CHEST CAD SR IOD TEMPLATES

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.

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Figure A-9: Chest CAD SR IOD Template Structure

TID 4100 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, 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), associated as Composite Features (see TID 4102).

See the figure entitled “Top Levels of Chest CAD SR Content Tree” in the “Chest CAD” Annex of PS 3.17.

TID 4100CHEST CAD DOCUMENT ROOTType: Non-Extensible Order: Significant

NL Rel with Parent VT Concept Name VM Req Type Condition Value Set Constraint
1 CONTAINER EV (112000, DCM, “Chest CAD Report”) 1 M
2 > HAS CONCEPT MOD INCLUDE DTID (1204) Language of Content Item and Descendants 1 M
3 > CONTAINS CONTAINER EV (111028, DCM, “Image Library”) 1 U
4 >> CONTAINS INCLUDE DTID (4020) CAD Image Library Entry 1-n M $ImageLaterality = DCID (244) Laterality $ImageView = DCID (4010) DX View $ImageViewMod = DCID (4011) DX View Modifier
5 > CONTAINS INCLUDE DTID (4101) Chest CAD Findings Summary 1 M
6 > CONTAINS CODE EV (111064, DCM, “Summary of Detections”) 1 M DCID (6042) Status of Results
7 >> INFERRED FROM INCLUDE DTID (4015) CAD Detections Performed 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 EV (111065, DCM, “Summary of Analyses”) 1 M DCID (6042) Status of Results
9 >> INFERRED FROM INCLUDE DTID (4016) CAD Analyses Performed 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, 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, 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

TID 4101 Chest CAD Findings Summary Template

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). The data from which the details are inferred are expressed in the Composite Features (see TID 4102) and/or Single Image Findings (see TID 4104), 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” Annex of PS 3.17.

TID 4101CHEST CAD FINDINGS SUMMARYType: Non-Extensible Order: Significant

NL Rel with Parent VT Concept Name VM Req Type Condition Value Set Constraint
1 CODE EV (111017, DCM, “CAD Processing and Findings Summary”) 1 M DCID (6047) CAD Processing and Findings Summary
2 > INFERRED FROM INCLUDE DTID (4102) Chest CAD Composite Feature 1-n U
3 > INFERRED FROM INCLUDE DTID (4104) Chest CAD Single Image Finding 1-n U
4 > HAS PROPERTIES INCLUDE DTID (4106) Response Evaluation 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.

TID 4102 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 4101). The details of the composition are expressed in the Chest CAD Composite Feature Body (see TID 4103). The data from which the details are inferred, are expressed in the Composite Features (see TID 4102) and/or Single Image Findings (see TID 4104), 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.

TID 4102CHEST CAD COMPOSITE FEATUREType: Non-Extensible Order: Significant

NL Rel with Parent VT Concept Name VM Req Type Condition Value Set Constraint
1 CODE EV (111015, DCM, “Composite Feature”) 1 M DCID (6101) Chest Finding or Feature
2 > HAS CONCEPT MOD CODE EV (112023, DCM, “Composite Feature Modifier”) 1 U DCID (6102) Chest Finding or Feature Modifier
3 > HAS CONCEPT MOD TEXT EV (112050, DCM, “Anatomic Identifier”) 1 U
4 > HAS CONCEPT MOD CODE EV (112003, DCM, “Associated Chest Component”) 1 MC Shall be present IFF value of row 1 is (112005, DCM, “Radiographic anatomy”) DCID (6100) Chest Component Categories
5 > HAS CONCEPT MOD CODE EV (112037, DCM, “Non-lesion Modifier”) 1 UC May be present IFF value of row 1 is (111102, DCM, ”Non-lesion”) DCID (6139) Non-lesion Modifiers
6 > HAS CONCEPT MOD CODE EV (112038, DCM, “Osseous Modifier”) 1 UC May be present IFF value of row 2 is from DCID (6114) Osseous Anatomy Finding or Feature DCID (6115) Osseous Anatomy Modifiers
7 > HAS CONCEPT MOD CODE EV (111056, DCM, “Rendering Intent”) 1 M DCID (6034) Intended Use of CAD Output
8 > HAS OBS CONTEXT INCLUDE DTID (4108) Tracking Identifier 1 U
9 > HAS OBS CONTEXT CODE EV (112016, DCM, “Baseline Category”) 1 U DCID (6145) Baseline Category
10 > HAS OBS CONTEXT INCLUDE DTID (4022) CAD Observation Context 1 MC Shall be present IFF this feature is duplicated from a different report than its parent.
11 > HAS OBS CONTEXT INCLUDE DTID (4019) CAD Algorithm Identification 1 M
12 > HAS PROPERTIES INCLUDE DTID (4103) Chest CAD Composite Feature Body 1 M
13 > INFERRED FROM INCLUDE DTID (4102) Chest CAD Composite Feature 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 DTID (4104) Chest CAD Single Image Finding 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 PS 3.4, Annex O Structured Reporting Standard SOP Classes for SCU and SCP Behavior.

TID 4103 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 4102).

TID 4103CHEST CAD COMPOSITE FEATURE BODYType: Non-Extensible Order: Significant

NL Rel with Parent VT Concept Name VM Req Type Condition Value Set Constraint
1 CODE EV (111016, DCM, “Composite type”) 1 M DCID (6035) Composite Feature Relations
2 CODE EV (111057, DCM, “Scope of Feature”) 1 M DCID (6036) Scope of Feature
3 NUM EV (111011, DCM, “Certainty of feature”) 1 U UNITS = EV (%, UCUM, “Percent”) Value = 0 – 100
4 INCLUDE DTID (4107) Chest CAD Geometry 1 U
5 INCLUDE DTID (1400) Linear Measurement 1-n U
6 INCLUDE DTID (1401) Area Measurement 1-n U
7 INCLUDE DTID (1402) Volume Measurement 1-n U
8 INCLUDE DTID (4105) Chest CAD Descriptors 1 U
9 NUM DCID (6133) Chest Quantitative Temporal Difference Type 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 EV (111049, DCM, “Qualitative Difference”) 1-n UC May be present only if the value of row 1 is (111153, DCM, “Target content items are related temporally”) DCID (6134) Qualitative Temporal Difference Type
12 > HAS PROPERTIES TEXT EV (111021, DCM, “Description of Change”) 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.

TID 4104 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.

TID 4104CHEST CAD SINGLE IMAGE FINDINGType: Non-Extensible Order: Significant

NL Rel with Parent VT Concept Name VM Req Type Condition Value Set Constraint
1 CODE EV (111059, DCM, “Single Image Finding”) 1 M DCID (6101) Chest Finding or Feature
2 > HAS CONCEPT MOD CODE EV (112024, DCM, “Single Image Finding Modifier”) 1 U DCID (6102) Chest Finding or Feature Modifier
3 > HAS CONCEPT MOD TEXT EV (112050, DCM, “Anatomic Identifier”) 1 U
4 > HAS CONCEPT MOD CODE EV (112003, DCM, “Associated Chest Component”) 1 MC Shall be present IFF value of row 1 is (112005, DCM, “Radiographic anatomy”) DCID (6100) Chest Component Categories
5 > HAS CONCEPT MOD CODE EV (112037, DCM, “Non-lesion Modifier”) 1 UC May be present IFF value of row 1 is (111102, DCM, ”Non-lesion”) DCID (6139) Non-lesion Modifiers
6 > HAS CONCEPT MOD CODE EV (111056, DCM, “Rendering Intent”) 1 M DCID (6034) Intended Use of CAD Output
7 >> HAS PROPERTIES NUM EV (111071, DCM, “CAD Operating Point”) 1 UC IFF value of row 6 is (111151, DCM, “Presentation Optional”) and row 1 of TID 4023 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 for the finding identified in row 1. Value is restricted to being an integer
8 > HAS OBS CONTEXT INCLUDE DTID (4108) Tracking Identifier 1 U
9 > HAS OBS CONTEXT CODE EV (112016, DCM, “Baseline Category”) 1 U DCID (6145) Baseline Category
10 > HAS OBS CONTEXT INCLUDE DTID (4022) CAD Observation Context 1 MC Shall be present IFF this finding is duplicated from a different report than its parent.
11 > HAS OBS CONTEXT INCLUDE DTID (4019) CAD Algorithm Identification 1 M
12 > HAS PROPERTIES NUM EV (111012, DCM, “Certainty of Finding”) 1 U UNITS = EV (%, UCUM, “Percent”) Value = 0 – 100
13 > HAS PROPERTIES TEXT EV (111058, DCM, “Selected Region Description”) 1 MC Shall be present IFF value of row 1 is (111099, DCM, “Selected region”)
14 > HAS PROPERTIES INCLUDE DTID (4107) Chest CAD Geometry 1 MC Shall be present unless value of row 1 is (111101, DCM, “Image quality”)
15 > HAS PROPERTIES INCLUDE DTID (1400) Linear Measurement 1-n U
16 > HAS PROPERTIES INCLUDE DTID (1401) Area Measurement 1-n U
17 > HAS PROPERTIES INCLUDE DTID (1402) Volume Measurement 1-n U
18 > HAS PROPERTIES INCLUDE DTID (4105) Chest CAD Descriptors 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 EV (111030, DCM, “Image Region”) 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 DTID (4014) CAD Image Quality 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 PS 3.4 section on Structured Reporting Storage SOP Classes for SCU and SCP Behavior.
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 PS 3.4 section on Structured Reporting Storage SOP Classes for SCU and SCP Behavior and PS 3.17 annex on Mammography.
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.

TID 4105 Chest CAD Descriptors

This template provides qualitative detail for a Single Image Finding or Composite Feature. It is applied to Chest CAD Composite Feature (TID 4102) and Chest CAD Single Image Finding (TID 4104).

TID 4105CHEST CAD DESCRIPTORSType: Non-Extensible Order: Significant

NL Rel with Parent VT Concept Name VM Req Type Condition Value Set Constraint
1 CODE EV (112025, DCM, “Size Descriptor”) 1 U DCID (6118) Size Descriptor
2 CODE EV (112026, DCM, “Width Descriptor”) 1 U DCID (6107) Width Descriptor
3 CODE EV (112015, DCM, “Border shape”) 1 U DCID (6119) Chest Border Shape
4 CODE EV (112007, DCM, “Border definition”) 1 U DCID (6120) Chest Border Definition
5 CODE EV (112014, DCM, “Orientation Descriptor”) 1 U DCID (6121) Chest Orientation Descriptor
6 CODE EV (112009, DCM, “Type of Content”) 1-n U DCID (6122) Chest Content Descriptor
7 CODE EV (112027, DCM, “Opacity Descriptor”) 1 U DCID (6123) Chest Opacity Descriptor
8 CODE EV (112013, DCM, “Location in Chest”) 1 U DCID (6124) Location in Chest
9 CODE EV (G-C171, SRT, “Laterality”) 1 U DCID (244) Laterality
10 CODE EV (112006, DCM, “Distribution Descriptor”) 1-n U DCID (6128) Chest Distribution Descriptor
11 CODE EV (112028, DCM, “Abnormal Distribution of Anatomic Structure”) 1 U DCID (6108) Chest Anatomic Structure Abnormal Distribution
12 CODE EV (112008, DCM, “Site involvement”) 1-n U DCID (6129) Chest Site Involvement
13 CODE EV (G-C197, SRT, “Severity”) 1 U DCID (6130) Severity Descriptor
14 CODE EV (112010, DCM, “Texture Descriptor”) 1 U DCID (6131) Chest Texture Descriptor
15 CODE EV (112030, DCM, “Calcification Descriptor”) 1 U DCID (6132) Chest Calcification Descriptor
16 NUM DCID (6142) Calculated Value 1-n U
17 > HAS CONCEPT MOD CODE EV (121401, DCM, “Derivation”) 1 M DCID (6140) Calculation Methods
18 > INFERRED FROM NUM EV (112032, DCM, “Threshold Attenuation Coefficient”) 1 U UNITS = EV ([hnsf’U], UCUM, “Hounsfield unit”)
19 > INFERRED FROM TEXT EV (112034, DCM, “Calculation Description”) 1 U
20 NUM DCID (6141) Attenuation Coefficient Measurements 1-n U UNITS = EV ([hnsf’U], UCUM, “Hounsfield unit”)

TID 4106 Response Evaluation

This template provides a means to report response evaluation to cancer treatment, based on a method such as RECIST or WHO.

TID 4106 RESPONSE EVALUATION Type: Non-Extensible Order: Significant

NL Rel with Parent VT Concept Name VM Req Type Condition Value Set Constraint
1 CONTAINER EV (112020, DCM, “Response Evaluation”) 1 M
2 > HAS OBS CONTEXT CODE EV (112021, DCM, “Response Evaluation Method”) 1 M DT (112022, DCM “RECIST”) or DT (112029, DCM, “WHO”)
3 > CONTAINS CODE EV (112048, DCM, “Current Response”) 1 U DCID (6143) Response Criteria
4 > CONTAINS CODE EV (112049, DCM, “Best Overall Response”) 1 U DCID (6143) Response Criteria
5 > CONTAINS NUM EV (112051, DCM, “Measurement of Response”) 1 U UNITS not specified

TID 4107 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 4104) and composite features (see TID 4103).

TID 4107CHEST CAD GEOMETRYType: Non-Extensible Order: Significant

NL Rel with Parent VT Concept Name VM Req Type Condition Value Set Constraint
1 SCOORD EV (111010, DCM, “Center”) 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 EV (111041, DCM, “Outline”) 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

TID 4108 Tracking Identifier

This template provides a means to identify an object for longitudinal tracking, potentially across multiple Structured Reports, over time.

TID 4108TRACKING IDENTIFIERType: Non-Extensible Order: Significant

NL Rel with Parent VT Concept Name VM Req Type Condition Value Set Constraint
1 TEXT EV (112039, DCM, “Tracking Identifier”) 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 EV (112040, DCM, “Tracking Unique Identifier”) 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”.