Материал: part03

C.17.3.2.3 Continuity of Content​

See Section C.18.8.1.1.​

C.17.3.2.4 Content Sequence and Relationship Type​

ContentSequence(0040,A730)providesthehierarchicalstructuringoftheContentTree(seeSectionC.17.3.1)byrecursivelynesting​ Content Items. A parent (or source) Content Item has an explicit relationship to each child (or target) Content Item, conveyed by Re-​ lationship Type (0040,A010).​

Table C.17.3-8 describes the Relationship Types between Source Content Items and the Target Content Items.​

Table C.17.3-8. Relationship Type Definitions​

E.g., CONTAINER "Report" {HAS OBS CONTEXT: PNAME "Recording Observer"​ = "Smith^John^^Dr^"}​

HAS CONCEPT MOD​Has Concept Modifier​Used to qualify or describe the Concept Name of the Source Content Item, such as​ tocreateapost-coordinateddescriptionofaconcept,ortofurtherdescribeaconcept.​

E.g., SCOORD "POLYLINE1,1 5,10 5,10 1,10 1,1" {SELECTED FROM: IMAGE}.​

E.g., TCOORD "SEGMENT 60-200mS" {SELECTED FROM: WAVEFORM}.​

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C.17.3.2.5 Referenced Content Item Identifier​

ContentItemsareidentifiedbytheirpositionintheContentItemtree.TheyhaveanimplicitorderasdefinedbytheorderoftheSequence​ Items. When a Content Item is the target of a by-reference relationship, its position is specified in the Referenced Content Item​ Identifier (0040,DB73) in a Content Sequence Item subsidiary to the source Content Item.​

Note​

Figure C.17.3-3 illustrates an SR content tree and identifiers associated with each Content Item:​

Root

Content Item ID: 01

Seq(___,___)

Figure C.17.3-3. Use of Position as SR Content Item Identifier (Informative)​

C.17.4 SR Content Tree Example (Informative)​

Figure C.17.4-1 depicts the content of an example diagnostic interpretation.​

Note​

1.​For nodes of type CONTAINER, the contents of the Concept Name Code Sequence are shown in quotes and italicized.​

2.​For nodes of Value Type CODE, PNAME, NUM the contents are shown as "Concept Name Code Sequence = Value".​

3.​For the nodes of Value Type IMAGE and SCOORD, the contents of the Concept Name Code Sequence indicating the​ purpose of reference are shown in quotes and italicized.​

4.​The root node containing the Document Type is illustrated using a post-coordinated node of "Chest X-Ray", qualified​ using a HAS CONCEPT MOD relationship by a child with a CODE meaning "Views = PA and Lateral". An alternative​ would be to use a single pre-coordinated code in one node that applies to the entire concept of a "Two-view (PA and​ Lateral)ChestX-Ray".However,theuseofpre-coordinatedtermstodescribecomplexconceptsrapidlybecomesunwieldy​ and difficult to search on (in the sense that more specific pre-coordinated codes do not have a visible relationship with​ more general codes). If it were necessary to include a longer textual description of Document Type, then this could be​ achieved with a HAS CONCEPT MOD relationship with one or more TEXT nodes, perhaps in different languages.​

5.​The Document Type is only a title, and is not being used to convey the Procedure Context, although in this example it​ does appear to contain a description of some aspects of Procedure Context.​

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Document Root Node CONTAINER

"Chest X-ray" (Document Title)

By-Reference (BR)

Notes:

1.For nodes of type CONTAINER, the contents of the Concept Name Code Sequence are shown in quotes.

2.For nodes of Value Type CODE, PNAME, NUM the contents are shown as “Concept Name Code Sequence = Value”.

3.For the nodes of Value Type IMAGE and SCOORD, the contents of the Concept Name Code Sequence indicating the purpose of reference are shown in quotes.

Figure C.17.4-1. SR Content Tree for an Example Diagnostic Interpretation (Informative)​

C.17.5 Observation Context Encoding​

Observation Context describes who or what is performing the interpretation (observer context), whether the examination of evidence​ is direct or quoted (quotation mode), what procedure generated the evidence that is being interpreted (procedure context), and who​ or what is the subject of the evidence that is being interpreted (subject context).​

Initial Observation Context is defined outside the SR Document Content tree by other Modules in the SR IOD. The Patient Module​ specifies the default Subject Context, the General Study Module specifies the default Procedure Context, and the SR Document​ General Module specifies the default Observer Context. The default context has the meaning "this Structured Report was produced​ by the observer identified in the SR Document General Module, using direct observation, for the procedure identified in the General​ Study Module, and is about the patient identified in the Patient Module." Observation Context defined by Attributes in these Modules​ applies to all Content Items in the SR Document Content tree and need not be explicitly coded in the tree. The initial Observation​ Context from outside the tree can be explicitly replaced for the entire tree, or for any sub-tree.​

Observer Context is set from the Author Observer Sequence (0040,A078), if present, or secondarily from the Verifying Observer Se-​ quence (0040,A073). If neither is present, the Observer Context is undefined.​

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Note​

In the absence of Observer Context, it may be presumed that the observations were generated by or with the equipment​ identified in the General Equipment Module.​

The Procedure Context is set from the Study Instance UID (0020,000D), Study ID (0020,0010), Accession Number (0008,0050), and​ ProcedureCodeSequence(0008,1032)oftheGeneralStudyModule.TheReferencedRequestSequence(0040,A370)mightinclude​ an Item with the same Study Instance UID that further elaborates the Procedure Context, e.g., providing Placer Order Number​ (0040,2016)and/orFillerOrderNumber(0040,2017).IftheReferencedRequestSequenceincludesItemswithdifferentStudyInstance​ UIDs, those shall be treated as Procedure Context only if explicitly encoded in the Content Tree.​

Medical or clinical characteristics of the patient specified in the Patient Study Module, such as in Attributes Patient's Size (0010,1020)​ andPatient'sWeight(0010,1030),shallnotbeinheritedbytheContentTreeaspartofthedefaultPatientContext.Suchcharacteristics​ must be specifically encoded in the Content Tree to be part of the Structured Report.​

Note​

The Patient Study Module may be included in SR SOP Instances. As part of the Study IE shared by all SOP Instances​ within a Study, such inclusion should be consistent across all Instances. However, its purpose is to provide a minimum set​ ofclinicalcontextforthe(initial)interpretationoftheimagesorwaveformsoftheStudy.AnSRSOPInstancethatdocuments​ the interpretation must explicitly describe the relevant clinical context in the SR Content Tree.​

IfaContentItemintheSRDocumentContenttreehasObservationContextdifferentfromtheinitialcontextalreadyencodedelsewhere​ in the IOD, the context information applying to that Content Item shall be encoded as child nodes of the Content Item in the tree using​ the HAS OBS CONTEXT relationship. That is, Observation Context is a property of its parent Content Item.​

The context information specified in the Observation Context child nodes (i.e., target of the HAS OBS CONTEXT relationship) sets​ theObservationContext of their parent nodeContent Item.ObservationContextisencodedin thesamemannerasanyotherContent​ Item.​

TheObservationContextappliestoalltheby-valuedescendantnodesofthatparentnoderegardlessoftherelationshiptypebetween​ theparentandthedescendantnodes,untilandunlessthecontextofadescendantnodeisresetbyotherObservationContextContent​ Items. Observation Context shall not be inherited across by-reference relationships. The four dimensions of Observation Context​ (observer context, quotation mode, procedure context, and subject context) may be reset independently; e.g., resetting the subject​ context does not reset the observer or procedure context, or the quotation mode. See the example in Figure C.17.5-1.​

Note​

For example, the "subject context" may be defined by attaching an appropriate Content Item to the root node with a HAS​ OBS CONTEXT relationship. This "subject context" then applies not only to the root node, but to all its descendants, until​ such time as a Content Item explicitly replaces the "subject context" attribute, the new value of which is then inherited by all​ of that nodes descendants.​

Observation DateTime is not included as part of the HAS OBS CONTEXT relationship, and therefore is not inherited along with other​ Observation Context. The Observation DateTime Attribute is included in each Content Item, which allows different observation dates​ and times to be attached to different Content Items.​

The IOD may specify restrictions on Content Items and Relationship Types that also constrain the flexibility with which Observation​ Context may be described.​

The IOD may specify Templates that offer or restrict patterns and content in Observation Context.​

Note​

1.​Node 2 inherits any Observation Context of Node 1, which is then extended or replaced by the additional Observation​ Context defined in Nodes C1 and C2 (that is C1 and C2 are properties of 2).​

2.​Node 3 and its descendents inherit the Observation Context of Node 2, which includes C1 and C2.​

3.​Node 4 inherits the Observation Context of Node 2, which includes C1 and C2.​

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Patient Module

Patient Name

Patient ID

Patient Sex

Patient Date Of Birth

General Study Module

Study Instance UID

Accession Number

SR Document Series Module

Modality

SR Document General Module

Referenced Request Sequence

Requested Procedure ID

Requested Procedure Description

SR Document Content Module

Node 1

Contains

Node 2

Has Obs Ctx Has Obs Ctx Contains Has Properties

Notes:

1.Node 2 inherits any Observation Context of Node 1, which is then extended or replaced by the additional Observation Context defined in Nodes C1 and C2 (that is C1 and C2 are properties of 2).

2.Node 3 and its descendents inherit the Observation Context of Node 2, which includes C1 and C2.

3.Node 4 inherits the Observation Context of Node 2, which includes C1 and C2.

Figure C.17.5-1. Definition and Inheritance of Observation Context (Informative)​

C.17.6 Key Object Selection Modules​

C.17.6.1 Key Object Document Series Module​

Table C.17.6-1 defines the Attributes of the Key Object Document Series.​

Note​

Series of Key Object Selection Documents are separate from Series of Images or other Composite SOP Instances. Key​ Object Documents do not reside in a Series of Images or other Composite SOP Instances.​

Table C.17.6-1. Key Object Document Series Module Attributes​

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