F.3 Chest CAD SR Examples
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## F.3 Chest CAD SR Examples

The following is a simple and non-comprehensive illustration of an encoding of the Chest CAD SR IOD for chest 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.

### F.3.1 Example 1: Lung Nodule Detection With No Findings

A chest CAD device processes a typical screening chest case, i.e., there is one image and no nodule findings. Chest CAD runs lung nodule detection successfully and finds nothing.

The chest radiograph resembles:

Figure F.3-1. Chest Radiograph as Described in Example 1

The content tree structure would resemble:

Node | Code Meaning of Concept Name | Code Meaning or Example Value | TID
--- | --- | --- | ---
1 | Chest CAD Report |  | TID 4100
1.1 | Image Library |  | TID 4100
1.1.1 |  | IMAGE 1 | TID 4020
1.1.1.1 | Image View | Postero-anterior | TID 4020
1.1.1.2 | Study Date | 19980101 | TID 4020
1.2 | CAD Processing and Findings Summary | All algorithms succeeded; without findings | TID 4101
1.3 | Summary of Detections | Succeeded | TID 4100
1.3.1 | Successful Detections |  | TID 4015
1.3.1.1 | Detection Performed | Nodule | TID 4017
1.3.1.1.1 | Algorithm Name | "Lung Nodule Detector" | TID 4019
1.3.1.1.2 | Algorithm Version | "V1.3" | TID 4019
1.3.1.1.3 |  | Reference to node 1.1.1 | TID 4017
1.4 | Summary of Analyses | Not Attempted | TID 4100

### F.3.2 Example 2: Lung Nodule Detection With Findings and Anatomy/pathology Interpretation

A chest CAD device processes a screening chest case with one image, and a lung nodule detected. The chest radiograph resembles:

Figure F.3-2. Chest Radiograph 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.

Figure F.3-3. Content Tree Root of Example 2 Content Tree

The content tree structure would resemble:

Node | Code Meaning of Concept Name | Code Meaning or Example Value | TID
--- | --- | --- | ---
1 | Chest CAD Report |  | TID 4100
1.1 | Image Library |  | TID 4100
1.2 | CAD Processing and Findings Summary | All algorithms succeeded; with findings | TID 4101
1.3 | Summary of Detections | Succeeded | TID 4100
1.4 | Summary of Analyses | Not Attempted | TID 4100

Figure F.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 |  | TID 4100
1.1.1 |  | IMAGE 1 | TID 4020
1.1.1.1 | Image View | Postero-anterior | TID 4020
1.1.1.2 | Study Date | 19990101 | TID 4020

Figure F.3-5. CAD Processing and Findings Summary Portion 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 | TID 4101
1.2.1 | Single Image Finding | Abnormal Opacity | TID 4104
1.2.1.1 | Single Image Finding Modifier | Nodule | TID 4104
1.2.1.2 | Rendering Intent | Presentation Required:… | TID 4104
1.2.1.3 | Algorithm Name | "Lung Nodule Detector" | TID 4019
1.2.1.4 | Algorithm Version | "V1.3" | TID 4019
1.2.1.5 | Center | POINT | TID 4107
1.2.1.5.1 |  | Reference to Node 1.1.1 | TID 4107
1.2.1.6 | Outline | POLYLINE | TID 4107
1.2.1.6.1 |  | Reference to Node 1.1.1 | TID 4107
1.2.1.7 | Diameter | 2 cm | TID 1400
1.2.1.7.1 | Path | POLYLINE | TID 1400
1.2.1.7.1.1 |  | Reference to Node 1.1.1 | TID 1400

Figure F.3-6. Summary of Detections Portion of Example 2 Content Tree

Node | Code Meaning of Concept Name | Code Meaning or Example Value | TID
--- | --- | --- | ---
1.3 | Summary of Detections | Succeeded | TID 4100
1.3.1 | Successful Detections |  | TID 4015
1.3.1.1 | Detection Performed | Nodule | TID 4017
1.3.1.1.1 | Algorithm Name | "Lung Nodule Detector" | TID 4019
1.3.1.1.2 | Algorithm Version | "V1.3" | TID 4019
1.3.1.1.3 |  | Reference to node 1.1.1 | TID 4017

### F.3.3 Example 3: Lung Nodule Detection, Temporal Differencing With Findings

The patient in Example 2 returns for another chest radiograph. A more comprehensive chest CAD device processes the current chest radiograph, and analyses are performed that determine some temporally related content items for Composite Features. Portions of the prior chest CAD report (Example 2) are incorporated into this report. In the current chest radiograph the lung nodule has increased in size.

Figure F.3-8. Chest radiographs 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 Chest CAD SR instance (Example 2).

Node | Code Meaning of Concept Name | Code Meaning or Example Value | TID
--- | --- | --- | ---
1 | Chest CAD Report |  | TID 4100

While the Image Library contains references to content tree items reused from the prior Chest CAD SR instance, the images are actually used in the chest 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 |  | TID 4100
1.1.1 |  | IMAGE 1 | TID 4020
1.1.1.1 | Image View | Postero-anterior | TID 4020
1.1.1.2 | Study Date | 20000101 | TID 4020
1.1.2 |  | IMAGE 2 | TID 4020
1.1.2.1 | Image View | Postero-anterior | TID 4020
1.1.2.2 | Study Date | 19990101 | TID 4020

The CAD processing and findings consist of one composite feature, comprised of single image findings, one from each year. The temporal relationship allows a quantitative temporal difference to be calculated:

Node | Code Meaning of Concept Name | Code Meaning or Example Value | TID
--- | --- | --- | ---
1.2 | CAD Processing and Findings Summary | All algorithms succeeded; with findings | TID 4101
1.2.1 | Composite Feature | Abnormal Opacity | TID 4102
1.2.1.1 | Composite Feature Modifier | Nodule | TID 4102
1.2.1.2 | Rendering Intent | Presentation Required: … | TID 4102
1.2.1.3 | Algorithm Name | "Nodule Change" | TID 4019
1.2.1.4 | Algorithm Version | "V2.3" | TID 4019
1.2.1.5 | Composite Type | Target content items are related temporally | TID 4103
1.2.1.6 | Scope of Feature | Feature detected on multiple images | TID 4103
1.2.1.7 | Certainty of Feature | 85% | TID 4103
1.2.1.8 | Difference in size | 2 cm | TID 4103
1.2.1.8.1 |  | Reference to Node 1.2.1.9.8 | TID 4103
1.2.1.8.2 |  | Reference to Node 1.2.1.10.8 | TID 4103
1.2.1.9 | Single Image Finding | Abnormal Opacity | TID 4104
1.2.1.9.1 | Single Image Finding Modifier | Nodule | TID 4104
1.2.1.9.2 | Rendering Intent | Presentation Required: … | TID 4104
1.2.1.9.3 | Tracking Identifier | "Watchlist #1" | TID 4108
1.2.1.9.4 | Algorithm Name | "Lung Nodule Detector" | TID 4019
1.2.1.9.5 | Algorithm Version | "V1.3" | TID 4019
1.2.1.9.6 | Center | POINT | TID 4107
1.2.1.9.6.1 |  | Reference to Node 1.1.1 | TID 4107
1.2.1.9.7 | Outline | POLYLINE | TID 4107
1.2.1.9.7.1 |  | Reference to Node 1.1.1 | TID 4107
1.2.1.9.8 | Diameter | 4 cm | TID 1400
1.2.1.9.8.1 | Path | POLYLINE | TID 1400
1.2.1.9.8.1.1 |  | Reference to Node 1.1.1 | TID 1400
1.2.1.10 | Single Image Finding | Abnormal Opacity | TID 4104
1.2.1.10.1 | Single Image Finding Modifier | Nodule | TID 4104
1.2.1.10.2 | Rendering Intent | Presentation Required: … | TID 4104
1.2.1.10.3 | [Observation Context content items] |  | TID 4022
1.2.1.10.4 | Algorithm Name | "Lung Nodule Detector" | TID 4019
1.2.1.10.5 | Algorithm Version | "V1.3" | TID 4019
1.2.1.10.6 | Center | POINT | TID 4107
1.2.1.10.6.1 |  | Reference to Node 1.1.2 | TID 4107
1.2.1.10.7 | Outline | POLYLINE | TID 4107
1.2.1.10.7.1 |  | Reference to Node 1.1.2 | TID 4107
1.2.1.10.8 | Diameter | 2 cm | TID 1400
1.2.1.10.8.1 | Path | POLYLINE | TID 1400
1.2.1.10.8.1.1 |  | Reference to Node 1.1.2 | TID 1400
1.3 | Summary of Detections | Succeeded | TID 4100
1.3.1 | Successful Detections |  | TID 4015
1.3.1.1 | Detection Performed | Nodule | TID 4017
1.3.1.1.1 | Algorithm Name | "Lung Nodule Detector" | TID 4019
1.3.1.1.2 | Algorithm Version | "V1.3" | TID 4019
1.3.1.1.3 |  | Reference to node 1.1.1 | TID 4017
1.4 | Summary of Analyses | Succeeded | TID 4100
1.4.1 | Successful Analyses |  | TID 4016
1.4.1.1 | Analysis Performed | "Temporal correlation" | TID 4018
1.4.1.1.1 | Algorithm Name | "Nodule Change" | TID 4019
1.4.1.1.2 | Algorithm Version | "V2.3" | TID 4019
1.4.1.1.3 |  | Reference to node 1.1.1 | TID 4018
1.4.1.1.4 |  | Reference to node 1.1.2 | TID 4018

### F.3.4 Example 4: Lung Nodule Detection in Chest Radiograph, Spatially Correlated With CT

The patient in Example 3 is called back for CT to confirm the Lung Nodule found in Example 3. The patient undergoes CT of the Thorax and the initial chest radiograph and CT slices are sent to a more comprehensive CAD device for processing. Findings are detected and analyses are performed that correlate findings from the two data sets. Portions of the prior CAD report (Example 3) are incorporated into this report.

Figure F.3-9. Chest Radiograph and CT slice as described in Example 4

Italicized entries (xxx) in the following table denote references to or by-value inclusion of content tree items reused from the prior Chest CAD SR instance (Example 3).

Node | Code Meaning of Concept Name | Code Meaning of Example Value | TID
--- | --- | --- | ---
1 | Chest CAD Report |  | TID 4100
1.1 | Language of Content Item and Descendants | English | TID 1204
1.2 | Image Library |  | TID 4100
1.3 | CAD Processing and Findings Summary | All algorithms succeeded; with findings | TID 4101
1.4 | Summary of Detections | Succeeded | TID 4100
1.5 | Summary of Analyses | Succeeded | TID 4100

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

Node | Code Meaning of Concept Name | Code Meaning of Example Value | TID
--- | --- | --- | ---
1.2 | Image Library |  | TID 4100
1.2.1 |  | IMAGE 1 | TID 4020
1.2.1.1 | Image View | Postero-anterior | TID 4020
1.2.1.2 | Study Date | 20000101 | TID 4020

Most recent examination content:

Node | Code Meaning of Concept Name | Code Meaning of Example Value | TID
--- | --- | --- | ---
1.3 | CAD Processing and Findings Summary | All algorithms succeeded; with findings | TID 4101
1.3.1 | Composite Feature | Abnormal opacity | TID 4102

Node | Code Meaning of Concept Name | Code Meaning of Example Value | TID
--- | --- | --- | ---
1.3.1 | Composite Feature | Abnormal opacity | TID 4102
1.3.1.1 | Composite Feature Modifier | Nodule | TID 4102
1.3.1.2 | Rendering Intent | Presentation Required: … | TID 4102
1.3.1.3 | Tracking Identifier | "Watchlist #1" | TID 4108
1.3.1.4 | Algorithm Name | "Chest/CT Correlator" | TID 4019
1.3.1.5 | Algorithm Version | "V2.1" | TID 4019
1.3.1.6 | Composite type | Target content items are related spatially | TID 4103
1.3.1.7 | Scope of Feature | Feature detected on images from multiple modalities | TID 4103
1.3.1.8 | Diameter | 4 cm | TID 1400
1.3.1.8.1 | Path |  | TID 1400
1.3.1.8.1.1 |  | IMAGE 3 [CT slice 104] | TID 1400
1.3.1.9 | Volume estimated from single 2D region | 3.2 cm3 | TID 1402
1.3.1.9.1 | Perimeter Outline |  | TID 1402
1.3.1.9.1.1 |  | IMAGE 3 [CT slice 104] | TID 1402
1.3.1.10 | Size Descriptor | Small | TID 4105
1.3.1.11 | Border Shape | Lobulated | TID 4105
1.3.1.12 | Location in Chest | Mid lobe | TID 4105
1.3.1.13 | Laterality | Right | TID 4105
1.3.1.14 | Composite Feature | Abnormal opacity | TID 4102
1.3.1.15 | Single Image Finding | Abnormal opacity | TID 4104

Node | Code Meaning of Concept Name | Code Meaning of Example Value | TID
--- | --- | --- | ---
1.3.1.14 | Composite Feature | Abnormal opacity | TID 4102
1.3.1.14.1 | Composite Feature Modifier | Nodule | TID 4102
1.3.1.14.2 | Rendering Intent | Presentation Required: … | TID 4102
1.3.1.14.3 | Tracking Identifier | "Nodule #1" | TID 4108
1.3.1.14.4 | Algorithm Name | "Nodule Builder" | TID 4019
1.3.1.14.5 | Algorithm Version | "V1.4" | TID 4019
1.3.1.14.6 | Composite type | Target content items are related spatially | TID 4103
1.3.1.14.7 | Scope of Feature | Feature detected on multiple images | TID 4103
1.3.1.14.8 | Diameter | 4 cm | TID 1400
1.3.1.14.9 | Volume estimated from single 2D region | 3.2 cm3 | TID 1402
1.3.1.14.10 | Single Image Finding | Abnormal opacity | TID 4104
1.3.1.14.11 | Single Image Finding | Abnormal opacity | TID 4104
1.3.1.14.12 | Single Image Finding | Abnormal opacity | TID 4104

Node | Code Meaning of Concept Name | Code Meaning of Example Value | TID
--- | --- | --- | ---
1.3.1.14.10 | Single Image Finding | Abnormal opacity | TID 4104
1.3.1.14.10.1 | Single Image Finding Modifier | Nodule | TID 4104
1.3.1.14.10.2 | Rendering Intent | Presentation Required: … | TID 4104
1.3.1.14.10.3 | Tracking Identifier | "Detection #1" | TID 4108
1.3.1.14.10.4 | Algorithm Name | "CT Nodule Detector" | TID 4019
1.3.1.14.10.5 | Algorithm Version | "V2.5" | TID 4019
1.3.1.14.10.6 | Center | POINT | TID 4107
1.3.1.14.10.6.1 |  | IMAGE 2 [CT slice 103] | TID 4107
1.3.1.14.10.7 | Outline | POLYLINE | TID 4107
1.3.1.14.10.7.1 |  | IMAGE 2 [CT slice 103] | TID 4107

Node | Code Meaning of Concept Name | Code Meaning of Example Value | TID
--- | --- | --- | ---
1.3.1.14.11 | Single Image Finding | Abnormal opacity | TID 4104
1.3.1.14.11.1 | Single Image Finding Modifier | Nodule | TID 4104
1.3.1.14.11.2 | Rendering Intent | Presentation Required: … | TID 4104
1.3.1.14.11.3 | Tracking Identifier | "Detection #2" | TID 4108
1.3.1.14.11.4 | Algorithm Name | "CT Nodule Detector" | TID 4019
1.3.1.14.11.5 | Algorithm Version | "V2.5" | TID 4019
1.3.1.14.11.6 | Center | POINT | TID 4107
1.3.1.14.11.6.1 |  | IMAGE 3 [CT slice 104] | TID 4107
1.3.1.14.11.7 | Outline | POLYLINE | TID 4107
1.3.1.14.11.7.1 |  | IMAGE 3 [CT slice 104] | TID 4107

Node | Code Meaning of Concept Name | Code Meaning of Example Value | TID
--- | --- | --- | ---
1.3.1.14.12 | Single Image Finding | Abnormal opacity | TID 4104
1.3.1.14.12.1 | Single Image Finding Modifier | Nodule | TID 4104
1.3.1.14.12.2 | Rendering Intent | Presentation Required: … | TID 4104
1.3.1.14.12.3 | Tracking Identifier | "Detection #3" | TID 4108
1.3.1.14.12.4 | Algorithm Name | "CT Nodule Detector" | TID 4019
1.3.1.14.12.5 | Algorithm Version | "V2.5" | TID 4019
1.3.1.14.12.6 | Center | POINT | TID 4107
1.3.1.14.12.6.1 |  | IMAGE 4 [CT slice 105] | TID 4107
1.3.1.14.12.7 | Outline | POLYLINE | TID 4107
1.3.1.14.12.7.1 |  | IMAGE 4 [CT slice 105] | TID 4107

Node | Code Meaning of Concept Name | Code Meaning of Example Value | TID
--- | --- | --- | ---
1.3.1.15 | Single Image Finding | Abnormal opacity | TID 4104
1.3.1.15.1 | Single Image Finding Modifier | Nodule | TID 4104
1.3.1.15.2 | Rendering Intent | Presentation Required: … | TID 4104
1.3.1.15.3 | Tracking Identifier | "Watchlist #1" | TID 4108
1.3.1.15.4 | [Observation Context content items] |  | TID 4022
1.3.1.15.5 | Algorithm Name | "Lung Nodule Detector" | TID 4019
1.3.1.15.6 | Algorithm Version | "V1.3" | TID 4019
1.3.1.15.7 | Center | POINT | TID 4107
1.3.1.15.7.1 |  | Reference to node 1.2.1 | TID 4107
1.3.1.15.8 | Outline | POLYLINE | TID 4107
1.3.1.15.8.1 |  | Reference to node 1.2.1 | TID 4107
1.3.1.15.9 | Diameter | 4 cm | TID 1400
1.3.1.15.9.1 | Path | POLYLINE | TID 1400
1.3.1.15.9.1.1 |  | Reference to Node 1.2.1 | TID 1400

Node | Code Meaning of Concept Name | Code Meaning of Example Value | TID
--- | --- | --- | ---
1.4 | Summary of Detections | Succeeded | TID 4100
1.4.1 | Successful Detections |  | TID 4015
1.4.1.1 | Detection Performed | Nodule | TID 4017
1.4.1.1.1 | Algorithm Name | "CT Nodule Detector" | TID 4019
1.4.1.1.2 | Algorithm Version | "V2.5" | TID 4019
1.4.1.1.3 |  | IMAGE 2 [CT slice 103] | TID 4017
1.4.1.1.4 |  | IMAGE 3 [CT slice 104] | TID 4017
1.4.1.1.5 |  | IMAGE 4 [CT slice 105] | TID 4017
1.5 | Summary of Analyses | Succeeded | TID 4100
1.5.1 | Successful Analyses |  | TID 4016
1.5.1.1 | Analysis Performed | "Spatial colocation analysis" | TID 4018
1.5.1.1.1 | Algorithm Name | "Chest/CT Correlator" | TID 4019
1.5.1.1.2 | Algorithm Version | "V2.1" | TID 4019
1.5.1.1.3 |  | Reference to node 1.2.1 | TID 4018
1.5.1.1.4 |  | IMAGE 2 [CT slice 103] | TID 4018
1.5.1.1.5 |  | IMAGE 3 [CT slice 104] | TID 4018
1.5.1.1.6 |  | IMAGE 4 [CT slice 105] | TID 4018
1.5.1.2 | Analysis Performed | "Spatial colocation analysis" | TID 4018
1.5.1.2.1 | Algorithm Name | "Nodule Builder" | TID 4019
1.5.1.2.2 | Algorithm Version | "V1.4" | TID 4019
1.5.1.2.3 |  | IMAGE 2 [CT slice 103] | TID 4018
1.5.1.2.4 |  | IMAGE 3 [CT slice 104] | TID 4018
1.5.1.2.5 |  | IMAGE 4 [CT slice 105] | TID 4018

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