Mammography CAD SR IOD Templates
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## Mammography CAD SR IOD Templates

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

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

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 that 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 TID 4006 “Mammography CAD Single Image Finding”), associated as Composite Features (see TID 4004 “Mammography CAD Composite Feature”), and from which Individual and Overall Impressions are formed.

See Figure E.1-1 “Top Levels of Mammography CAD SR Content Tree” in PS3.17 .

Type:

  Non-Extensible

Order:

  Significant

Root:

  Yes

Table TID 4000. Mammography CAD Document Root

| NL | Rel with Parent | VT | Concept Name | VM | Req Type | Condition | Value Set Constraint
--- | --- | --- | --- | --- | --- | --- | --- | ---
1 |  |  | CONTAINER | EV (111036, DCM, "Mammography CAD Report") | 1 | M |  | Root node
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 “Mammography CAD Document Root”, 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 “Mammography CAD Document Root”, 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

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 “Mammography CAD Impression/Recommendation Body”). The data from which the details are inferred, are expressed in the Mammography CAD Individual Impression/Recommendations (see TID 4003 “Mammography CAD Individual Impression/Recommendation”), of which there may be several.

Type:

  Non-Extensible

Order:

  Significant

Table TID 4001. Mammography CAD Overall Impression/Recommendation

| 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 “Mammography CAD Individual Impression/Recommendation” or its underlying structure, other than the TID 4001 “Mammography CAD Overall Impression/Recommendation” and TID 4003 “Mammography CAD Individual Impression/Recommendation” 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

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

Type:

  Non-Extensible

Order:

  Significant

Table TID 4002. Mammography CAD Impression/Recommendation Body

| 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, 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

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 “Mammography CAD Impression/Recommendation Body”). The data from which the details are inferred are expressed in the Composite Features (see TID 4004 “Mammography CAD Composite Feature”) and/or Single Image Findings (see TID 4006 “Mammography CAD Single Image Finding”) of which there may be several.

The sub-tree headed by this template is illustrated in Figure E.1-3 “Example of Individual Impression/Recommendation Levels of Mammography CAD SR Content Tree” in PS3.17 .

Type:

  Non-Extensible

Order:

  Significant

Table TID 4003. Mammography CAD Individual Impression/Recommendation

| 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 Section O.2 “Structured Reporting Storage SOP Class SCU and SCP Behavior” in PS3.4 .

### TID 4004 Mammography CAD Composite Feature

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 “Mammography CAD Composite Feature Body”). The data from which the details are inferred, are expressed in the Composite Features (see TID 4004 “Mammography CAD Composite Feature”) and/or Single Image Findings (see TID 4006 “Mammography CAD Single Image Finding”), 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.

Type:

  Non-Extensible

Order:

  Significant

Table TID 4004. Mammography CAD Composite Feature

| 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 Section O.2 “Structured Reporting Storage SOP Class SCU and SCP Behavior” in PS3.4 .

### TID 4005 Mammography CAD Composite Feature Body

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

Type:

  Non-Extensible

Order:

  Significant

Table TID 4005. Mammography CAD Composite Feature Body

| 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 = EV (%, 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 = EV (%, 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” UNITS = DCID 7461 “Units of Area Measurement” UNITS = DCID 7462 “Units of Volume Measurement” UNITS = 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

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 “Mammography CAD Single Image Finding”) 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.

Type:

  Non-Extensible

Order:

  Significant

Table TID 4006. Mammography CAD Single Image Finding

| 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 “CAD Detection Performed” is present | UNITS = DT ({1:n}, UCUM, "range: 1:n"), where n is the maximum specified in Row 9 of TID 4017 “CAD Detection Performed”. 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 Section O.2 “Structured Reporting Storage SOP Class SCU and SCP Behavior” in PS3.4 .
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 Section O.2 “Structured Reporting Storage SOP Class SCU and SCP Behavior” in PS3.4 and Section E.4 “CAD Operating Point” in PS3.17 .
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

Type:

  Non-Extensible

Order:

  Significant

Table TID 4007. Mammography CAD Breast Composition

| 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

Type:

  Non-Extensible

Order:

  Significant

Table TID 4008. Mammography CAD Breast Geometry

| 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

Figure A-8a. Example of Breast Outline Including Pectoral Muscle Tissue | Figure A-8b. Example of Pectoral Muscle Outline

### TID 4009 Mammography CAD Individual Calcification

This template provides the detail specific to an individual calcification.

Type:

  Non-Extensible

Order:

  Significant

Table TID 4009. Mammography CAD Individual Calcification

| 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

This template provides the detail specific to a calcification cluster.

Type:

  Non-Extensible

Order:

  Significant

Table TID 4010. Mammography CAD Calcification Cluster

| 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

This template provides the detail specific to a density.

Type:

  Non-Extensible

Order:

  Significant

Table TID 4011. Mammography CAD Density

| 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

This template provides the detail specific to a finding other than a lesion (see CID 6040 “Non-lesion Object Type”).

Type:

  Non-Extensible

Order:

  Significant

Table TID 4012. Mammography CAD Non-Lesion

| 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

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.

Type:

  Non-Extensible

Order:

  Significant

Table TID 4013. Mammography CAD Selected Region

| 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

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

Table TID 4014. Parameters

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

Type:

  Non-Extensible

Order:

  Significant

Table TID 4014. CAD Image Quality

| 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 (%, UCUM, "Percent") 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

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 “Mammography CAD Document Root”). 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 Figure E.1-2 “Summary of Detections and Analyses Levels of Mammography CAD SR Content Tree” in PS3.17 .

Table TID 4015. Parameters

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

Type:

  Non-Extensible

Order:

  Significant

Table TID 4015. CAD Detections Performed

| 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

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 “Mammography CAD Document Root”). 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 Figure E.1-2 “Summary of Detections and Analyses Levels of Mammography CAD SR Content Tree” in PS3.17 .

Table TID 4016. Parameters

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

Type:

  Non-Extensible

Order:

  Significant

Table TID 4016. CAD Analyses Performed

| 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

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

Table TID 4017. Parameters

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

Type:

  Non-Extensible

Order:

  Significant

Table TID 4017. CAD Detection Performed

| 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 “Mammography Single Image Finding”) then the "CAD Algorithm Identification" shall unambiguously distinguish between algorithms.
Rows 5, 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 5, 6 | 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

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

Table TID 4018. Parameters

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

Type:

  Non-Extensible

Order:

  Significant

Table TID 4018. CAD Analysis Performed

| 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 “Types of Mammography CAD Analysis”) then the "CAD Algorithm Identification" shall unambiguously distinguish between algorithms.
Rows 5, 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 5, 6 | 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

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.

Type:

  Non-Extensible

Order:

  Significant

Table TID 4019. CAD Algorithm Identification

| 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

Each instance of the Image Library Entry template contains the Image SOP Class and Instance UIDs, and selected attributes for an image that facilitate spatial analysis without having to retrieve the entire set of referenced images. If values for the attributes are not present in the Image SOP Instance, then as many of the attributes as possible should be derived.

Table TID 4020. Parameters

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

Type:

  Extensible

Order:

  Significant

Table TID 4020. CAD Image Library Entry

| 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") UNITS = EV (mm, UCUM, "millimeter")
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") UNITS = EV (mm, UCUM, "millimeter")
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 |
15 | > | HAS ACQ CONTEXT | NUM | EV (112226, DCM, "Spacing between slices") | 1 | UC | May be computed from the Image Position (Patient) (0020,0032) projected onto the normal to the Image Orientation (Patient) (0020,0037) if present; may or may not be the same as the Spacing Between Slices (0018,0088) if present. | UNITS = EV (mm, UCUM, "millimeter")
16 | > | HAS ACQ CONTEXT | NUM | EV (112225, DCM, "Slice Thickness") | 1 | UC | May be present if Slice Thickness (0018,0050) is in the Image Instance. | UNITS = EV (mm, UCUM, "millimeter")
17 | > | HAS ACQ CONTEXT | UIDREF | EV (112227, DCM, "Frame of Reference UID") | 1 | UC | May be present if Frame of Reference UID (0020,0052) is in the Image Instance. |
18 | > | HAS ACQ CONTEXT | NUM | EV (110901, DCM, "Image Position (Patient) X") | 1 | UC | May be present if Image Position (Patient) (0020,0032) is in the Image Instance, and is the first value of Image Position (Patient) (0020,0032) for the referenced image or frame. | UNITS = EV (mm, UCUM, "millimeter")
19 | > | HAS ACQ CONTEXT | NUM | EV (110902, DCM, "Image Position (Patient) Y") | 1 | MC | Shall be present if Row 18 is present, and is the second value of Image Position (Patient) (0020,0032) in the Image Instance for the referenced image or frame. | UNITS = EV (mm, UCUM, "millimeter")
20 | > | HAS ACQ CONTEXT | NUM | EV (110903, DCM, "Image Position (Patient) Z") | 1 | MC | Shall be present if Row 18 is present, and is the second value of Image Position (Patient) (0020,0032) in the Image Instance for the referenced image or frame. | UNITS = EV (mm, UCUM, "millimeter")
21 | > | HAS ACQ CONTEXT | NUM | EV (110904, DCM, "Image Orientation (Patient) Row X") | 1 | UC | May be present if Image Position (Patient) (0020,0037) is in the Image Instance, and is the first value of Image Orientation (Patient) (0020,0037) for the referenced image or frame. | UNITS = EV ({-1:1}, UCUM, "{-1:1}")
22 | > | HAS ACQ CONTEXT | NUM | EV (110905, DCM, "Image Orientation (Patient) Row Y") | 1 | MC | Shall be present if Row 21 is present, and is the second value of Image Orientation (Patient) (0020,0037) in the Image Instance for the referenced image or frame. | UNITS = EV ({-1:1}, UCUM, "{-1:1}")
23 | > | HAS ACQ CONTEXT | NUM | EV (110906, DCM, "Image Orientation (Patient) Row Z") | 1 | MC | Shall be present if Row 21 is present, and is the third value of Image Orientation (Patient) (0020,0037) in the Image Instance for the referenced image or frame. | UNITS = EV ({-1:1}, UCUM, "{-1:1}")
24 | > | HAS ACQ CONTEXT | NUM | EV (110907, DCM, "Image Orientation (Patient) Column X") | 1 | MC | Shall be present if Row 21 is present, and is the fourth value of Image Orientation (Patient) (0020,0037) in the Image Instance for the referenced image or frame. | UNITS = EV ({-1:1}, UCUM, "{-1:1}")
25 | > | HAS ACQ CONTEXT | NUM | EV (110908, DCM, "Image Orientation (Patient) Column Y") | 1 | MC | Shall be present if Row 21 is present, and is the fifth value of Image Orientation (Patient) (0020,0037) in the Image Instance for the referenced image or frame. | UNITS = EV ({-1:1}, UCUM, "{-1:1}")
26 | > | HAS ACQ CONTEXT | NUM | EV (110909, DCM, "Image Orientation (Patient) Column Z") | 1 | MC | Shall be present if Row 21 is present, and is the sixth value of Image Orientation (Patient) (0020,0037) in the Image Instance for the referenced image or frame. | UNITS = EV ({-1:1}, UCUM, "{-1:1}")
27 | > | HAS ACQ CONTEXT | NUM | EV (110910, DCM, "Pixel Data Rows") | 1 | UC | May be present if Rows (0028,0010) is in the Image Instance. | UNITS = EV ({pixels}, UCUM, "pixels")
28 | > | HAS ACQ CONTEXT | NUM | EV (110911, DCM, "Pixel Data Columns") | 1 | MC | Shall be present if Row 27 is present, and is the value of Columns (0028,0011) in the Image Instance. | UNITS = EV ({pixels}, UCUM, "pixels")

Content Item Descriptions

Patient Orientation Row | First (row) and second (column) components of Patient Orientation (0020,0020) in the Image IOD. See Section C.7.6.1.1.1 in PS3.3 .
Patient Orientation Column
Horizontal Imager Pixel Spacing | The row (first) component of Imager Pixel Spacing (0018,1164) in the Image IOD. See Section C.8.11.4 in PS3.3 .
Vertical Imager Pixel Spacing | The column (second) component of Imager Pixel Spacing (0018,1164) in the Image IOD. See Section C.8.11.4 in PS3.3 .

### TID 4021 Mammography CAD Geometry

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

Type:

  Non-Extensible

Order:

  Significant

Table TID 4021. Mammography CAD Geometry

| 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

This template is invoked when a content item, which may be the "root" of a sub-tree, is paraphrased from a prior SR document.

Type:

  Non-Extensible

Order:

  Significant

Table TID 4022. CAD Observation Context

| 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.

Type:

  Non-Extensible

Order:

  Significant

Table TID 4023. CAD Operating Points

| 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.

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