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This document describes changes applied to the Annotation and Image Markup (AIM) model between version 3.0, revision 11 , and version 4.0, revision 47. The latter is also called the AIM Foundation model. You can download the AIM Foundation model. 

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Introduction

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You can download the AIM 3.0 model.

The most significant changes from version 3.0 to 4.0 of , revision 11 to the AIM Foundation model is the use of ISO 21090 data types, a caBIG® mandate, and the introduction of AIM Statements. An AIM Statement describes a relationship of a finding found on an image or series of images. It represents a relationship between the subject and object entities in the AIM foundation model.

You can download the AIM 3.0 model and the AIM Foundation model.

Why Use AIM Statements?

The AIM 3.0 model reflects relationships between classes using containment of a source class by a target class, and inheritance such as IS-A relationships. The expressive power of the model is limited by these two types of relationships. No other types of relationships in the AIM 3.0 model are possible and not all necessary relationships are present. For instance, there is no direct relationship between instances of the AnatomicEntity class, e.g. right-upper lobe of lung, and the ImagingObservation class, e.g. mass. Such classes can be indirectly linked to each other only via the Annotation class.

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  • Annotation was renamed as AnnotationEntity.
  • AnnatomicEntity was renamed as ImagingPhysicalEntity.
  • ImagingObservation was renamed as ImagingObservationEntity.
  • Inference was renamed as InferenceEntity.
  • AnnotationRole was renamed as AnnotationRoleEntity.
  • GeometricShape was renamed as GeometricShapeEntity.
  • TextAnnotation was renamed as TextAnnotationEntity.
  • ImageReference was renamed as ImageReferenceEntity.
  • DICOMImageReference DicomImageReference was renamed as DICOMImageReferenceEntity DicomImageReferenceEntity.
  • WebImageReference was renamed as UriImageReferenceEntity.
  • Calculation was renamed to CalculationEntity.

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A Statement class represents relationships via the use of the predicates listed above, inserted between subject and object. Subject and object associations can link to ImagingPhysicalEntity, ImagingObservationEntity, InferenceEntity, ReferencedAnnotationEntity, GeometricShapeEntity, TextAnnotationEntity, UriImageReferenceEntity, SegmentationEntity, DICOMImageReferenceEntity DicomImageReferenceEntity, ImageAnnotation, or AnnotationOfAnnotation. Not all combinations between these classes are valid AIM statements. See the AnnotationStatement, AnnotationOfAnnotationStatement, and ImageAnnotationStatement sections in the AIM 4.0 UML diagram for all valid AIM statements.

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This class contains identifying and descriptive attributes of the reading session and the reading subtask that result in clinical environment or trial results. The class consists of the overall task and the specific subtask. A task represents a unit of overall work, e.g. "Read all of the available time points for the subjects". It may have one or more subtasks. It can be used to capture planned (scheduled) and to record performed tasks.

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ThreeDimensionGeometricShapeEntity

This abstract class represents three-dimensional coordinates of a graphical drawing that can be placed on an image to identify a region of interest (ROI).

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TwoDimensionGeometricShapeEntity

This abstract class represents two-dimensional coordinates of a graphical drawing that can be placed on an image to identify a region of interest (ROI).

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  1. Create an image annotation instance.
  2. Create a DICOM image reference instance and its associated image study, image series and image instances.
  3. Create an imaging physical entity containing left upper lobe, RID1327, RadLex.
  4. Create an imaging observation containing mass, RID3874, RadLex.
  5. Create ImagingPhysicalEntityHasImagingObservationEntityStatement to link imaging physical entity (subject) with imaging observation (object).

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AnnotationEntityHasPerformedTaskContextEntityStatement

The class is used to record an activity or a performed task used to create an AIM instance. The AIM instance may contain zero or more performed tasks. Either the ImageAnnotation or AnnotationOfAnnotation class can be a subject of this statement.

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  1. Create ImageAnnotation.
  2. Create GeometricShapeEntity and record user makeup.
  3. Create TaskContextEntity and fill in the required information; e.g., task name and subtask. The task information must be related to markup activity.
  4. Create AnnotationEntityHasPerformedTaskContextStatement AnnotationEntityHasPerformedTaskContextEntityStatement to link ImageAnnotation (subject) with TaskContextEntity (object).

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AnnotationEntityHasPlannedTaskContextEntityStatement

The class is used to record a planned activity or task. The task is used to inform users or computer programs of what activity needs to be performed in order to create an AIM instance. The instance may be created from one or more planned tasks. Either the ImageAnnotation or AnnotationOfAnnotation class can be a subject of this statement.

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  1. Create ImageAnnotation.
  2. Create TaskContextEntityand fill in the required information; e.g., task name and subtask. Both subtasks below have the same task information; e.g., search for a lesion in an organ.
    1. Identify an imaging observation found on an image.
    2. Identify an anatomic entity location associated with the imaging observation.
  3. Create AnnotationEntityHasPerformedTaskContextStatement AnnotationEntityHasPerformedTaskContextEntityStatement to link ImageAnnotation (subject) with TaskContextEntity (object).

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Classes derived from ImageAnnotationStatement

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DicomImageReferenceEntityHasCalculationEntityStatement

A DICOM image can have a calculation associated with the image.

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  1. Create an image annotation instance.
  2. Create DICOMImageReferenceEntity DicomImageReferenceEntity containing an image with a mass.
  3. Create ImageAnnotationHasDICOMImageReferenceEntityStatement ImageAnnotationHasDicomImageReferenceEntityStatement to link the image annotation (subject) to the DICOM image reference entity (object).
  4. The user creates the ROI of the mass.
  5. Compute area of the mass.
  6. Create CalculationEntity and store the ROI result.
  7. Create DICOMImageReferenceEntityHasCalculationEntityStatement DicomImageReferenceEntityHasCalculationEntityStatement to link the DICOM image (subject) with the calculation entity (object).

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DicomImageReferenceEntityHasImagingObservationEntityStatement

A DICOM image, captured in DICOMImageReferenceEntity DicomImageReferenceEntity, can be associated with an imaging observation, captured in ImagingObservationEntity, to describe an observation on the image.

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  1. Create an image annotation instance.
  2. Create DICOMImageReferenceEntity DicomImageReferenceEntity containing an image with a mass.
  3. Create an ImageAnnotationHasDICOMImageReferenceEntityStatement ImageAnnotationHasDicomImageReferenceEntityStatement to link the image annotation (subject) to the DICOM image reference entity (object).
  4. The user creates ROI of the mass.
  5. The user provides an imaging observation with the values of mass, RID3874, RadLex.
  6. Create ImagingObservationEntity and store the value above.
  7. Create DICOMImageReferenceEntityHasImagingObservationEntityStatement DicomImageReferenceEntityHasImagingObservationEntityStatement to link the DICOM image (subject) with the imaging observation entity (object).

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DicomImageReferenceEntityHasImagingPhysicalEntity

A DICOM image, captured in DICOMImageReferenceEntity DicomImageReferenceEntity, can associate with an image physical entity, captured in ImagingPhysicalEntity, to describe an observation on the image.

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  1. Create an image annotation instance.
  2. Create DICOMImageReferenceEntity DicomImageReferenceEntity containing an image with a mass.
  3. Create ImageAnnotationHasDICOMImageReferenceEntityStatement ImageAnnotationHasDicomImageReferenceEntityStatement to link the image annotation (subject) to the DICOM image reference entity (object).    
  4. The user creates the ROI of the mass.
  5. The user provides an imaging physical entity with the values of left upper lobe, RID1327, RadLex.
  6. Create ImagingPhysicalEntity and store the value above.
  7. Create DICOMImageReferenceEntityHasImagingPhysicalEntity DicomImageReferenceEntityHasImagingPhysicalEntity to link DICOM image (subject) with the imaging physical entity (object).

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DicomSegmentationEntityHasImagingObservationEntityStatement

A DICOM segmentation object can have an imaging observation to further describe the segmentation object.

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  1. Create an image annotation instance.
  2. Create DICOMImageReferenceEntity DicomImageReferenceEntity containing images with a mass.
  3. Create ImageAnnotationHasDICOMImageReferenceEntityStatement ImageAnnotationHasDicomImageReferenceEntityStatement to link the image annotation (subject) to the DICOM image reference entity (object).    
  4. The user designates the ROI of the mass.
  5. The system creates a DICOM segmentation object.
  6. Create DICOMSegmentationEntity DicomSegmentationEntity with the required information from step 5.
  7. The user provides an imaging observation with values of mass, RID3874, RadLex.
  8. Create ImagingObservationEntity and store the value above.
  9. Create DICOMSegmentationEntityHasImagingObservationEntityStatement DicomSegmentationEntityHasImagingObservationEntityStatement to link DICOM segmentation entity (subject) with the imaging observation entity (object).

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A user wants to link a mammography image with a corresponding magnification image.

Assumption:

  • There is a DICOMImageReferenceEntity DicomImageReferenceEntity containing the original image.

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  1. Create an image annotation instance.
  2. User views a left mediolateral oblique (MLO)
  3. User creates a magnification view of the ROI and save it as a DICOM secondary captured image.
  4. Create DICOMImageReferenceEntity DicomImageReferenceEntity containing the secondary captured image.
  5. Create ImageAnnotationHasChildImageAnnotationStatement to link the image annotation (subject) to an instance of DICOMImageReferenceEntity DicomImageReferenceEntity containing secondary captured image (object).

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ImageAnnotationHasDicomImageReferenceEntityStatement

An instance of image annotation can have DICOM images of the same series.

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  1. Create an image annotation instance.
  2. Create a DICOM image reference instance and its associated image study, image series, and image instances using DICOMImageReferenceEntity DicomImageReferenceEntity.
  3. Create ImageAnnotationHasDICOMImageReferenceEntityStatement ImageAnnotationHasDicomImageReferenceEntityStatement to link image annotation (subject) and DICOM image reference (object).

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ImageAnnotationHasDicomSegmentationEntityStatement

An image annotation can have one or more DICOM segmentation objects. An ImageAnnotationHasDICOMSegmentationEntityStatement ImageAnnotationHasDicomSegmentationEntityStatement statement represents a direct relationship between an image annotation and a DICOM segmentation entity. If the image annotation has three DICOM segmentation entities, there needs to be three ImageAnnotationHasDICOMSegmentationEntityStatements ImageAnnotationHasDicomSegmentationEntityStatements.

A use case:

A user found two nodules in a CT axial series. The user used a workstation to create two DICOM segmentation objects. The user annotated and stored the findings in AIM format with segmentation information.

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  1. Create an image annotation instance.
  2. Create a DICOM image reference instance and its associated image study, image series, and image instances.
  3. An image annotation has the set of CT images in the series. We need to create a statement that associates image annotation with DICOM images.

** Use ImageAnnotationHasDICOMImageReferenceEntityStatement ImageAnnotationHasDicomImageReferenceEntityStatement 

** The statement has the image annotation instance as subject and DICOM image reference instance as object.

  1. Create two DICOM segmentation entity instances. Each instance references DICOM segmentation object from step 2.
  2. Create two statements of type ImageAnnotationHasDICOMSegmentationEntityStatement ImageAnnotationHasDicomSegmentationEntityStatement. Each statement has the same image annotation (subject) but different DICOM segmentation entity (object).

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  1. Create an image annotation instance.
  2. Create a DICOM image reference instance and its associated image study, image series, and image instances using DICOMImageReferenceEntity DicomImageReferenceEntity.
  3. Create a text markup on a mass.
  4. Create TextAnnotationEntity to store information in step 3.
  5. Create ImageAnnotationHasTextAnnotationEntityStatement to link the image annotation (subject) with the text annotation entity (object).

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  1. Create an image annotation instance.
  2. Create a DICOM image reference instance and its associated image study, image series, and image instances using DICOMImageReferenceEntity DicomImageReferenceEntity.
  3. Create a three-dimensional polyline markup on a mass.
  4. Create ThreeDimensionPolyline to store information in step 3.
  5. Create ImageAnnotationHasThreeDimensionGeometricShapeEntityStatement to link the image annotation (subject) with the ThreeDimensionPolyline entity (object).

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  1. Create an image annotation instance.
  2. Create a DICOM image reference instance and its associated image study, image series, and image instances using DICOMImageReferenceEntity DicomImageReferenceEntity.
  3. Create a two-dimension polyline markup on a mass.
  4. Create TwoDimensionPolyline to store information in step 3.
  5. Create ImageAnnotationHasTwoDimensionGeometricShapeEntityStatement to link the image annotation (subject) with the TwoDimensionPolyline entity (object).

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  1. Create an imaging observation entity instance.
  2. Create a DICOM image reference instance and its associated image study, image series and image instances using DICOMImageReferenceEntity DicomImageReferenceEntity.
  3. Create a three-dimensional polyline markup on a mass.
  4. Create ThreeDimensionPolyline to store information in step 3.
  5. Create ImagingObservationEntityIsIdentifiedByThreeDimensionGeometricShapeEntityStatement to link the imaging observation entity (subject) with the ThreeDimensionPolyline entity (object).

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  1. Create an imaging observation entity instance.
  2. Create a DICOM image reference instance and its associated image study, image series, and image instances using DICOMImageReferenceEntity DicomImageReferenceEntity.
  3. Create a two-dimensional polyline markup on a mass.
  4. Create TwoDimensionPolyline to store information in step 3.
  5. Create ImagObservationIsIdentifiedByTwoDimensionGeometricShapeEntityStatement to link the imaging observation entity (subject) with the TwoDimensionPolyline entity (object).

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  1. Create an imaging physical entity instance.
  2. Create a DICOM image reference instance and its associated image study, image series, and image instances using DICOMImageReferenceEntity DicomImageReferenceEntity.
  3. Create an imaging physical entity containing left upper lobe, RID1327, RadLex.
  4. Create a three-dimensional polyline markup on a mass.
  5. Create ThreeDimensionPolyline to store information in step 3.
  6. Create ImagingPhysicalEntityHasThreeDimensionGeometricShapeEntityStatement to link the imaging physical entity (subject) with the ThreeDimensionPolyline entity (object).

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  1. Create an imaging physical entity instance.
  2. Create a DICOM image reference instance and its associated image study, image series, and image instances using DICOMImageReferenceEntity DicomImageReferenceEntity.
  3. Create an imaging physical entity containing left upper lobe, RID1327, RadLex.
  4. Create a two-dimensional polyline markup on a mass.
  5. Create a TwoDimensionPolyline to store information in step 3.
  6. Create ImagingPhysicalEntityHasTwoDimensionGeometricShapeEntityStatement to link the imaging observation entity (subject) with the TwoDimensionPolyline entity (object).

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  1. Create an image annotation instance.
  2. Create a DICOM image reference instance and its associated image study, image series, and image instances using DICOMImageReferenceEntity DicomImageReferenceEntity.
  3. Create an imaging physical entity containing left upper lobe, RID1327, RadLex.
  4. Create a text markup on a mass.
  5. Create TextAnnotationEntity to store information from step 4.
  6. Create ImagingPhysicalEntityHasTextAnnotationEntityStatement to link the imaging physical entity (subject) with the text annotation entity (object).

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UriImageReferenceEntity is a source image for the annotation. It can be accessed via Intranet, Internet, local computer and/or file sharing systems.

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DicomImageReference was renamed

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DicomImageReferenceEntity

DICOMImageReferenceEntity DicomImageReferenceEntity is a source image for the annotation.

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GeometricShapeEntity is the shape of a region of interest (ROI).

Segmentation was renamed

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DicomSegmentation

DICOMSegmentation DicomSegmentation is a multi-frame image representing a classification of pixels in one or more referenced images. Segmentations are either binary or fractional. See DICOM part 3 Segmentation IOD for more information.

PresentationState was renamed

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ReferencedDicomObject

ReferencedDICOMObject ReferencedDicomObject is a collection of related DICOM objects created from the image(s), e.g. presentation state, SR document, radiotherapy objects, waveform, encapsulated document, etc. 

The old association between PresentationState and DICOMImageReferenceEntity DicomImageReferenceEntity was removed. It was replaced by an association between ReferencedDICOMObject ReferencedDicomObject and ImageStudy.

Deleted Classes

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