Rendering Intent concept modifiers in the Mammography CAD SR, Chest CAD SR and Colon CAD SR objects 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 Mammography CAD SR, Chest CAD SR or Colon 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.

The concept of extensibility implies that a recipient may encounter Content Items, Value Types and Relationship Types that are unanticipated and unsupported and hence potentially unrenderable.

An implementation shall identify in its Conformance Statement which Content Items, Value Types and Relationship Types it creates.