Mammography CAD SR IOD Templates

The templates that comprise the Mammography CAD SR IOD are interconnected as in Figure A-8:

[pic]

Figure A-8: Mammography CAD SR IOD Template Structure

In Figure A-8, ‘ ( ( (’ indicates possible recursive application of subordinate templates.

TID 4000 Mammography CAD Document Root Template

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

This template defines a Container which contains an Image Library, the mammography 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 mammography CAD results.

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 mammography CAD report may produce no (or fewer than anticipated) results. Mammography CAD results are constructed bottom-up, starting from Single Image Findings (see Template 4006), associated as Composite Features (see Template 4004), and from which Individual and Overall Impressions are formed.

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

TID 4000MAMMOGRAPHY CAD DOCUMENT ROOTType: Non-Extensible Order: Significant

NL Rel with Parent VT Concept Name VM Req Type Condition Value Set Constraint
1 CONTAINER EV(111036, DCM, “Mammography 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 M
4 >> CONTAINS INCLUDE DTID (4020) CAD Image Library Entry 1-n M $ImageLaterality = DCID (6022) Side, $ImageView = DCID (4014) View for Mammography, $ImageViewMod = DCID (4015) View Modifier for Mammography
5 > CONTAINS INCLUDE DTID (4001) Mammography CAD Overall Impression / Recommendation” 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 (111064, DCM, “Summary of Detections”) is (111225, DCM, “Not Attempted”) $DetectionCode = DCID (6014) Mammography Single Image Finding
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 (111065, DCM, “Summary of Analyses”) is (111225, DCM, “Not Attempted”) $AnalysisCode = DCID (6043) Types of Mammography CAD Analysis

Content Item Descriptions

Image Library The “Image Library” section of the Content Tree (TID 4000, 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 Mammography CAD SR IOD is duplicated in the “Overall Impression/ Recommendation” section of the Content Tree, the “Image Library” shall also include all Image Library Entries referenced from the duplicated portions of the Mammography CAD SR.
Detections Performed The “Detections Performed” and “Analyses Performed” sections of the Content Tree (TID 4000, rows 6 and 8) 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 4001 Mammography CAD Overall Impression/Recommendation Template

This template forms the top of the mammography CAD results sub-tree. The contents of this template describe the overall impression the mammography CAD device had for the mammographic evidence presented and any recommendations that the mammography CAD device made. The details of the overall impression and recommendation are expressed in this instance of the Mammography CAD Impression/Recommendation Body (see TID 4002). The data from which the details are inferred, are expressed in the Mammography CAD Individual Impression/Recommendations (see TID 4003), of which there may be several.

TID 4001MAMMOGRAPHY CAD OVERALL IMPRESSION/RECOMMENDATIONType: 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 > HAS PROPERTIES INCLUDE DTID (4002) Mammography CAD Impression/Recommendation Body” 1 U
3 > INFERRED FROM INCLUDE DTID (4003) Mammography CAD Individual Impression/Recommendation 1-n MC Shall be present if 1 or more (111059, DCM, “Single Image Finding”) or (111015, DCM, “Composite Feature”) content items are reported.

Content Item Descriptions

CAD Processing and Findings Summary This code value is used to express if and why the Overall Impression/Recommendation 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 mammography CAD processing occurred successfully, without parsing the Summary of Detections and Summary of Analyses sub-trees.
Row 3 There are no constraints regarding the 1-n multiplicity of the inclusion of TID 4003 or its underlying structure, other than the TID 4001 and TID 4003 requirements. Individual Impression/Recommendation containers may be organized, for example per image, per finding or composite feature, or some combination thereof.

TID 4002 Mammography CAD Impression/Recommendation Body Template

The details of an impression and recommendation are expressed in this template. It is applied to both Mammography CAD Overall Impression/Recommendation (TID 4001) and Mammography CAD Individual Impression/Recommendation (TID 4003).

TID 4002MAMMOGRAPHY CAD IMPRESSION/RECOMMENDATION BODYType: Non-Extensible Order: Significant

NL Rel with Parent VT Concept Name VM Req Type Condition Value Set Constraint
1 CODE EV (111005, DCM, “Assessment Category”) 1-n MC At least one of rows 1, 3, 5, 6, 8, 9 shall be present. DCID (6026) Mammography Assessment
2 > HAS CONCEPT MOD CODE EV (G-C171, SRT, ”Laterality”) 1 U DCID (6022) Side
3 CODE EV (111023, DCM, “Differential Diagnosis/ Impression”) 1-n MC At least one of rows 1, 3, 5, 6, 8, 9 shall be present. DCID (6002) Change Since Last Mammogram or Prior Surgery
4 > HAS CONCEPT MOD CODE EV (G-C171, SRT, ”Laterality”) 1 U DCID (6022) Side
5 TEXT EV (111033, DCM, “Impression Description”) 1 MC At least one of rows 1, 3, 5, 6, 8, 9 shall be present.
6 CODE EV (111053, DCM, “Recommended Follow-up”) 1-n MC At least one of rows 1, 3, 5 5, 6, 8, 9 shall be present. DCID (6028) Mammography Recommended Follow-up
7 > HAS CONCEPT MOD CODE EV (G-C171, SRT, ”Laterality”) 1 U DCID (6022) Side
8 NUM EV (111055, DCM, “Recommended Follow-up Interval”) 1 MC At least one of rows 1, 3, 5, 6, 8, 9 shall be present. May be present only if (111054, DCM, “Recommended Follow-up Date”) is not present. UNITS = DCID (6046) Units of Follow-up Interval; Values = Integer ( 0, where 0 = immediate follow-up
9 DATE EV (111054, DCM, “Recommended Follow-up Date”) 1 MC At least one of rows 1, 3, 5, 6, 8, 9 shall be present. May be present only if (111055, DCM, “Recommended Follow-up Interval”) is not present. Shall be later than date of exam
10 NUM EV (111013, DCM, “Certainty of impression”) 1 UC May be present only if (111005, DCM, “Assessment Category”), (111023, DCM, “Differential Diagnosis/Impression”) or (111033, DCM, “Impression Description”) is present. UNITS = EV (%, UCUM, “Percent”) Values = 0 – 100
11 INCLUDE DTID (4019) CAD Algorithm Identification 1-n M
12 NUM DCID (6142) Calculated Value 1-n U
13 > HAS CONCEPT MOD CODE EV (G-C171, SRT, ”Laterality”) 1 U DCID (6022) Side
14 > HAS CONCEPT MOD CODE EV (121401, DCM, “Derivation”) 1 M DCID (6140) Calculation Methods
15 > INFERRED FROM TEXT EV (112034, DCM, “Calculation Description”) 1 U

Content Item Descriptions

Certainty of Impression The certainty that the device populating the Mammography CAD SR report places on this impression, where 0 equals no certainty and 100 equals certainty.
Impression Description Free-form text describing the overall or an individual impression

TID 4003 Mammography CAD Individual Impression/Recommendation Template

This template collects an individual impression the mammography CAD device had for a lesion, non-lesion object, or correlation of related objects. The details of the impression and recommendation are expressed in the Mammography CAD Impression/Recommendation Body (see TID 4002). The data from which the details are inferred are expressed in the Composite Features (see TID 4004) and/or Single Image Findings (see TID 4006) of which there may be several.

The sub-tree headed by this template is illustrated in PS 3.17 in the Annex on Mammography CAD SR Content Tree Structure.

TID 4003MAMMOGRAPHY CAD INDIVIDUAL IMPRESSION/RECOMMENDATIONType: Non-Extensible Order: Significant

NL Rel with Parent VT Concept Name VM Req Type Condition Value Set Constraint
1 CONTAINER EV (111034, DCM, “Individual Impression/ Recommendation”) 1 M
2 > HAS CONCEPT MOD CODE EV (111056, DCM, “Rendering Intent”) 1 M DCID (6034) Intended Use of CAD Output
3 > CONTAINS INCLUDE DTID (4002) Mammography CAD Impression / Recommendation Body 1 U
4 > CONTAINS INCLUDE DTID (4004) Mammography CAD Composite Feature 1-n MC At least one of rows 4, 5 shall be present.
5 > CONTAINS INCLUDE DTID (4006) Mammography CAD Single Image Finding 1-n MC At least one of rows 4, 5 shall be present.

Content Item Descriptions

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

TID 4004 Mammography CAD Composite Feature Template

This template collects a composite feature for a lesion, non-lesion object, or correlation of related objects. The details of the composition are expressed in the Mammography CAD Composite Feature Body (see TID 4005). The data from which the details are inferred, are expressed in the Composite Features (see TID 4004) and/or Single Image Findings (see TID 4006), 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 4004MAMMOGRAPHY 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 (6016) Mammography Composite Feature
2 > HAS CONCEPT MOD CODE EV (111056, DCM, “Rendering Intent”) 1 M DCID (6034) Intended Use of CAD Output
3 > HAS OBS CONTEXT INCLUDE DTID (4108) Tracking Identifier 1 U
4 > HAS PROPERTIES INCLUDE DTID (4005) Mammography CAD Composite Feature Body 1 M
5 > INFERRED FROM INCLUDE DTID (4004) Mammography CAD Composite Feature 1-n MC At least two items shall be present: two of row 5, two of row 6, or one of each.
6 > INFERRED FROM INCLUDE DTID (4006) Mammography CAD Single Image Finding 1-n MC At least two items shall be present: two of row 5, two of row 6, or one of each.
7 > HAS OBS CONTEXT INCLUDE DTID (4022) CAD Observation Context 1 MC Shall be present only if this feature is incorporated from a different report than its parent.

Content Item Descriptions

Rendering Intent This content item constrains the SCP receiving the Mammography CAD SR IOD in its use of the contents of this template and its target content items. Mammography CAD devices may opt to use data marked “Not for Presentation” or “Presentation Optional” as input to subsequent mammography CAD processing steps. Refer to PS 3.4, Annex O Structured Reporting Standard SOP Classes for SCU and SCP Behavior.
TID 4005 Mammography CAD Composite Feature Body Template

The details of a composite feature are expressed in this template. It is applied to Mammography CAD Composite Feature (TID 4004).

TID 4005MAMMOGRAPHY 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. The value shall be (111155, DCM, “Target content items are related contra-laterally”) if the parent content item has code value (F-01792, SRT, “Focal asymmetric breast tissue”) or (F-01793, SRT, “Asymmetric breast tissue”).
2 CODE EV (111057, DCM, “Scope of Feature”) 1 M DCID (6036) Scope of Feature
3 INCLUDE DTID (4019) CAD Algorithm Identification 1 M
4 NUM EV (111011, DCM, “Certainty of Feature”) 1 U UNITS = (%, UCUM, “Percent”) Value = 0 – 100
5 NUM EV (111047, DCM, “Probability of cancer”) 1 UC May be present only if value of parent is not (111102, DCM, “Non-lesion”) UNITS = (%, UCUM, “Percent”) Value = 0 – 100
6 CODE EV (111042, DCM, “Pathology”) 1-n U BCID (6030) “Mammography Pathology Codes”
7 INCLUDE DTID (1400) Linear Measurement 1-n U If the measured path is encoded, the SCOORD and its by-reference relationship to the IMAGE in TID (1400) “Linear Measurement” shall be used.
8 INCLUDE DTID (1401) Area Measurement 1-n U If the measured path is encoded, the SCOORD and its by-reference relationship to the IMAGE in TID (1401) “Area Measurement” shall be used.
9 INCLUDE DTID (1402) Volume Measurement 1-n U If the measured path is encoded, the SCOORD and its by-reference relationship to the IMAGE in TID (1402) “Volume Measurement” shall be used.
10 INCLUDE DTID (4021) Mammography CAD Geometry 1-n U
11 NUM DCID (6037) Mammography 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 DT (1, UCUM, “no units”)
12 > R-INFERRED FROM NUM 2 U The referenced numeric values shall have the same Concept Name. Their UNITS shall be the same as row 11
13 CODE EV (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 (6038) Mammography Qualitative Temporal Difference Type
14 > HAS PROPERTIES TEXT EV (111021, DCM, “Description of Change”) 1 U
15 > R-INFERRED FROM CODE 2 M The referenced code values shall have the same Concept Name and be from the same context group.
16 CODE EV (111048, DCM, “Quadrant location”) 1 U DCID (6020) Quadrant Location
17 CODE EV (111014, DCM, “Clockface or region”) 1 U DCID (6018) Clockface Location or Region
18 CODE EV (111020, DCM, “Depth”) 1 U DCID (6024) Depth
19 CODE EV (111035, DCM, “Lesion Density”) 1 UC May be present only if value of parent is (F-01791, SRT, “Mammographic breast mass”) or (F-01796,SRT,”Mammography breast density”) DCID (6008) Density Modifier
20 CODE EV (M-020F9, SRT, “Shape”) 1 UC May be present only if value of parent is (F-01791, SRT, “Mammographic breast mass”) or (F-01796,SRT,”Mammography breast density”) DCID (6004) Mammography Characteristics of Shape
21 CODE EV (111037, DCM, “Margins”) 1-n UC May be present only if value of parent is (F-01791, SRT, “Mammographic breast mass”) or (F-01796,SRT,”Mammography breast density”) DCID (6006) “Mammography Characteristics of Margin”
22 CODE EV (111009, DCM, “Calcification Type”) 1-n UC May be present only if value of parent is (F-01775,SRT, “Calcification Cluster”) or (F-01776,SRT, “Individual Calcification”) DCID (6010) “Mammography Calcification Types”
23 CODE EV (111008, DCM, “Calcification Distribution”) 1 UC May be present only if value of parent is (F-01775,SRT, “Calcification Cluster”) DCID (6012) “Calcification Distribution Modifier”
24 NUM EV (111038, DCM, “Number of calcifications”) 1 UC May be present only if value of parent is (F-01775,SRT, “Calcification Cluster”) UNITS = EV (1, UCUM, “no units”) Value = Integer 1 – n
25 NUM DCID (6142) Calculated Value 1-n U
26 > HAS CONCEPT MOD CODE EV (121401, DCM, “Derivation”) 1 M DCID (6140) Calculation Methods
27 > INFERRED FROM TEXT EV (112034, DCM, “Calculation Description”) 1 U

Content Item Descriptions

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 11 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 4006 Mammography 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. The details from which a single image Calcification Cluster is inferred may be expressed in a number of Single Image Findings (see TID 4006) of type Individual Calcification.

A Single Image Finding of type Breast Composition may be INFERRED FROM by-reference to a Single Image Finding of type Breast Geometry.

TID 4006MAMMOGRAPHY 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 (6014) Mammography Single Image Finding
2 > HAS CONCEPT MOD CODE EV (111056, DCM, “Rendering Intent”) 1 M DCID (6034) Intended Use of CAD Output
3 >> HAS PROPERTIES NUM EV (111071, DCM, “CAD Operating Point”) 1 UC IFF value of row 2 is (111151, DCM, “Presentation Optional”) and row 9 of TID 4017 is present UNITS = DT ({1:n}, UCUM, “range: 1:n”), where n is the maximum specified in Row 9 of TID 4017. Value is restricted to being an integer
4 > HAS OBS CONTEXT INCLUDE DTID (4108) Tracking Identifier 1 U
5 > HAS PROPERTIES INCLUDE DTID (4019) CAD Algorithm Identification 1 M
6 > HAS PROPERTIES NUM EV(111012, DCM, “Certainty of Finding”) 1 U UNITS = EV(%, UCUM, “Percent”) Value = 0 – 100
7 > HAS PROPERTIES NUM EV (111047, DCM, “Probability of cancer”) 1 UC May be present unless value of parent is (F-01710,SRT, “Breast composition”), (111100, DCM, “Breast geometry”), (T-04100, SRT, “Nipple”), (111099, DCM, “Selected region”), (111101, DCM, “Image quality”) or (111102, DCM, “Non-lesion”) UNITS = EV(%, UCUM, “Percent”) Value = 0 – 100
8 > HAS PROPERTIES INCLUDE DTID (4021) Mammography CAD Geometry 1 MC Shall be present unless value of parent is (F-01710,SRT, “Breast composition”), (111100, DCM, “Breast geometry”) or (111101, DCM, “Image quality”)
9 > HAS PROPERTIES INCLUDE DTID (4007) Mammography CAD Breast Composition 1 MC Shall be present only if value of parent is (F-01710,SRT, “Breast composition”)
10 > R-INFERRED FROM CODE 1-n UC May be present only if value of parent is (F-01710,SRT, “Breast composition”) Shall reference a (111059, DCM, “Single Image Finding”) of value: EV (111100, DCM, “Breast geometry”)
11 > HAS PROPERTIES INCLUDE DTID (4008) Mammography CAD Breast Geometry 1 MC Shall be present only if value of parent is (111100, DCM, “Breast geometry”)
12 > HAS PROPERTIES INCLUDE DTID (4009) Mammography CAD Individual Calcification 1 UC May be present only if value of parent is (F-01776,SRT, “Individual Calcification”)
13 > HAS PROPERTIES INCLUDE DTID (4010) Mammography CAD Calcification Cluster 1 UC May be present only if value of parent is (F-01775,SRT, “Calcification Cluster”)
14 > HAS PROPERTIES INCLUDE DTID (4011) Mammography CAD Density 1 UC May be present only if value of parent is (F-01796,SRT,”Mammography breast density”)
15 > HAS PROPERTIES CODE EV (111297,DCM, “Nipple Characteristic”) 1 UC May be present only if value of parent is (T-04100, SRT, “Nipple”) DCID (6039) Nipple Characteristic
16 > HAS PROPERTIES INCLUDE DTID (4012) Mammography CAD Non-Lesion 1 MC Shall be present only if value of parent is (111102, DCM, “Non-lesion”)
17 > HAS PROPERTIES INCLUDE DTID (4013) Mammography CAD Selected Region 1 MC Shall be present only if value of parent is (111099, DCM, “Selected Region”)
18 > R-INFERRED FROM IMAGE 1 MC IF value of parent is (111101, DCM, “Image quality”) and IFF row 19 is not present Shall reference an IMAGE content item in the (111028, DCM, “Image Library”)
19 > HAS PROPERTIES SCOORD EV (111030, DCM, “Image Region”) 1-n MC IF value of parent is (111101, DCM, “Image quality”) and IFF row 18 is not present
20 >> 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”)
21 > HAS PROPERTIES INCLUDE DTID (4014) CAD Image Quality 1-n MC Shall be present only if value of parent is (111101, DCM, “Image quality”) $QualityFinding = DCID (6041) “Mammography Image Quality Finding”, $QualityStandard = DCID (6045) “Mammography Types of Quality Control Standard”
22 > HAS PROPERTIES NUM DCID (6142) Calculated Value 1-n U
23 >> HAS CONCEPT MOD CODE EV (121401, DCM, “Derivation”) 1 M DCID (6140) Calculation Methods
24 >> INFERRED FROM TEXT EV (112034, DCM, “Calculation Description”) 1 U
25 > INFERRED FROM INCLUDE DTID (4006) Mammography CAD Single Image Finding 1-n UC May be present only if value of parent is (F-01775,SRT, “Calcification Cluster”) EV (F-01776,SRT, “Individual Calcification”)
26 > HAS OBS CONTEXT INCLUDE DTID (4022) CAD Observation Context 1 MC Shall be present only if this finding is incorporated from a different report than its parent.

Content Item Descriptions

Rendering Intent This content item constrains the SCP receiving the Mammography CAD SR IOD in its use of the contents of this template and its target content items. Mammography CAD devices may opt to use data marked “Not for Presentation” or “Presentation Optional” as input to subsequent mammography CAD processing steps. Refer to PS 3.4, Annex O 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.
Single Image Finding A Single Image Finding (whose parent is a Single Image Finding of type Calcification Cluster) allows one level of nesting for the definition of individual calcifications within the cluster. To use this template recursively, this Single Image Finding code value shall be “Individual Calcification”.
Certainty of Finding The likelihood that the finding detected, and classified by the CODE specified in the Single Image Finding parent template, is in fact that type of finding.

TID 4007 Mammography CAD Breast Composition Template

TID 4007MAMMOGRAPHY CAD BREAST COMPOSITIONType: Non-Extensible Order: Significant

NL Rel with Parent VT Concept Name VM Req Type Condition Value Set Constraint
1 CODE EV (F-01710,SRT, “Breast composition”) 1 MC At least one of row 1 or 2 shall be present DCID (6000) Overall Breast Composition
2 NUM EV (111046, DCM, “Percent Fibroglandular Tissue”) 1 MC At least one of row 1 or 2 shall be present UNITS = EV (%, UCUM, “Percent”) Value = 0 – 100

Content Item Descriptions

Percent Fibroglandular Tissue Percent of breast area that is mammographically dense, excluding pectoralis muscle.

TID 4008 Mammography CAD Breast Geometry Template

TID 4008MAMMOGRAPHY CAD BREAST GEOMETRYType: Non-Extensible Order: Significant

NL Rel with Parent VT Concept Name VM Req Type Condition Value Set Constraint
1 SCOORD EV (111007, DCM, “Breast Outline Including Pectoral Muscle Tissue”) 1 M GRAPHIC TYPE = {POLYLINE}
2 > R-SELECTED FROM IMAGE 1 M Shall reference an IMAGE content item in the (111028, DCM, “Image Library”)
3 SCOORD EV (111045, DCM, “Pectoral Muscle Outline”) 1 U GRAPHIC TYPE = {POLYLINE}
4 > R-SELECTED FROM IMAGE 1 M Shall reference the same node as row 2

Content Item Descriptions

Breast Outline Including Pectoral Muscle Tissue [pic] Example Pectoral Muscle Outline [pic] Example

TID 4009 Mammography CAD Individual Calcification Template

This template provides the detail specific to an individual calcification.

TID 4009MAMMOGRAPHY CAD INDIVIDUAL CALCIFICATIONType: Non-Extensible Order: Significant

NL Rel with Parent VT Concept Name VM Req Type Condition Value Set Constraint
1 CODE EV (111009, DCM, “Calcification Type”) 1-n MC At least one of rows 1, 2, 3 shall be present DCID (6010) Mammography Calcification Types
2 INCLUDE DTID (1400) Linear Measurement 1-n MC At least one of rows 1, 2, 3 shall be present If the measured path is encoded, the SCOORD and its by-reference relationship to the IMAGE in TID (1400) Linear Measurement shall be used.
3 INCLUDE DTID (1401) Area Measurement 1-n MC At least one of rows 1, 2, 3 shall be present If the measured path is encoded, the SCOORD and its by-reference relationship to the IMAGE in TID (1401) Area Measurement shall be used.
4 INCLUDE DTID (1402) Volume Measurement 1-n U If the measured path is encoded, the SCOORD and its by-reference relationship to the IMAGE in TID (1402) Volume Measurement shall be used.

TID 4010 Mammography CAD Calcification Cluster Template

This template provides the detail specific to a calcification cluster.

TID 4010MAMMOGRAPHY CAD CALCIFICATION CLUSTERType: Non-Extensible Order: Significant

NL Rel with Parent VT Concept Name VM Req Type Condition Value Set Constraint
1 CODE EV (111009, DCM, “Calcification Type”) 1-n MC At least one of rows 1, 2, 3, 4, 5 shall be present DCID (6010) Mammography Calcification Types
2 CODE EV (111008, DCM, “Calcification Distribution”) 1 MC At least one of rows 1, 2, 3, 4, 5 shall be present DCID (6012) Calcification Distribution Modifier
3 NUM EV (111038, DCM, “Number of calcifications”) 1 MC At least one of rows 1, 2, 3, 4, 5 shall be present UNITS = EV (1, UCUM, “no units”) Value = Integer >= 1
4 INCLUDE DTID (1400) Linear Measurement 1-n MC At least one of rows 1, 2, 3, 4, 5 shall be present If the measured path is encoded, the SCOORD and its by-reference relationship to the IMAGE in TID (1400) Linear Measurement shall be used.
5 INCLUDE DTID (1401) Area Measurement 1-n MC At least one of rows 1, 2, 3, 4, 5 shall be present If the measured path is encoded, the SCOORD and its by-reference relationship to the IMAGE in TID (1401) Area Measurement shall be used.
6 INCLUDE DTID (1402) Volume Measurement 1-n U If the measured path is encoded, the SCOORD and its by-reference relationship to the IMAGE in TID (1402) Volume Measurement shall be used.

TID 4011 Mammography CAD Density Template

This template provides the detail specific to a density.

TID 4011MAMMOGRAPHY CAD DENSITYType: Non-Extensible Order: Significant

NL Rel with Parent VT Concept Name VM Req Type Condition Value Set Constraint
1 CODE EV (111035, DCM, “Lesion Density”) 1 MC At least one of rows 1, 2, 3, 4, 5 shall be present DCID (6008) Density Modifier
2 CODE EV (M-020F9, SRT, “Shape”) 1 MC At least one of rows 1, 2, 3, 4, 5 shall be present DCID (6004) Mammography Characteristics of Shape
3 CODE EV (111037, DCM, “Margins”) 1-n MC At least one of rows 1, 2, 3, 4, 5 shall be present DCID (6006) Mammography Characteristics of Margin
4 INCLUDE DTID (1400) Linear Measurement 1-n MC At least one of rows 1, 2, 3, 4, 5 shall be present If the measured path is encoded, the SCOORD and its by-reference relationship to the IMAGE in TID (1400) Linear Measurement shall be used.
5 INCLUDE DTID (1401) Area Measurement 1-n MC At least one of rows 1, 2, 3, 4, 5 shall be present If the measured path is encoded, the SCOORD and its by-reference relationship to the IMAGE in TID (1401) Area Measurement shall be used.
6 INCLUDE DTID (1402) Volume Measurement 1-n U If the measured path is encoded, the SCOORD and its by-reference relationship to the IMAGE in TID (1402) Volume Measurement shall be used.

TID 4012 Mammography CAD Non-Lesion Template

This template provides the detail specific to a finding other than a lesion (see CID 6040).

TID 4012 MAMMOGRAPHY CAD NON-LESION Type: Non-Extensible Order: Significant

NL Rel with Parent VT Concept Name VM Req Type Condition Value Set Constraint
1 CODE EV (111039, DCM, “Object type”) 1 M DCID (6040) Non-Lesion Object Type
2 INCLUDE DTID (1400) Linear Measurement 1-n U If the measured path is encoded, the SCOORD and its by-reference relationship to the IMAGE in TID (1400) Linear Measurement shall be used.
3 INCLUDE DTID (1401) Area Measurement 1-n U If the measured path is encoded, the SCOORD and its by-reference relationship to the IMAGE in TID (1401) Area Measurement shall be used.
4 INCLUDE DTID (1402) Volume Measurement 1-n U If the measured path is encoded, the SCOORD and its by-reference relationship to the IMAGE in TID (1402) Volume Measurement shall be used.

TID 4013 Mammography CAD Selected Region Template

This template provides the detail specific to a selected region. A selected region is any mammography CAD derived arbitrary region of the image, whether within the breast outline or not. This can be use to delineate regions such as the intramammary fold.

TID 4013MAMMOGRAPHY CAD SELECTED REGIONType: Non-Extensible Order: Significant

NL Rel with Parent VT Concept Name VM Req Type Condition Value Set Constraint
1 TEXT EV (111058, DCM, “Selected Region Description”) 1 M
2 INCLUDE DTID (1400) Linear Measurement 1-n U If the measured path is encoded, the SCOORD and its by-reference relationship to the IMAGE in TID (1400) Linear Measurement shall be used.
3 INCLUDE DTID (1401) Area Measurement 1-n U If the measured path is encoded, the SCOORD and its by-reference relationship to the IMAGE in TID (1401) Area Measurement shall be used.
4 INCLUDE DTID (1402) Volume Measurement 1-n U If the measured path is encoded, the SCOORD and its by-reference relationship to the IMAGE in TID (1402) Volume Measurement shall be used.

TID 4014 CAD Image Quality Template

This template provides the detail specific to image quality. It allows the encoding of descriptors of image quality (e.g., CID 6041) for a given image or region of an image. For instance, images with partial motion blur can be identified with the region noted.

Parameter Name Parameter Usage
$QualityFinding Coded term or Context Group for Quality Finding
$QualityStandard Coded term or Context Group for Quality Control Standard

TID 4014 CAD IMAGE QUALITYType: Non-Extensible Order: Significant

NL Rel with Parent VT Concept Name VM Req Type Condition Value Set Constraint
1 CODE EV(111052, DCM, “Quality Finding”) 1 M $QualityFinding
2 > HAS PROPERTIES CODE EV(111050, DCM, “Quality Assessment”) 1 U DCID (6044) Types of Image Quality Assessment
3 > HAS PROPERTIES CODE EV(111051, DCM, “Quality Control Standard”) 1 UC Shall be present if row 2 is present. $QualityStandard
4 > HAS PROPERTIES NUM EV(111029, DCM, “Image Quality Rating”) 1 U UNITS = EV({0:100}, UCUM, “range:0:100”) Value = 0 – 100

Content Item Descriptions

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

TID 4015 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 (e.g., TID 4000). This information forms the basis for understanding why a CAD report may produce no (or fewer than anticipated) detection results.

The sub-tree formed by this template is illustrated in PS 3.17 in the Annex on Mammography CAD SR Content Tree Structure.

Parameter Name Parameter Usage
$DetectionCode Coded term or Context Group for Detection Performed

TID 4015 CAD DETECTIONS PERFORMEDType: Non-Extensible Order: Significant

NL Rel with Parent VT Concept Name VM Req Type Condition Value Set Constraint
1 CONTAINER EV(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 DTID (4017) CAD Detection Performed 1-n M $DetectionCode = $DetectionCode
3 CONTAINER EV(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 DTID (4017) CAD Detection Performed 1-n M $DetectionCode = $DetectionCode

TID 4016 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 (e.g., TID 4000). This information forms the basis for understanding why a CAD report may produce no (or fewer than anticipated) analysis results.

The sub-tree formed by this template is illustrated in PS 3.17 in the Annex on Mammography CAD SR Content Tree Structure.

Parameter Name Parameter Usage
$AnalysisCode Coded term or Context Group for Analysis Performed

TID 4016 CAD ANALYSES PERFORMEDType: Non-Extensible Order: Significant

NL Rel with Parent VT Concept Name VM Req Type Condition Value Set Constraint
1 CONTAINER EV(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 DTID (4018) CAD Analysis Performed 1-n M $AnalysisCode=$AnalysisCode
3 CONTAINER EV(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 DTID (4018) CAD Analysis Performed 1-n M $AnalysisCode=$AnalysisCode

TID 4017 CAD Detection Performed Template

This template fully identifies a detection algorithm and the images and/or image regions on which it operated (see TID 4015).

Parameter Name Parameter Usage
$DetectionCode Coded term or Context Group for Detection Performed

TID 4017 CAD DETECTION PERFORMEDType: Non-Extensible Order: Significant

NL Rel with Parent VT Concept Name VM Req Type Condition Value Set Constraint
1 CODE EV(111022, DCM, “Detection Performed”) 1 M $DetectionCode
2 > HAS PROPERTIES INCLUDE DTID (4019) CAD Algorithm Identification 1 M
3 > HAS PROPERTIES IMAGE 1-n MC At least one of row 3, 4, 5 or 6 shall be present
4 > R-HAS PROPERTIES IMAGE 1-n MC At least one of row 3,4,5 or 6 shall be present Shall reference IMAGE content item(s) in the (111028, DCM, “Image Library”)
5 > HAS PROPERTIES UIDREF EV(112002,DCM,”Series Instance UID”) 1-n MC At least one of row 3,4,5 or 6 shall be present
6 > HAS PROPERTIES SCOORD EV(111030, DCM, “Image Region”) 1-n MC At least one of row 3,4,5 or 6 shall be present
7 >> SELECTED FROM IMAGE 1 MC XOR row 8
8 >> R-SELECTED FROM IMAGE 1 MC XOR row 7 Shall reference an IMAGE content item in the (111028, DCM, “Image Library”)
9 > INCLUDE DTID (4023) CAD Operating Points 1 U

Content Item Descriptions

CAD Algorithm Identification If more than one detection algorithm has the same “Detection Performed” code value (e.g., CID 6014) then the “CAD Algorithm Identification” shall unambiguously distinguish between algorithms.
Rows 3 - 6 Mammography CAD SR: When this template is invoked for the Mammography CAD SR, the Image Library is mandatory, thus only row 4 and/or row 6 shall be present. Chest CAD SR: When this template is invoked for the Chest CAD SR, the Image Library is optional, thus any combination of rows 3, 4, 5 and 6 may be present. Colon CAD SR: When this template is invoked for the Colon CAD SR, the Image Library does not exist, thus rows 3, 5, and/or 6 may be present and row 4 shall not be present.
Rows 7 - 8 Mammography CAD SR: When this template is invoked for the Mammography CAD SR, the Image Library is mandatory, thus only row 8 shall be present. Chest CAD SR: When this template is invoked for the Chest CAD SR, the Image Library is optional, thus row 7 or 8 may be present. Colon CAD SR: When this template is invoked for the Colon CAD SR, the Image Library does not exist, thus only row 7 may be present.

TID 4018 CAD Analysis Performed Template

This template fully identifies an analysis algorithm and the images and/or image regions on which it operated (see TID 4016).

Parameter Name Parameter Usage
$AnalysisCode Coded term or Context Group for Analysis Performed

TID 4018 CAD ANALYSIS PERFORMEDType: Non-Extensible Order: Significant

NL Rel with Parent VT Concept Name VM Req Type Condition Value Set Constraint
1 CODE EV(111004, DCM, “Analysis Performed”) 1 M $AnalysisCode
2 > HAS PROPERTIES INCLUDE DTID (4019) CAD Algorithm Identification 1 M
3 > HAS PROPERTIES IMAGE 1-n MC At least one of row 3, 4, 5 or 6 shall be present
4 > R-HAS PROPERTIES IMAGE 1-n MC At least one of row 3, 4, 5 or 6 shall be present Shall reference IMAGE content item(s) in the (111028, DCM, “Image Library”)
5 > HAS PROPERTIES UIDREF EV(112002,DCM,”Series Instance UID”) 1-n MC At least one of row 3, 4, 5 or 6 shall be present
6 > HAS PROPERTIES SCOORD EV(111030, DCM, “Image Region”) 1-n MC At least one of row 3, 4, 5 or 6 shall be present
7 >> SELECTED FROM IMAGE 1 MC XOR Row 8
8 >> R-SELECTED FROM IMAGE 1 MC XOR Row 7 Shall reference an IMAGE content item in the (111028, DCM, “Image Library”)
9 > INCLUDE DTID (4023) CAD Operating Points 1 U

Content Item Descriptions

CAD Algorithm Identification If more than one analysis algorithm has the same “Analysis Performed” code value (e.g., CID 6043) then the “CAD Algorithm Identification” shall unambiguously distinguish between algorithms.
Rows 3 - 6 Mammography CAD SR: When this template is invoked for the Mammography CAD SR, the Image Library is mandatory, and a total of at least two instances of row 4 or row 6 shall be present. Chest CAD SR: When this template is invoked for the Chest CAD SR, the Image Library is optional, thus any combination of rows 3, 4, 5 and 6 may be present. Colon CAD SR: When this template is invoked for the Colon CAD SR, the Image Library does not exist, thus rows 3, 5 and/or 6 may be present and row 4 shall not be present.
Rows 7 - 8 Mammography CAD SR: When this template is invoked for the Mammography CAD SR, the Image Library is mandatory, thus only row 8 shall be present. Chest CAD SR: When this template is invoked for the Chest CAD SR, the Image Library is optional, thus row 7 or 8 may be present. Colon CAD SR: When this template is invoked for the Colon CAD SR, the Image Library does not exist, thus only row 7 may be present.

TID 4019 CAD Algorithm Identification Template

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

TID 4019CAD ALGORITHM IDENTIFICATIONType: Non-Extensible Order: Significant

NL Rel with Parent VT Concept Name VM Req Type Condition Value Set Constraint
1 TEXT EV(111001, DCM, “Algorithm Name”) 1 M
2 TEXT EV (111003, DCM, “Algorithm Version”) 1 M
3 TEXT EV (111002, DCM, “Algorithm Parameters”) 1-n U

TID 4020 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. If values for the attributes are not present in the Image SOP Instance, then as many of the attributes as possible should be derived.

Parameter Name Parameter Usage
$ImageLaterality Coded term or Context Group for Image Laterality
$ImageView Coded term or Context Group for Image View
$ImageViewMod Coded term or Context Group for Image View Modifier

TID 4020 CAD IMAGE LIBRARY ENTRYType: Non-Extensible Order: Significant

NL Rel with Parent VT Concept Name VM Req Type Condition Value Set Constraint
1 IMAGE 1 M
2 > HAS ACQ CONTEXT CODE EV(111027, DCM, “Image Laterality”) 1 MC Shall be present if (0020,0062) is in the Image Instance $ImageLaterality
3 > HAS ACQ CONTEXT CODE EV (111031, DCM, “Image View”) 1 MC Shall be present if (0054,0220) is in the Image Instance $ImageView
4 >> HAS CONCEPT MOD CODE EV (111032, DCM, “Image View Modifier”) 1-n MC Shall be present if (0054,0222) is in the Image Instance $ImageViewMod
5 > HAS ACQ CONTEXT TEXT EV (111044, DCM, “Patient Orientation Row”) 1 MC Shall be present if (0020,0020) is in the Image Instance
6 > HAS ACQ CONTEXT TEXT EV (111043, DCM, “Patient Orientation Column”) 1 MC Shall be present if (0020,0020) is in the Image Instance
7 > HAS ACQ CONTEXT DATE EV (111060, DCM, “Study Date”) 1 MC Shall be present if (0008,0020) is in the Image Instance
8 > HAS ACQ CONTEXT TIME EV (111061, DCM, “Study Time”) 1 MC Shall be present if (0008,0030) is in the Image Instance
9 > HAS ACQ CONTEXT DATE EV (111018, DCM, “Content Date”) 1 MC Shall be present if (0008,0023) is in the Image Instance
10 > HAS ACQ CONTEXT TIME EV (111019, DCM, “Content Time”) 1 MC Shall be present if (0008,0033) is in the Image Instance
11 > HAS ACQ CONTEXT NUM EV (111026, DCM, “Horizontal Pixel Spacing”) 1 MC Shall be present if (0018,1164) or (0028,0030) is in the Image Instance UNITS = EV (um, UCUM, “micrometer”)
12 > HAS ACQ CONTEXT NUM EV (111066, DCM, “Vertical Pixel Spacing”) 1 MC Shall be present if (0018,1164) or (0028,0030) is in the Image Instance UNITS = EV (um, UCUM, “micrometer”)
13 > HAS ACQ CONTEXT NUM EV (112011, DCM, “Positioner Primary Angle”) 1 UC May be present if (0018,1510) is in the Image Instance
14 > HAS ACQ CONTEXT NUM EV (112012, DCM, “Positioner Secondary Angle”) 1 UC May be present if (0018,1511) is in the Image Instance

Content Item Descriptions

Patient Orientation Row First (row) and Second (column) components of Patient Orientation (0020,0020) in the Image IOD. See PS 3, C.7.6.1.1.1.
Patient Orientation Column
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 4021 Mammography CAD Geometry Template

All geometry template invocations require specification of the location of the center of the object. Outline is optional.

TID 4021MAMMOGRAPHY 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 M GRAPHIC TYPE = {POINT}
2 > R-SELECTED FROM IMAGE 1 M Shall reference an IMAGE content item in the (111028, DCM, “Image Library”)
3 SCOORD EV(111041, DCM, “Outline”) 1 U
4 > R-SELECTED FROM IMAGE 1 M Shall reference the same content item as row 2
5 SCOORD DCID (6166) CAD Geometry Secondary Graphical Representation 1-n U
6 > R-SELECTED FROM IMAGE 1 M Shall reference the same content item as row 2

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.

TID 4022 CAD OBSERVATION CONTEXT Type: Non-Extensible Order: Significant

NL Rel with Parent VT Concept Name VM Req Type Condition Value Set Constraint
1 COMPOSITE EV(111040, DCM, “Original Source”) 1 MC Shall be present if the original source is a DICOM object.
2 > HAS CONCEPT MOD INCLUDE DTID (1204) Language of Content Item and Descendants 1 M
3 INCLUDE DTID (1001) Observation Context 1 M

TID 4023 CAD Operating Points

This template describes CAD operating points. The description is deliberately left flexible and optional to allow implementation at differing levels of complexity.

TID 4023CAD OPERATING POINTSType: Non-Extensible Order: Significant

NL Rel with Parent VT Concept Name VM Req Type Condition Value Set Constraint
1 HAS PROPERTIES NUM EV (111072, DCM, “Maximum CAD Operating Point”) 1 M UNITS = DT ([arb’U], UCUM, “arbitrary unit”) Value is restricted to being an integer
2 HAS PROPERTIES NUM EV (111092, DCM, “Recommended CAD Operating Point”) 1 U UNITS = DT ({0:n}, UCUM, “range: 0:n”), where n is the value specified in row 1 Value is restricted to being an integer
3 HAS PROPERTIES CONTAINER EV (111093,DCM,“CAD Operating Point Table”) 1 U
4 > CONTAINS CODE EV (122698, DCM, "X-Concept") 1 M DCID (6048) CAD Operating Point Axis Label
5 > CONTAINS CODE EV (122699, DCM, "Y-Concept") 1 M DCID (6048) CAD Operating Point Axis Label
6 > CONTAINS NUM EV (111071, DCM, “CAD Operating Point”) 1-n M Number of instances of this row shall equal value of row 1, plus 1. UNITS = DT ({0:n}, UCUM, “range: 0:n”), where n is the value of Row 1. Value is restricted to being an integer that is unique within the invocation of this template.
7 >> HAS PROPERTIES TEXT EV (111081, DCM, “CAD Operating Point Description”) 1 U
8 >> HAS PROPERTIES NUM The value of Row 4 1 U
9 >> HAS PROPERTIES NUM The value of Row 5 1 U

Content Item Descriptions

Maximum CAD Operating Point The maximum possible value of CAD Operating Point for this type of Detection Performed. No CAD Operating Point value recorded in the CAD Processing and Findings Summary sub-tree of the report for this type of Detection Performed shall exceed this value. The report may or may not contain Rendering Intent = “Presentation Optional” detections that are assigned the maximum value.
Recommended CAD Operating Point A number indicating which of the CAD operating points is recommended by the creator of a CAD SR instance as the first operating point to be used when rendering the CAD SR instance contents. Subsequent changes to the displayed operating point are implementation dependent.