CP-2000

<informaltable rules="all" frame="box"> <tr> <td> <para><emphasis role="italic">Amend PS3.3 as follows (changes to existing text are bold and <emphasis role="bold"><emphasis role="underline" >underlined</emphasis></emphasis> for additions and <emphasis role="bold" ><emphasis role="strikethrough">struckthrough</emphasis></emphasis> for removals):</emphasis></para> </td> </tr> </informaltable> <section label="C.18.6" status="3" xml:id="sect_C.18.6"> <title>Spatial Coordinates Macro specifies the Attributes that convey Spatial Coordinates in an SCOORD Content Item. An SCOORD Content Item shall always be the Source Content Item of one or more SELECTED FROM Relationships with IMAGE Target Content Items. Each IMAGE Target Content Item shall contain a reference to one single-frame or multi-frame Image. The same set of spatial coordinates may be selected from more than one single-frame image, or more than one frame of a multi-frame image when the purpose of reference is applicable to multiple images. For example, the spatial coordinates may specify the outline of a sampling region at the same spatial location on multiple images acquired over time.

Spatial Coordinates Macro Attributes
Attribute Name	Tag	Type	Attribute Description
Graphic Data	(0070,0022)	1	An ordered set of (column,row) pairs that denote positions in an image specified with sub-pixel resolution such that the origin at the TLHC of the TLHC pixel is 0.0\0.0, the BRHC of the TLHC pixel is 1.0\1.0, and the BRHC of the BRHC pixel is Columns\Rows. The values must be within the range 0\0 to Columns\Rows. The maximum values are those contained in the referenced image in Attributes Columns (0028,0011) and Rows (0028,0010), or in the case of spatial coordinates with Pixel Origin Interpretation (0048,0301) value VOLUME, in Attributes Total Pixel Matrix Columns (0048,0006) and Total Pixel Matrix Rows (0048,0007). See for further explanation.
Graphic Type	(0070,0023)	1	See for Enumerated Values.
Pixel Origin Interpretation	(0048,0301)	1C	For a referenced multi-frame image, specifies whether the Graphic Data (0070,0022) values are to be interpreted relative to the individual frame pixel origins, or relative to the Total Pixel Matrix origin (see ). Required if the value of Referenced SOP Class UID (0008,1150) of the referenced image is 1.2.840.10008.5.1.4.1.1.77.1.6 (VL Whole Slide Microscopy Image). May be present otherwise. Enumerated Values: FRAME relative to individual frame VOLUME relative to Total Image Matrix If not present, Graphic Data values are defined relative to the frame pixel origin.
Fiducial UID	(0070,031A)	3	The globally unique identifier for this fiducial Item. The fiducial UID can be used to associate this set of graphics with other Content Items.

Spatial Coordinates Macro Attribute Descriptions

Graphic Data Graphic Data may be used to associate an anatomic or spatial Concept with a defined subset of one or more images. Graphic Data may be explicitly defined as a single point (i.e., to denote the epicenter of an anatomic site or lesion) or more than one point (i.e., representing a set of points or an open or closed polygon). Spatial coordinates may be used to associate observational data with a set of Image features. Spatial coordinates also may be used to convey coordinates that are input data for a measurement.

Graphic Type When annotation applies to an image, this Attribute defines the type of geometry of the annotated region of interest. Enumerated Values: POINT a single pixel denoted by a single (column,row) pair MULTIPOINT multiple pixels each denoted by an (column,row) pair POLYLINE a series of connected line segments with ordered vertices denoted by (column,row) pairs; if the first and last vertices are the same it is a closed polygon CIRCLE a circle defined by two (column,row) pairs. The first point is the central pixel. The second point is a pixel on the perimeter of the circle. ELLIPSE an ellipse defined by four pixel (column,row) pairs, the first two points specifying the endpoints of the major axis and the second two points specifying the endpoints of the minor axis of an ellipse The order of encoding of successive points for any particular Graphic Type is significant, but its meaning is not specified. The meaning of the order may be defined by a particular Template that uses them. For example, a closed POLYLINE may be encoded with a clockwise (right) or counter-clockwise (left) winding order (when viewed from a specified direction). A two-point POLYLINE used to encode a vector with a direction might be expected to originate at the first encoded point and be directed towards the second encoded point, but that is not specified. A Polygon encoded as a POLYLINE is not restricted to being a simple polygon, unless so specified by the Template that uses it.

3D Spatial Coordinates Macro specifies the Attributes that convey 3D Spatial Coordinates in an SCOORD3D Content Item.

3D Spatial Coordinates Macro Attributes
Attribute Name	Tag	Type	Attribute Description
Referenced Frame of Reference UID	(3006,0024)	1	Uniquely identifies the Frame of Reference within which the coordinates are defined. There is no requirement that the Frame of Reference be the same for all SCOORD3D Content Items in the same SR SOP Instance, nor is there any requirement that the be present. The Frame of Reference may be any type of DICOM Reference Coordinate System, whether it be patient-relative (Patient Based Coordinate System), volume-relative (including acquired and presentation state volumes), or whole slide relative (Slide Coordinate System).
Graphic Data	(0070,0022)	1	An ordered set of (x,y,z) triplets (in mm and may be negative) that define a region of interest in the patient-relative Reference Coordinate System defined by Referenced Frame of Reference UID (3006,0024). See . See for further explanation.
Graphic Type	(0070,0023)	1	See for Enumerated Values.
Fiducial UID	(0070,031A)	3	The globally unique identifier for this fiducial Item. The fiducial UID can be used to associate this set of graphics with other Content Items.

3D Spatial Coordinates Macro Attribute Descriptions

Graphic Data Graphic Data may be used to associate an anatomic or spatial Concept with a defined set of patient relative 3D locations in a defined Frame of Reference, independent of any image. Graphic Data may be defined explicitly as a single point (i.e., to denote the epicenter of an anatomic site or lesion) or more than one point (i.e., representing a set of points or an open or closed polygon).

Graphic Type This Attribute defines the type of geometry of the region of interest. Enumerated Values: POINT a single location denoted by a single (x,y,z) triplet MULTIPOINT multiple locations each denoted by an (x,y,z) triplet; the points need not be coplanar POLYLINE a series of connected line segments with ordered vertices denoted by (x,y,z) triplets; the points need not be coplanar POLYGON a series of connected line segments with ordered vertices denoted by (x,y,z) triplets, where the first and last vertices shall be the same forming a polygon; the points shall be coplanar ELLIPSE an ellipse defined by four (x,y,z) triplets, the first two triplets specifying the endpoints of the major axis and the second two triplets specifying the endpoints of the minor axis ELLIPSOID a three-dimensional geometric surface whose plane sections are either ellipses or circles and contains three intersecting orthogonal axes, "a", "b", and "c"; the ellipsoid is defined by six (x,y,z) triplets, the first and second triplets specifying the endpoints of axis "a", the third and fourth triplets specifying the endpoints of axis "b", and the fifth and sixth triplets specifying the endpoints of axis "c" A circle is a special case of ELLIPSE where the major and minor axis points are equidistant from the center. Coplanar is in the mathematical sense and is not necessarily related to a specific Image Instance. The order of encoding of successive points for any particular Graphic Type is significant, but its meaning is not specified. The meaning of the order may be defined by a particular Template that uses them. For example, a closed POLYGON may be encoded with a clockwise (right) or counter-clockwise (left) winding order (when viewed from a specified direction). A two-point POLYLINE used to encode a vector with a direction might be expected to originate at the first encoded point and be directed towards the second encoded point, but that is not specified. A POLYGON is not restricted to being a simple polygon, unless so specified by the Template that uses it.

Amend PS3.16 as follows (changes to existing text are bold and underlined for additions and struckthrough for removals):

Measurement Type: Extensible Order: Significant Root: No

Measurement
	NL	Rel with Parent	VT	Concept Name	VM	Req Type	Value Set Constraint
1			NUM	$Measurement	1	M	UNITS = $Units
2	>	HAS CONCEPT MOD	CODE	$ModType	1-n	U	$ModValue
3	>	HAS CONCEPT MOD	CODE	EV (370129005, SCT, "Measurement Method")	1	U	$Method
4	>	HAS CONCEPT MOD	CODE	EV (121401, DCM, "Derivation")	1	U	$Derivation
5	>	HAS CONCEPT MOD	CODE	EV (363698007, SCT, "Finding Site")	1-n	U	$TargetSite
6	>>	HAS CONCEPT MOD	CODE	EV (272741003, SCT, "Laterality")	1	U	$TargetSiteLaterality Defaults to D
...
13	>		INCLUDE	DTID 320 "Image or Spatial Coordinates"	1-n	U	$Purpose = $ImagePurpose
...

Content Item Descriptions Rows 2, 3, 4, 5 The HAS CONCEPT MOD items allow the explicit definition of terms for post-coordination of the measurement concept name. Additional post-coordinated modifier terms may be included in a SOP Instance based on this Template, in accordance with section 6.2.4, or as defined by Templates that invoke this Template and explicitly define additional post-coordinated modifiers (e.g., TID 5203). Row 5 Finding site may be multiple when a region of interest spans multiple anatomical locations and there is not a single pre-coordinated code describing the combination of locations. E.g., when a maligant, inflammatory or traumatic process spans actual or defined anatomical boundaries. There is no requirement that the multiple locations be contiguous. Row 13 Multiple SCOORD content items may be necessary to describe the source of the measurement. E.g., the measurement of an angle between two non-intersecting line segments requires two separate POLYLINE SCOORD content items with the concept name of (ddd001, DCM, "Arm of angle") conveyed in $Purpose. ...

Measurement Report This Root Template encodes a list of Measurement Groups each containing lists of measurements, together with any derived measurements. Each Measurement Group is identified by Tracking ID and UIDs. An image library is available to describe characteristics of the images referenced by the measurements, if any. Type: Extensible Order: Non-Significant Root: Yes

Measurement Report
	NL	Rel with Parent	VT	Concept Name	VM	Req Type	Value Set Constraint
...
9	>>	CONTAINS	INCLUDE	D	1-n	U	$Measurement = B $ImagePurpose = B $Units = B $Derivation = B $Method = B $QualModType = B $QualModValue = B
...
14	>>	CONTAINS	TEXT		1-n	U

Content Item Descriptions Rows 7, 8, 9 The baseline context group allows for generic intensity, size, texture and other feature measurements, regardless of the geometry of the ROI (e.g., linear distance can be measured on volumes, or volume can be estimated from a linear distance), and being baseline, do not constrain the invoker from using other appropriate concepts specific to the application. Different measurements of the same real world lesion made using different types of measurements (different templates) can be correlated by a shared value of Tracking Unique Identifer. See also . ... ... Row 9 Generic measurements include those specified on an image as a whole or by unconstrained graphic coordinates. These may be used for such things as whole image scores or quality measures, and for linear distance meaurements, such as for RECIST or WHO tumor treatment response criteria evaluation, or angle measurements. A Measurement Group is used to contain one or more individual measurements that are invocations of TID 300, consistent with TIDs 1410 and 1411, which both already have Measurement Group containers as their roots. ... ...

Quantitative Image Features Resources: HTML | FHIR JSON | FHIR XML | IHE SVS XML Type: Extensible Version: 20190121yyyymmdd UID: 1.2.840.10008.6.1.1269

Quantitative Image Features
Coding Scheme Designator	Code Value	Code Meaning
Include CID 7468 "Texture Measurements"
Include
Include CID 7477 "Global Shape Descriptors"
Include

Generic Intensity and Size Measurements Resources: HTML | FHIR JSON | FHIR XML | IHE SVS XML Type: Extensible Version: 20141110 UID: 1.2.840.10008.6.1.1003

Generic Intensity and Size Measurements
Coding Scheme Designator	Code Value	Code Meaning
Include CID 7180 "Abstract Multi-dimensional Image Model Component Semantics"
Include
Include CID 7471 ""Area Measurements
Include CID 7472 "Volume Measurements"

Linear Measurements Resources: HTML | FHIR JSON | FHIR XML | IHE SVS XML Type: Extensible Version: 20190121yyyymmdd UID: 1.2.840.10008.6.1.524

Linear Measurements
Coding Scheme Designator	Code Value	Code Meaning	SNOMED-RT ID	UMLS Concept Unique ID
SCT	410668003	Length	G-D7FE	C1444754
DCM	121211	Path length
DCM	121206	Distance
SCT	103355008	Width	G-A220	C0487742
SCT	131197000	Depth	G-D785	C0205125
SCT	81827009	Diameter	M-02550	C1301886
SCT	103339001	Long Axis	G-A185	C0522487
SCT	103340004	Short Axis	G-A186	C0522488
SCT	131187009	Major Axis	G-A193	C1295723
SCT	131188004	Minor Axis	G-A194	C1295724
SCT	131189007	Perpendicular Axis	G-A195	C1295725
SCT	131190003	Radius	G-A196	C1306504
SCT	131191004	Perimeter	G-A197	C1295726
SCT	74551000	Circumference	M-02560	C0332520
SCT	131192006	Diameter of circumscribed circle	G-A198	C1295727
DCM	121207	Height
DCM	ddd005	Line segment
IBSI	L0JK	Maximum 3D Diameter of a Mesh
IBSI	TDIC	Major Axis in 3D Length
IBSI	P9VJ	Minor Axis in 3D Length
IBSI	7J51	Least Axis in 3D Length

Amend PS3.16 to add new Context Groups:

Angle Measurements on Images Resources: HTML | FHIR JSON | FHIR XML | IHE SVS XML Type: Extensible Version: yyyymmdd UID: 1.2.840.10008.6.1.uuu1

Angle Measurements on Images
Coding Scheme Designator	Code Value	Code Meaning	SNOMED-RT ID	UMLS Concept Unique ID
SCT	285285000	Cobb angle	F-00E5C	C0563192
DCM	ddd002	Acetabular angle

Generic Purpose of Reference to Images and Coordinates in Measurements Resources: HTML | FHIR JSON | FHIR XML | IHE SVS XML Type: Extensible Version: yyyymmdd UID: 1.2.840.10008.6.1.uuu2

Generic Purpose of Reference to Images and Coordinates in Measurements
Coding Scheme Designator	Code Value	Code Meaning	SNOMED-RT ID	UMLS Concept Unique ID
Include
Include

Generic Purpose of Reference to Images in Measurements Resources: HTML | FHIR JSON | FHIR XML | IHE SVS XML Type: Extensible Version: yyyymmdd UID: 1.2.840.10008.6.1.uuu3

Generic Purpose of Reference to Images in Measurements
Coding Scheme Designator	Code Value	Code Meaning	SNOMED-RT ID	UMLS Concept Unique ID
DCM	121112	Source of Measurement
SCT	260753009	Source	G-C05F	C0449416

Generic Purpose of Reference to Coordinates in Measurements Resources: HTML | FHIR JSON | FHIR XML | IHE SVS XML Type: Extensible Version: yyyymmdd UID: 1.2.840.10008.6.1.uuu4

Generic Purpose of Reference to Coordinates in Measurements
Coding Scheme Designator	Code Value	Code Meaning
DCM	ddd001	Arm of angle
DCM	ddd003	Vector
DCM	ddd004	Approximate spatial location

Amend PS3.16 to add new codes:

DICOM Controlled Terminology Definitions (Normative)

DICOM Controlled Terminology Definitions (Coding Scheme Designator "DCM" Coding Scheme Version "01")
Code Value	Code Meaning	Definition	Notes
ddd001	Arm of angle	A line segment that is an arm of a pair of arms that defines an angle, whether or not those line segments share a common vertex.
ddd002	Acetabular angle	The angle between a line drawn an AP radiograph of the pelvis horizontally through the inferior aspect of both triradiate cartilages (Hilgenreiner's line) and a line parallel to the acetabular roof.	Used to evaluate developmental dysplasia of the hip.
ddd003	Vector	An entity that has both a magnitude and a direction.
ddd004	Approximate spatial location	The approximate geometric location on an image or in space where an entity is located.	Intended for use when it is known that the source of the information, such as a crude hand-drawn pointer, is in the neighborhood of the entity, but is not expected to be accurate.
ddd005	Line segment	That part of a line (a straight object having no curvature with negligible width and depth) that is bounded by two distinct end points and contains every point on the line between its end points, including both of the two end points.	Derived from https://en.wikipedia.org/wiki/Line_(geometry)#Line_segment.