
3 |
CODE |
1 |
U |
|||||
4 |
CODE |
1 |
U |
|||||
5 |
CODE |
1 |
U |
|||||
6 |
CODE |
1-n |
U |
|||||
7 |
CODE |
1 |
U |
|||||
8 |
CODE |
1 |
U |
|||||
9 |
CODE |
EV (G-C171, SRT, "Laterality") |
1 |
U |
||||
10 |
CODE |
1-n |
U |
|||||
11 |
CODE |
EV (112028, DCM, "Abnormal Distribution of Anatomic Structure") |
1 |
U |
||||
12 |
CODE |
1-n |
U |
|||||
13 |
CODE |
EV (G-C197, SRT, "Severity") |
1 |
U |
||||
14 |
CODE |
1 |
U |
|||||
15 |
CODE |
1 |
U |
|||||
16 |
NUM |
1-n |
U |
|||||
17 |
> |
HAS CONCEPT MOD |
CODE |
1 |
M |
|||
18 |
> |
INFERRED FROM |
NUM |
1 |
U |
UNITS = EV ([hnsf'U], UCUM, "Hounsfield unit") |
||
19 |
> |
INFERRED FROM |
TEXT |
1 |
U |
|||
20 |
NUM |
1-n |
U |
UNITS = EV ([hnsf'U], UCUM, "Hounsfield unit") |
This template provides a means to report response evaluation to cancer treatment, based on a method such as RECIST or WHO.
Non-Extensible
Significant
Table TID 4106. Response Evaluation
NL |
Rel with Parent |
VT |
Concept Name |
VM |
Req Type |
Condition |
Value Set Constraint |
|
---|---|---|---|---|---|---|---|---|
1 |
CONTAINER |
1 |
M |
|||||
2 |
> |
HAS OBS CONTEXT |
CODE |
1 |
M |
DT (112022, DCM, "RECIST") or |
||
3 |
> |
CONTAINS |
CODE |
1 |
U |
|||
4 |
> |
CONTAINS |
CODE |
1 |
U |
|||
5 |
> |
CONTAINS |
NUM |
1 |
U |
UNITS not specified |
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 4104 “Chest CAD Single Image Finding”) and composite features (see TID 4103 “Chest CAD Composite Feature Body”).
Non-Extensible
Significant
Table TID 4107. Chest CAD Geometry
NL |
Rel with Parent |
VT |
Concept Name |
VM |
Req Type |
Condition |
Value Set Constraint |
|
---|---|---|---|---|---|---|---|---|
1 |
SCOORD |
1 |
MC |
At least one of rows 1, 4 shall be present. |
GRAPHIC TYPE = {POINT} |
|||
2 |
> |
SELECTED FROM |
IMAGE |
1 |
MC |
XOR row 3 |
||
3 |
> |
R-SELECTED FROM |
IMAGE |
1 |
MC |
XOR row 2 |
Shall reference an IMAGE content item in the (111028, DCM, "Image Library") |
|
4 |
SCOORD |
1 |
MC |
At least one of rows 1, 4 shall be present. |
||||
5 |
> |
SELECTED FROM |
IMAGE |
1 |
MC |
XOR row 6 |
Shall reference the same content item as row 2 |
|
6 |
> |
R-SELECTED FROM |
IMAGE |
1 |
MC |
XOR row 5 |
Shall reference the same content item as row 3 |
This template provides a means to identify an object for longitudinal tracking, potentially across multiple Structured Reports, over time.
Non-Extensible
Significant
Table TID 4108. Tracking Identifier
NL |
Rel with Parent |
VT |
Concept Name |
VM |
Req Type |
Condition |
Value Set Constraint |
|
---|---|---|---|---|---|---|---|---|
1 |
TEXT |
1 |
MC |
At least one of row 1 or 2 shall be present. |
A string of characters with case being non-significant. Leading and trailing spaces and control characters are forbidden. |
|||
2 |
UIDREF |
1 |
MC |
At least one of row 1 or 2 shall be present. |
Content Item Descriptions
Tracking Identifier |
A human readable identifier for longitudinal tracking, e.g., "Watchlist Nodule 1". |
Tracking Unique Identifier |
This is distinct from the Observation UID (0040,A171) that may be present in the data set for each content item, which identifies only a specific observation, not an object tracked over time, and each tracked object may have many observations. |