Annex E Mammography CAD (Informative)

This Annex was formerly located in Annex L of PS 3.3 in the 2003 and earlier revisions of the standard.

E.1 Mammography CAD SR Content Tree Structure

The templates for the Mammography CAD SR IOD are defined in PS 3.16, Annex A, DCMR Templates. Relationships defined in the Mammography CAD SR IOD templates are by-value, unless otherwise stated. Content items referenced from another SR object instance, such as a prior Mammography CAD SR, are 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.

[pic] Figure E.1-1: Top Levels of Mammography CAD SR Content Tree

The Document Root, Image Library, Summaries of Detections and Analyses, and CAD Processing and Findings Summary sub-trees together form the content tree of the Mammography CAD SR IOD. There are no constraints regarding the 1-n multiplicity of the Individual Impression/Recommendation or its underlying structure, other than the TID 4001 and TID 4003 requirements in PS 3.16. Individual Impression/Recommendation containers may be organized, for example per image, per finding or composite feature, or some combination thereof.

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Figure E.1-2: Summary of Detections and Analyses Levels of Mammography CAD SR Content Tree

The Summary of Detections and Summary of Analyses sub-trees identify the algorithms used and the work done by the CAD device, and whether or not each process was performed on one or more entire images or selected regions of images. The findings of the detections and analyses are not encoded in the summary sub-trees, but rather in the CAD Processing and Findings Summary sub-tree. CAD processing may produce no findings, in which case the sub-trees of the CAD Processing and Findings Summary sub-tree are incompletely populated. This occurs in the following situations:

  1. All algorithms succeeded, but no findings resulted

  2. Some algorithms succeeded, some failed, but no findings resulted

  3. All algorithms failed

Note 1: If the tree contains no Individual Impression/Recommendation nodes and all attempted detections and analyses succeeded then the mammography CAD device made no findings.

Note 2: Detections and Analyses that are not attempted are not listed in the Summary of Detections and Summary of Analyses trees.

Note 3: If the code value of the Summary of Detections or Summary of Analyses codes in TID 4000 is “Not Attempted” then no detail is provided as to which algorithms were not attempted.

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Figure E.1-3: Example of Individual Impression/Recommendation Levels of Mammography CAD SR Content Tree

The shaded area in Figure E.1-3 demarcates information resulting from Detection, whereas the unshaded area is information resulting from Analysis. This distinction is used in determining whether to place algorithm identification information in the Summary of Detections or Summary of Analyses sub-trees.

The clustering of calcifications within a single image is considered to be a Detection process which results in a Single Image Finding. The spatial correlation of a calcification cluster in two views, resulting in a Composite Feature, is considered Analysis. The clustering of calcifications in a single image is the only circumstance in which a Single Image Finding can result from the combination of other Single Image Findings, which must be Individual Calcifications.

Once a Single Image Finding or Composite Feature has been instantiated, it may be referenced by any number of Composite Features higher in the tree.

E.2 Mammography CAD SR Observation Context Encoding

The Impression/Recommendation section of the SR Document Content tree of a Mammography CAD SR IOD may contain a mixture of current and prior single image findings and composite features. The content items from current and prior contexts are target content items that have a by-value INFERRED FROM relationship to a Composite Feature content item. Content items that come from a context other than the Initial Observation Context have a HAS OBS CONTEXT relationship to target content items that describe the context of the source document.

In Figure E.2-1, Composite Feature and Single Image Finding are current, and Single Image Finding (from Prior) is duplicated from a prior document.

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Figure E.2-1: Example of Use of Observation Context

E.3 Mammography CAD SR Examples

The following is a simple and non-comprehensive illustration of an encoding of the Mammography CAD SR IOD for Mammography computer aided detection results. For brevity, some Mandatory content items are not included, such as several acquisition context content items for the images in the Image Library.

E.3.1 Example 1: Calcification and Mass Detection with No Findings

A mammography CAD device processes a typical screening mammography case, i.e., there are four films and no cancer. Mammography CAD runs both density and calcification detection successfully and finds nothing. The mammograms resemble:

[pic] [pic] [pic] [pic]

Figure E.3-1: Mammograms as Described in Example 1

The content tree structure would resemble:

Node Code Meaning of Concept Name Code Meaning or Example Value TID
1 Mammography CAD Report 4000
1.1 Image Library 4000
1.1.1 IMAGE 1 4020
1.1.1.1 Image Laterality Right 4020
1.1.1.2 Image View Cranio-caudal 4020
1.1.1.3 Study Date 19980101 4020
1.1.2 IMAGE 2 4020
1.1.2.1 Image Laterality Left 4020
1.1.2.2 Image View Cranio-caudal 4020
1.1.2.3 Study Date 19980101 4020
1.1.3 IMAGE 3 4020
1.1.3.1 Image Laterality Right 4020
1.1.3.2 Image View Medio-lateral oblique 4020
1.1.3.3 Study Date 19980101 4020
1.1.4 IMAGE 4 4020
1.1.4.1 Image Laterality Left 4020
1.1.4.2 Image View Medio-lateral oblique 4020
1.1.4.3 Study Date 19980101 4020
1.2 CAD Processing and Findings Summary All algorithms succeeded; without findings 4001
1.3 Summary of Detections Succeeded 4000
1.3.1 Successful Detections 4015
1.3.1.1 Detection Performed Mammography breast density 4017
1.3.1.1.1 Algorithm Name “Density Detector” 4019
1.3.1.1.2 Algorithm Version “V3.7 4019
1.3.1.1.3 Reference to node 1.1.1 4017
1.3.1.1.4 Reference to node 1.1.2 4017
1.3.1.1.5 Reference to node 1.1.3 4017
1.3.1.1.6 Reference to node 1.1.4 4017
1.3.1.2 Detection Performed Individual Calcification 4017
1.3.1.2.1 Algorithm Name “Calc Detector” 4019
1.3.1.2.2 Algorithm Version “V2.4 4019
1.3.1.2.3 Reference to node 1.1.1 4017
1.3.1.2.4 Reference to node 1.1.2 4017
1.3.1.2.5 Reference to node 1.1.3 4017
1.3.1.2.6 Reference to node 1.1.4 4017
1.4 Summary of Analyses Not Attempted 4000

E.3.2 Example 2: Calcification and Mass Detection with Findings

A mammography CAD device processes a screening mammography case with four films and a mass in the left breast. Mammography CAD runs both density and calcification detection successfully. It finds two densities in the LCC, one density in the LMLO, a cluster of two calcifications in the RCC and a cluster of 20 calcifications in the RMLO. It performs two clustering algorithms. One identifies individual calcifications and then clusters them, and the second simply detects calcification clusters. It performs mass correlation and combines one of the LCC densities and the LMLO density into a mass; the other LCC density is flagged Not for Presentation, therefore not intended for display to the end-user. The mammograms resemble:

[pic] [pic] [pic] [pic]

Figure E.3-2: Mammograms as Described in Example 2

The content tree structure in this example is complex. Structural illustrations of portions of the content tree are placed within the content tree table to show the relationships of data within the tree. Some content items are duplicated (and shown in boldface) to facilitate use of the diagrams.

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Figure E.3-3: Content Tree Root of Example 2 Content Tree

Node Code Meaning of Concept Name Code Meaning or Example Value TID
1 Mammography CAD Report 4000
1.1 Image Library 4000
1.2 CAD Processing and Findings Summary All algorithms succeeded; with findings 4001
1.3 Summary of Detections Succeeded 4000
1.4 Summary of Analyses Succeeded 4000

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Figure E.3-4: Image Library Branch of Example 2 Content Tree

Node Code Meaning of Concept Name Code Meaning or Example Value TID
1.1 Image Library 4000
1.1.1 IMAGE 1 4020
1.1.1.1 Image Laterality Right 4020
1.1.1.2 Image View Cranio-caudal 4020
1.1.1.3 Study Date 19990101 4020
1.1.2 IMAGE 2 4020
1.1.2.1 Image Laterality Left 4020
1.1.2.2 Image View Cranio-caudal 4020
1.1.2.3 Study Date 19990101 4020
1.1.3 IMAGE 3 4020
1.1.3.1 Image Laterality Right 4020
1.1.3.2 Image View Medio-lateral oblique 4020
1.1.3.3 Study Date 19990101 4020
1.1.4 IMAGE 4 4020
1.1.4.1 Image Laterality Left 4020
1.1.4.2 Image View Medio-lateral oblique 4020
1.1.4.3 Study Date 19990101 4020

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Figure E.3-5: CAD Processing and Findings Summary Bifurcation of Example 2 Content Tree

Node Code Meaning of Concept Name Code Meaning or Example Value TID
1.2 CAD Processing and Findings Summary All algorithms succeeded; with findings 4001
1.2.1 Individual Impression/Recommendation 4003
1.2.2 Individual Impression/Recommendation 4003
1.2.3 Individual Impression/Recommendation 4003
1.2.4 Individual Impression/Recommendation 4003

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Figure E.3-6: Individual Impression/Recommendation 1.2.1 from Example 2 Content Tree

Node Code Meaning of Concept Name Code Meaning or Example Value TID
1.2.1 Individual Impression/Recommendation 4003
1.2.1.1 Rendering Intent Presentation Required 4003
1.2.1.2 Composite Feature Mass 4004
1.2.1.2.1 Rendering Intent Presentation Required 4004
1.2.1.2.2 Composite type Target content items are related spatially 4005
1.2.1.2.3 Scope of Feature Feature was detected on multiple images 4005
1.2.1.2.4 Algorithm Name “Mass Maker” 4019
1.2.1.2.5 Algorithm Version “V1.9 4019
1.2.1.2.6 Single Image Finding Mammography breast density 4006
1.2.1.2.7 Single Image Finding Mammography breast density 4006

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Figure E.3-7: Single Image Finding Density 1.2.1.2.6 from Example 2 Content Tree

Node Code Meaning of Concept Name Code Meaning or Example Value TID
1.2.1.2.6 Single Image Finding Mammography breast density 4006
1.2.1.2.6.1 Rendering Intent Presentation Required 4006
1.2.1.2.6.2 Algorithm Name “Density Detector” 4019
1.2.1.2.6.3 Algorithm Version “V3.7 4019
1.2.1.2.6.4 Center POINT 4021
1.2.1.2.6.4.1 Reference to node 1.1.2 4021
1.2.1.2.6.5 Outline SCOORD 4021
1.2.1.2.6.5.1 Reference to node 1.1.2 4021

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Figure E.3-8: Single Image Finding Density 1.2.1.2.7 from Example 2 Content Tree

Node Code Meaning of Concept Name Code Meaning or Example Value TID
1.2.1.2.7 Single Image Finding Mammography breast density 4006
1.2.1.2.7.1 Rendering Intent Presentation Required 4006
1.2.1.2.7.2 Algorithm Name “Density Detector” 4019
1.2.1.2.7.3 Algorithm Version “V3.7 4019
1.2.1.2.7.4 Center POINT 4021
1.2.1.2.7.4.1 Reference to node 1.1.4 4021
1.2.1.2.7.5 Outline SCOORD 4021
1.2.1.2.7.5.1 Reference to node 1.1.4 4021
1.2.1.2.7.6 Area of Defined Region 1 cm2 1401
1.2.1.2.7.6.1 Area Outline SCOORD 1401
1.2.1.2.7.6.1.1 Reference to node 1.1.4 1401

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Figure E.3-9: Individual Impression/Recommendation 1.2.2 from Example 2 Content Tree

Node Code Meaning of Concept Name Code Meaning or Example Value TID
1.2.2 Individual Impression/Recommendation 4003
1.2.2.1 Rendering Intent Not for Presentation 4003
1.2.2.2 Single Image Finding Mammography breast density 4006
1.2.2.2.1 Rendering Intent Not for Presentation 4006
1.2.2.2.2 Algorithm Name “Density Detector” 4019
1.2.2.2.3 Algorithm Version “V3.7 4019
1.2.2.2.4 Center POINT 4021
1.2.2.2.4.1 Reference to node 1.1.2 4021
1.2.2.2.5 Outline SCOORD 4021
1.2.2.2.5.1 Reference to node 1.1.2 4021

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Figure E.3-10: Individual Impression/Recommendation 1.2.3 from Example 2 Content Tree

Node Code Meaning of Concept Name Code Meaning or Example Value TID
1.2.3 Individual Impression/Recommendation 4003
1.2.3.1 Rendering Intent Presentation Required 4003
1.2.3.2 Single Image Finding Calcification Cluster 4006
1.2.3.2.1 Rendering Intent Presentation Required 4006
1.2.3.2.2 Algorithm Name “Calc Cluster Detector” 4019
1.2.3.2.3 Algorithm Version “V2.4 4019
1.2.3.2.4 Center POINT 4021
1.2.3.2.4.1 Reference to node 1.1.3 4021
1.2.3.2.5 Outline SCOORD 4021
1.2.3.2.5.1 Reference to node 1.1.3 4021
1.2.3.2.6 Number of Calcifications 20 4010

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Figure E.3-11: Individual Impression/Recommendation 1.2.4 from Example 2 Content Tree

Node Code Meaning of Concept Name Code Meaning or Example Value TID
1.2.4 Individual Impression/Recommendation 4003
1.2.4.1 Rendering Intent Presentation Required 4003
1.2.4.2 Single Image Finding Calcification Cluster 4006
1.2.4.2.1 Rendering Intent Presentation Required 4006
1.2.4.2.2 Algorithm Name “Calc Clustering” 4019
1.2.4.2.3 Algorithm Version “V2.4 4019
1.2.4.2.4 Center POINT 4021
1.2.4.2.4.1 Reference to node 1.1.1 4021
1.2.4.2.5 Outline SCOORD 4021
1.2.4.2.5.1 Reference to node 1.1.1 4021
1.2.4.2.6 Number of Calcifications 2 4010

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Figure E.3-12: Single Image Finding 1.2.4.2.7 from Example 2 Content Tree

Node Code Meaning of Concept Name Code Meaning or Example Value TID
1.2.4.2.7 Single Image Finding Individual Calcification 4006
1.2.4.2.7.1 Rendering Intent Presentation Optional 4006
1.2.4.2.7.2 Algorithm Name “Calc Detector” 4019
1.2.4.2.7.3 Algorithm Version “V2.4 4019
1.2.4.2.7.4 Center POINT 4021
1.2.4.2.7.4.1 Reference to node 1.1.1 4021
1.2.4.2.7.5 Outline SCOORD 4021
1.2.4.2.7.5.1 Reference to node 1.1.1 4021

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Figure E.3-13: Single Image Finding 1.2.4.2.8 from Example 2 Content Tree

Node Code Meaning of Concept Name Code Meaning or Example Value TID
1.2.4.2.8 Single Image Finding Individual Calcification 4006
1.2.4.2.8.1 Rendering Intent Presentation Optional 4006
1.2.4.2.8.2 Algorithm Name “Calc Detector” 4019
1.2.4.2.8.3 Algorithm Version “V2.4 4019
1.2.4.2.8.4 Center POINT 4021
1.2.4.2.8.4.1 Reference to node 1.1.1 4021
1.2.4.2.8.5 Outline SCOORD 4021
1.2.4.2.8.5.1 Reference to node 1.1.1 4021

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Figure E.3-14: Summary of Detections Branch of Example 2 Content Tree

Node Code Meaning of Concept Name Code Meaning or Example Value TID
1.3 Summary of Detections Succeeded 4000
1.3.1 Successful Detections 4015
1.3.1.1 Detection Performed Mammography breast density 4017
1.3.1.1.1 Algorithm Name “Density Detector” 4019
1.3.1.1.2 Algorithm Version “V3.7 4019
1.3.1.1.3 Reference to node 1.1.1 4017
1.3.1.1.4 Reference to node 1.1.2 4017
1.3.1.1.5 Reference to node 1.1.3 4017
1.3.1.1.6 Reference to node 1.1.4 4017
1.3.1.2 Detection Performed Individual Calcification 4017
1.3.1.2.1 Algorithm Name “Calc Detector” 4019
1.3.1.2.2 Algorithm Version “V2.4 4019
1.3.1.2.3 Reference to node 1.1.1 4017
1.3.1.2.4 Reference to node 1.1.2 4017
1.3.1.2.5 Reference to node 1.1.3 4017
1.3.1.2.6 Reference to node 1.1.4 4017
1.3.1.3 Detection Performed Calcification Cluster 4017
1.3.1.3.1 Algorithm Name “Calc Clustering” 4019
1.3.1.3.2 Algorithm Version “V2.4 4019
1.3.1.3.3 Reference to node 1.1.1 4017
1.3.1.4 Detection Performed Calcification Cluster 4017
1.3.1.4.1 Algorithm Name “Calc Cluster Detector” 4019
1.3.1.4.2 Algorithm Version “V2.4 4019
1.3.1.4.3 Reference to node 1.1.1 4017
1.3.1.4.4 Reference to node 1.1.2 4017
1.3.1.4.5 Reference to node 1.1.3 4017
1.3.1.4.6 Reference to node 1.1.4 4017

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Figure E.3-15: Summary of Analyses Branch of Example 2 Content Tree

Node Code Meaning of Concept Name Code Meaning or Example Value TID
1.4 Summary of Analyses Succeeded 4000
1.4.1 Successful Analyses 4016
1.4.1.1 Analysis Performed Mass Correlation 4018
1.4.1.1.1 Algorithm Name “Mass Maker” 4019
1.4.1.1.2 Algorithm Version “V1.9 4019
1.4.1.1.3 Reference to node 1.1.2 4018
1.4.1.1.4 Reference to node 1.1.4 4018

E.3.3 Example 3: Calcification and Mass Detection, Temporal Differencing with Findings

The patient in Example 2 returns for another mammogram. A more comprehensive mammography CAD device processes the current mammogram; analyses are performed that determine some content items for Overall and Individual Impression/Recommendations. Portions of the prior mammography CAD report (Example 2) are incorporated into this report. In the current mammogram the number of calcifications in the RCC has increased, and the size of the mass in the left breast has increased from 1 to 4 cm 2.

PRIOR
[pic] [pic] [pic] [pic]
CURRENT
[pic] [pic] [pic] [pic]

Figure E.3-16: Mammograms as Described in Example 3

Italicized entries ( xxx ) in the following table denote references to or by-value inclusion of content tree items reused from the prior Mammography CAD SR instance (Example 2).

Node Code Meaning of Concept Name Code Meaning or Example Value TID
1 Mammography CAD Report 4000

While the Image Library contains references to content tree items reused from the prior Mammography CAD SR instance, the images are actually used in the mammography CAD analysis and are therefore not italicized as indicated above.

Node Code Meaning of Concept Name Code Meaning or Example Value TID
1.1 Image Library 4000
1.1.1 IMAGE 1 4020
1.1.1.1 Image Laterality Right 4020
1.1.1.2 Image View Cranio-caudal 4020
1.1.1.3 Study Date 20000101 4020
1.1.2 IMAGE 2 4020
1.1.2.1 Image Laterality Left 4020
1.1.2.2 Image View Cranio-caudal 4020
1.1.2.3 Study Date 20000101 4020
1.1.3 IMAGE 3 4020
1.1.3.1 Image Laterality Right 4020
1.1.3.2 Image View Medio-lateral oblique 4020
1.1.3.3 Study Date 20000101 4020
1.1.4 IMAGE 4 4020
1.1.4.1 Image Laterality Left 4020
1.1.4.2 Image View Medio-lateral oblique 4020
1.1.4.3 Study Date 20000101 4020
1.1.5 IMAGE 5 4020
1.1.5.1 Image Laterality Right 4020
1.1.5.2 Image View Cranio-caudal 4020
1.1.5.3 Study Date 19990101 4020
1.1.6 IMAGE 6 4020
1.1.6.1 Image Laterality Left 4020
1.1.6.2 Image View Cranio-caudal 4020
1.1.6.3 Study Date 19990101 4020
1.1.7 IMAGE 7 4020
1.1.7.1 Image Laterality Right 4020
1.1.7.2 Image View Medio-lateral oblique 4020
1.1.7.3 Study Date 19990101 4020
1.1.8 IMAGE 8 4020
1.1.8.1 Image Laterality Left 4020
1.1.8.2 Image View Medio-lateral oblique 4020
1.1.8.3 Study Date 19990101 4020

Current year content:

Node Code Meaning of Concept Name Code Meaning or Example Value TID
1.2 CAD Processing and Findings Summary All algorithms succeeded; with findings 4001
1.2.1 Assessment Category 4 – Suspicious abnormality, biopsy should be considered 4002
1.2.2 Recommend Follow-up Interval 0 days 4002
1.2.3 Algorithm Name “Mammogram Analyzer” 4019
1.2.4 Algorithm Version “V1.0 4019
1.2.5 Individual Impression/Recommendation 4003
1.2.5.1 Rendering Intent Presentation Required 4003
1.2.5.2 Differential Diagnosis/Impression Increase in size 4002
1.2.5.3 Impression Description “Worrisome increase in size” 4002
1.2.5.4 Recommended Follow-up Needle localization and biopsy 4002
1.2.5.5 Certainty of impression 84% 4002
1.2.5.6 Algorithm Name “Lesion Analyzer” 4019
1.2.5.7 Algorithm Version “V1.0 4019
1.2.5.8 Composite Feature Mass 4004
1.2.5.8.1 Rendering Intent Presentation Required 4004
1.2.5.8.2 Composite type Target content items are related temporally 4005
1.2.5.8.3 Scope of Feature Feature was detected on multiple images 4005
1.2.5.8.4 Algorithm Name “Temporal Change” 4019
1.2.5.8.5 Algorithm Version “V0.1 4019
1.2.5.8.6 Certainty of Feature 91% 4005
1.2.5.8.7 Probability of Cancer 84% 4005
1.2.5.8.8 Pathology Invasivelobular carcinoma 4005
1.2.5.8.9 Difference in Size 3 cm2 4005
1.2.5.8.9.1 Reference to node 1.2.5.8.13.7.6 4005
1.2.5.8.9.2 Reference to node 1.2.5.8.14.8.6 4005
1.2.5.8.10 Lesion Density High density 4005
1.2.5.8.11 Shape Lobular 4005
1.2.5.8.12 Margins Microlobulated 4005
1.2.5.8.13 Composite Feature Mass 4004
1.2.5.8.13.1 Rendering Intent Presentation Required 4004
1.2.5.8.13.2 Composite type Target content items are related spatially 4005
1.2.5.8.13.3 Scope of Feature Feature was detected on multiple images 4005
1.2.5.8.13.4 Algorithm Name “Mass Maker” 4019
1.2.5.8.13.5 Algorithm Version “V1.9 4019
1.2.5.8.13.6 Single Image Finding Mammography breast density 4006
1.2.5.8.13.6.1 Rendering Intent Presentation Required 4006
1.2.5.8.13.6.2 Algorithm Name “Density Detector” 4019
1.2.5.8.13.6.3 Algorithm Version “V3.7 4019
1.2.5.8.13.6.4 Center POINT 4021
1.2.5.8.13.6.4.1 Reference to node 1.1.2 4021
1.2.5.8.13.6.5 Outline SCOORD 4021
1.2.5.8.13.6.5.1 Reference to node 1.1.2 4021
1.2.5.8.13.7 Single Image Finding Mammography breast density 4006
1.2.5.8.13.7.1 Rendering Intent Presentation Required 4006
1.2.5.8.13.7.2 Algorithm Name “Density Detector” 4019
1.2.5.8.13.7.3 Algorithm Version “V3.7 4019
1.2.5.8.13.7.4 Center POINT 4021
1.2.5.8.13.7.4.1 Reference to node 1.1.4 4021
1.2.5.8.13.7.5 Outline SCOORD 4021
1.2.5.8.13.7.5.1 Reference to node 1.1.4 4021
1.2.5.8.13.7.6 Area of Defined Region 4 cm2 1401
1.2.5.8.13.7.6.1 Area Outline SCOORD 1401
1.2.5.8.13.7.6. 1.1 Reference to node 1.1.4 1401

Included content from prior mammography CAD report (see Example 2, starting with node 1.2.1.2)

Node Code Meaning of Concept Name Code Meaning or Example Value TID
1.2.5.8.14 Composite Feature Mass 4004
1.2.5.8.14.1 Rendering Intent Presentation Required 4004
1.2.5.8.14.2 Composite type Target content items are related spatially 4005
1.2.5.8.14.3 Scope of Feature Feature was detected on multiple images 4005
1.2.5.8.14.4 Algorithm Name “Mass Maker” 4019
1.2.5.8.14.5 Algorithm Version “V1.9 4019
1.2.5.8.14.6 [Observation Context content items] 4022
1.2.5.8.14.7 Single Image Finding Mammography breast density 4006
1.2.5.8.14.7.1 Rendering Intent Presentation Required 4006
1.2.5.8.14.7.2 Algorithm Name “Density Detector” 4019
1.2.5.8.14.7.3 Algorithm Version “V3.7 4019
1.2.5.8.14.7.4 Center POINT 4021
1.2.5.8.14.7.4.1 Reference to node 1.1.6 4021
1.2.5.8.14.7.5 Outline SCOORD 4021
1.2.5.8.14.7.5.1 Reference to node 1.1.6 4021
1.2.5.8.14.8 Single Image Finding Mammography breast density 4006
1.2.5.8.14.8.1 Rendering Intent Presentation Required 4006
1.2.5.8.14.8.2 Algorithm Name “Density Detector” 4019
1.2.5.8.14.8.3 Algorithm Version “V3.7 4019
1.2.5.8.14.8.4 Center POINT 4021
1.2.5.8.14.8.4.1 Reference to node 1.1.8 4021
1.2.5.8.14.8.5 Outline SCOORD 4021
1.2.5.8.14.8.5.1 Reference to node 1.1.8 4021
1.2.5.8.14.8.6 Area of Defined Region 1 cm2 1401
1.2.5.8.14.8.6.1 Area Outline SCOORD 1401
1.2.5.8.14.8.6.1.1 Reference to node 1.1.8 1401

More current year content:

Node Code Meaning of Concept Name Code Meaning or Example Value TID
1.2.6 Individual Impression/Recommendation 4003
1.2.6.1 Rendering Intent Not for Presentation 4003
1.2.6.2 Single Image Finding Mammography breast density 4006
1.2.6.2.1 Rendering Intent Not for Presentation 4006
1.2.6.2.2 Algorithm Name “Density Detector” 4019
1.2.6.2.3 Algorithm Version “V3.7 4019
1.2.6.2.4 Center POINT 4021
1.2.6.2.4.1 Reference to node 1.1.2 4021
1.2.6.2.5 Outline SCOORD 4021
1.2.6.2.5.1 Reference to node 1.1.2 4021
1.2.7 Individual Impression/Recommendation INDIVIDUAL 4003
1.2.7.1 Rendering Intent Presentation Required 4003
1.2.7.2 Single Image Finding Calcification Cluster 4006
1.2.7.2.1 Rendering Intent Presentation Required 4006
1.2.7.2.2 Algorithm Name “Calc Cluster Detector” 4019
1.2.7.2.3 Algorithm Version “V2.4 4019
1.2.7.2.4 Center POINT 4021
1.2.7.2.4.1 Reference to node 1.1.3 4021
1.2.7.2.5 Outline SCOORD 4021
1.2.7.2.5.1 Reference to node 1.1.3 4021
1.2.7.2.6 Number of Calcifications 20 4010
1.2.8 Individual Impression/Recommendation 4003
1.2.8.1 Rendering Intent Presentation Required 4003
1.2.8.2 Differential Diagnosis/Impression Increase in number of calcifications 4002
1.2.8.3 Impression Description “Calcification cluster has increased in size” 4002
1.2.8.4 Recommended Follow-up Magnification views 4002
1.2.8.5 Certainty of impression 100% 4002
1.2.8.6 Algorithm Name “Lesion Analyzer” 4019
1.2.8.7 Algorithm Version “V1.0 4019
1.2.8.8 Composite Feature Calcification Cluster 4004
1.2.8.8.1 Rendering Intent Presentation Required 4004
1.2.8.8.2 Composite type Target content items are related temporally 4005
1.2.8.8.3 Scope of Feature Feature was detected on multiple images 4005
1.2.8.8.4 Algorithm Name “Lesion Analyzer” 4019
1.2.8.8.5 Algorithm Version “V1.0 4019
1.2.8.8.6 Certainty of Feature 99% 4005
1.2.8.8.7 Probability of Cancer 54% 4005
1.2.8.8.8 Pathology Intraductal carcinoma, low grade 4005
1.2.8.8.9 Difference in Number of calcifications 4 4005
1.2.8.8.9.1 Reference to node 1.2.8.8.12.6 4005
1.2.8.8.9.2 Reference to node 1.2.8.8.13.6 4005
1.2.8.8.10 Calcification type Fine, linear, branching (casting) 4005
1.2.8.8.11 Calcification distribution Grouped or clustered 4005
1.2.8.8.12 Single Image Finding Calcification Cluster 4006
1.2.8.8.12.1 Rendering Intent Presentation Required 4006
1.2.8.8.12.2 Algorithm Name “Calc Clustering” 4019
1.2.8.8.12.3 Algorithm Version “V2.4 4019
1.2.8.8.12.4 Center POINT 4021
1.2.8.8.12.4.1 Reference to node 1.1.1 4021
1.2.8.8.12.5 Outline SCOORD 4021
1.2.8.8.12.5.1 Reference to node 1.1.1 4021
1.2.8.8.12.6 Number of Calcifications 6 4010
1.2.8.8.12.7 Single Image Finding Individual Calcification 4006
1.2.8.8.12.7.1 Rendering Intent Presentation Optional 4006
1.2.8.8.12.7.2 Algorithm Name “Calc Detector” 4019
1.2.8.8.12.7.3 Algorithm Version “V2.4 4019
1.2.8.8.12.7.4 Center POINT 4021
1.2.8.8.12.7.4.1 Reference to node 1.1.1 4021
1.2.8.8.12.7.5 Outline SCOORD 4021
1.2.8.8.12.7.5.1 Reference to node 1.1.1 4021
1.2.8.8.12.8 Single Image Finding Individual Calcification 4006
1.2.8.8.12.8.1 Rendering Intent Presentation Optional 4006
1.2.8.8.12.8.2 Algorithm Name “Calc Detector” 4019
1.2.8.8.12.8.3 Algorithm Version “V2.4 4019
1.2.8.8.12.8.4 Center POINT 4021
1.2.8.8.12.8.4.1 Reference to node 1.1.1 4021
1.2.8.8.12.8.5 Outline SCOORD 4021
1.2.8.8.12.8.5.1 Reference to node 1.1.1 4021
1.2.8.8.12.9 Single Image Finding Individual Calcification 4006
1.2.8.8.12.9.1 Rendering Intent Presentation Optional 4006
1.2.8.8.12.9.2 Algorithm Name “Calc Detector” 4019
1.2.8.8.12.9.3 Algorithm Version “V2.4 4019
1.2.8.8.12.9.4 Center POINT 4021
1.2.8.8.12.9.4.1 Reference to node 1.1.1 4021
1.2.8.8.12.9.5 Outline SCOORD 4021
1.2.8.8.12.9.5.1 Reference to node 1.1.1 4021
1.2.8.8.12.10 Single Image Finding Individual Calcification 4006
1.2.8.8.12.10.1 Rendering Intent Presentation Optional 4006
1.2.8.8.12.10.2 Algorithm Name “Calc Detector” 4019
1.2.8.8.12.10.3 Algorithm Version “V2.4 4019
1.2.8.8.12.10.4 Center POINT 4021
1.2.8.8.12.10.4.1 Reference to node 1.1.1 4021
1.2.8.8.12.10.5 Outline SCOORD 4021
1.2.8.8.12.10.5.1 Reference to node 1.1.1 4021
1.2.8.8.12.11 Single Image Finding Individual Calcification 4006
1.2.8.8.12.11.1 Rendering Intent Presentation Optional 4006
1.2.8.8.12.11.2 Algorithm Name “Calc Detector” 4019
1.2.8.8.12.11.3 Algorithm Version “V2.4 4019
1.2.8.8.12.11.4 Center POINT 4021
1.2.8.8.12.11.4.1 Reference to node 1.1.1 4021
1.2.8.8.12.11.5 Outline SCOORD 4021
1.2.8.8.12.11.5.1 Reference to node 1.1.1 4021
1.2.8.8.12.12 Single Image Finding Individual Calcification 4006
1.2.8.8.12.12.1 Rendering Intent Presentation Optional 4006
1.2.8.8.12.12.2 Algorithm Name “Calc Detector” 4019
1.2.8.8.12.12.3 Algorithm Version “V2.4 4019
1.2.8.8.12.12.4 Center POINT 4021
1.2.8.8.12.12.4.1 Reference to node 1.1.1 4021
1.2.8.8.12.12.5 Outline SCOORD 4021
1.2.8.8.12.12.5.1 Reference to node 1.1.1 4021

Included content from prior mammography CAD report (see Example 2, starting with node 1.2.4.2)

Node Code Meaning of Concept Name Code Meaning or Example Value TID
1.2.8.8.13 Single Image Finding Calcification Cluster 4006
1.2.8.8.13.1 Rendering Intent Presentation Required 4006
1.2.8.8.13.2 Algorithm Name “Calc Clustering” 4019
1.2.8.8.13.3 Algorithm Version “V2.4 4019
1.2.8.8.13.4 Center POINT 4021
1.2.8.8.13.4.1 Reference to node 1.1.5 4021
1.2.8.8.13.5 Outline SCOORD 4021
1.2.8.8.13.5.1 Reference to node 1.1.5 4021
1.2.8.8.13.6 Number of Calcifications 2 4010
1.2.8.8.13.7 [Observation Context content items] 4022
1.2.8.8.13.8 Single Image Finding Individual Calcification 4006
1.2.8.8.13.8.1 Rendering Intent Presentation Optional 4006
1.2.8.8.13.8.2 Algorithm Name “Calc Detector” 4019
1.2.8.8.13.8.3 Algorithm Version “V2.4 4019
1.2.8.8.13.8.4 Center POINT 4021
1.2.8.8.13.8.4.1 Reference to node 1.1.5 4021
1.2.8.8.13.8.5 Outline SCOORD 4021
1.2.8.8.13.8.5.1 Reference to node 1.1.5 4021
1.2.8.8.13.9 Single Image Finding Individual Calcification 4006
1.2.8.8.13.9.1 Rendering Intent Presentation Optional 4006
1.2.8.8.13.9.2 Algorithm Name “Calc Detector” 4019
1.2.8.8.13.9.3 Algorithm Version “V2.4 4019
1.2.8.8.13.9.4 Center POINT 4021
1.2.8.8.13.9.4.1 Reference to node 1.1.5 4021
1.2.8.8.13.9.4 Outline SCOORD 4021
1.2.8.8.13.9.4.1 Reference to node 1.1.5 4021

More current year content:

Node Code Meaning of Concept Name Code Meaning or Example Value TID
1.3 Summary of Detections Succeeded 4000
1.3.1 Successful Detections 4015
1.3.1.1 Detection Performed Mammography breast density 4017
1.3.1.1.1 Algorithm Name “Density Detector” 4019
1.3.1.1.2 Algorithm Version “V3.7 4019
1.3.1.1.3 Reference to node 1.1.1 4017
1.3.1.1.4 Reference to node 1.1.2 4017
1.3.1.1.5 Reference to node 1.1.3 4017
1.3.1.1.6 Reference to node 1.1.4 4017
1.3.1.2 Detection Performed Individual Calcification 4017
1.3.1.2.1 Algorithm Name “Calc Detector” 4019
1.3.1.2.2 Algorithm Version “V2.4 4019
1.3.1.2.3 Reference to node 1.1.1 4017
1.3.1.2.4 Reference to node 1.1.2 4017
1.3.1.2.5 Reference to node 1.1.3 4017
1.3.1.2.6 Reference to node 1.1.4 4017
1.3.1.3 Detection Performed Calcification Cluster 4017
1.3.1.3.1 Algorithm Name “Calc Clustering” 4019
1.3.1.3.2 Algorithm Version “V2.4 4019
1.3.1.3.3 Reference to node 1.1.1 4017
1.3.1.4 Detection Performed Calcification Cluster 4017
1.3.1.4.1 Algorithm Name “Calc Cluster Detector” 4019
1.3.1.4.2 Algorithm Version “V2.4 4019
1.3.1.4.3 Reference to node 1.1.1 4017
1.3.1.4.4 Reference to node 1.1.2 4017
1.3.1.4.5 Reference to node 1.1.3 4017
1.3.1.4.6 Reference to node 1.1.4 4017
1.4 Summary of Analyses Succeeded 4000
1.4.1 Successful Analyses 4016
1.4.1.1 Analysis Performed Mass Correlation 4018
1.4.1.1.1 Algorithm Name “Mass Maker” 4019
1.4.1.1.2 Algorithm Version “V1.9 4019
1.4.1.1.3 Reference to node 1.1.2 4018
1.4.1.1.4 Reference to node 1.1.4 4018
1.4.1.2 Analysis Performed Temporal Correlation 4018
1.4.1.2.1 Algorithm Name “Temporal Change” 4019
1.4.1.2.2 Algorithm Version “V0.1 4019
1.4.1.2.3 Reference to node 1.1.2 4018
1.4.1.2.4 Reference to node 1.1.4 4018
1.4.1.2.5 Reference to node 1.1.6 4018
1.4.1.2.6 Reference to node 1.1.8 4018
1.4.1.3 Analysis Performed Individual Impression / Recommendation Analysis 4018
1.4.1.3.1 Algorithm Name “Lesion Analyzer” 4019
1.4.1.3.2 Algorithm Version “V1.0 4019
1.4.1.3.3 Reference to node 1.1.2 4018
1.4.1.3.4 Reference to node 1.1.4 4018
1.4.1.3.5 Reference to node 1.1.6 4018
1.4.1.3.6 Reference to node 1.1.8 4018
1.4.1.4 Analysis Performed Overall Impression / Recommendation Analysis 4018
1.4.1.4.1 Algorithm Name “Mammogram Analyzer” 4019
1.4.1.4.2 Algorithm Version “V1.0 4019
1.4.1.4.3 Reference to node 1.1.2 4018
1.4.1.4.4 Reference to node 1.1.4 4018
1.4.1.4.5 Reference to node 1.1.6 4018
1.4.1.4.6 Reference to node 1.1.8 4018

E.4 CAD OPERATING POINT

Computer-aided detection algorithms often compute an internal “CAD score” for each Single Image Finding detected by the algorithm. In some implementations the algorithms then group the findings into “bins” as a function of their CAD score. The number of bins is a function of the algorithm and the manufacturer’s implementation, and must be one or more. The bins allow an application that is displaying CAD marks to provide a number of operating points on the Free-response Receiver-Operating Characteristic (FROC) curve for the algorithm, as illustrated in Figure E.4-1.

[pic]

Figure E.4-1 - Free-response Receiver-Operating Characteristic (FROC) curve

This is accomplished by displaying all CAD marks of Rendering Intent “Presentation Required” or “Presentation Optional” according to the following rules:

E.5 Mammography CAD SR AND For Processing / For Presentation IMAGES

If a Mammography CAD SR Instance references Digital Mammography X-ray Image Storage – For Processing Instances, but a review workstation has access only to Digital Mammography X-Ray Image Storage – For Presentation Instances, the following steps are recommended in order to display such Mammography CAD SR content with Digital Mammography X-Ray Image – For Presentation Instances.