Annex O STRUCTURED REPORTING STORAGE SOP CLASSES (Normative)

O.1 Overview

The Structured Reporting Storage SOP Classes extend the functionality of the Storage Service class (defined in Annex B) to extend the SCP behavior and conformance requirements.

O.2 Behavior

O.2.1 Behavior of an SCU

O.2.1.1 CAD SR SOP Classes

Rendering Intent concept modifiers in the Mammography CAD SR, Chest CAD SR and Colon CAD SR objects shall be consistent. Content items marked “For Presentation” shall not be subordinate to content items marked “Not for Presentation” or “Presentation Optional” in the content tree. Similarly, content items marked “Presentation Optional” shall not be subordinate to content items marked “Not for Presentation” in the content tree.

Content items referenced from another SR object instance, such as a prior Mammography CAD SR, Chest CAD SR or Colon CAD SR shall be inserted by-value in the new SR object instance, with appropriate original source observation context. It is necessary to update Rendering Intent, and referenced content item identifiers for by-reference relationships, within content items paraphrased from another source.

O.2.2 Behavior of an SCP

An SCP intending to display or otherwise render a Structured Report shall convey its full meaning in an unambiguous manner.

Note: “Full meaning” includes not just the Content Tree (i.e., the Items of the Content Sequence), but all attributes of the Data Set that are necessary to properly interpret the Structured Report. This includes those attributes that set the initial Observation Context for the Content Tree, i.e., the patient, procedure, and observer identifiers, and the Completion status and Verification status of the Structured Report.

An Icon Image in an IMAGE reference has no meaning, and is not required to be rendered.

For a device, that is both an SCU and an SCP of these Storage SOP Classes, in addition to the behavior for the Storage Service Class specified in B.2.2, the following additional requirements are specified for Structured Reporting Storage SOP Classes:

— an SCP of this SOP Class shall support Level 2 Conformance as defined in Section B.4.1.

Note: This requirement means that all Type 1, Type 2, and Type 3 Attributes defined in the Information Object Definition associated with the SOP Class will be stored and may be accessed.

O.2.2.1 CAD SR SOP Classes

The Mammography CAD SR, Chest CAD SR and Colon CAD SR objects contain data not only for presentation to the clinician, but also data solely for use in subsequent mammography CAD analyses.

The SCU provides rendering guidelines via “Rendering Intent” concept modifiers associated with “Individual Impression/Recommendation”, “Composite Feature” and “Single Image Finding” content items. The full meaning of the SR is provided if all content items marked “Presentation Required” are rendered down to the first instance of “Not for Presentation” or “Presentation Optional” for each branch of the tree. Use of the SCU’s Conformance Statement is recommended if further enhancement of the meaning of the SR can be accomplished by rendering some or all of the data marked “Presentation Optional”. Data marked “Not for Presentation” should not be rendered by the SCP; it is embedded in the SR content tree as input to subsequent CAD analysis work steps.

The SCP may further interpret whether or not to render a Single Image Finding that has Rendering Intent “Presentation Optional” by interpreting the value of the CAD Operating Point content item that is subordinate to the Rendering Intent, if present. If the CAD Operating Point content item is not present, then rendering of the Single Image Finding may be based on recommendations in the creator’s DICOM Conformance Statement. For further information on the intended use of CAD Operating Point see PS 3.17, Mammography CAD (Informative) Annex, CAD Operating Point.

O.3 Modification of SR DOCUMENT CONTENT

A device that is an SR Storage SOP Class SCU may modify information in a SOP Instance which it has previously sent or received. When this SOP Instance is modified and sent to an SCP, it shall be assigned a new SOP Instance UID if any of the following conditions are met:

O.4 CONFORMANCE

In addition to the Conformance Statement requirements for the Storage Service Class specified in B.4.3, the following additional requirements are specified for Structured Reporting Storage SOP Classes:

O.4.1 Conformance Statement for an SCU

The following shall be documented in the Conformance Statement of any implementation claiming conformance to the Structured Reporting Storage SOP Classes as an SCU:

— The Image or other composite object Storage SOP Classes that are also supported by the SCU and which may be referenced by instances of Structured Reporting Storage SOP Class.

— The range of Value Types and Relationship Types that are supported by the SCU.

— The conditions under which a new SOP Instance UID is generated for an existing SR Document.

— If the implementation provides Query/Retrieve of Structured Reporting SOP Instances as an SCU, whether it supports the Optional Keys Concept Name Code Sequence or Content Template Sequence.

O.4.1.1 CAD SR SOP Classes

The following shall be documented in the Conformance Statement of any implementation claiming conformance to the Mammography CAD SR SOP Class as an SCU:

The following shall be documented in the Conformance Statement of any implementation claiming conformance to the Chest CAD SR SOP Class as an SCU:

The following shall be documented in the Conformance Statement of any implementation claiming conformance to the Colon CAD SR SOP Class as an SCU:

The following shall be documented in the Conformance Statement of any implementation claiming conformance to the Mammography CAD SR, Chest CAD SR or Colon CAD SR SOP Classes as an SCU that creates instances:

O.4.2 Conformance Statement for an SCP

The following shall be documented in the Conformance Statement of any implementation claiming conformance to the Structured Reporting Storage SOP Class as an SCP:

— For an SCP of a Structured Reporting Storage SOP Class that is displaying or otherwise rendering the structured report contained in a SOP Instance of the Class, the general form in which the structured report related attributes are rendered.

— For an SCP of a Structured Reporting Storage SOP Class, the Image or other composite object Storage SOP Classes that are also supported by the SCP and which may be referenced by instances of the Structured Reporting Storage SOP Class, and whether or not they will be displayed or otherwise rendered.

— For an SCP of a Structured Reporting Storage SOP Class that is displaying or otherwise rendering an image or other composite object referred to by a SOP Instance of the Class, the manner in which the structured report related attributes (such as spatial coordinates and referenced presentation states) are used to influence the display of the image or object.

— If the implementation supports Query/Retrieve of Structured Reporting SOP Instances as an SCP, whether it supports the Optional Keys Concept Name Code Sequence or Content Template Sequence.

O.4.2.1 CAD SR SOP Classes

The following shall be documented in the Conformance Statement of any implementation claiming conformance to the Mammography CAD SR, Chest CAD SR or Colon CAD SR SOP Classes as an SCP: