What Is a DICOM Structured Report (SR)?

A report software can read, not only display

A DICOM Structured Report (SR) stores the content of a report as a tree of coded items instead of a block of prose. Each item pairs a concept with a value — a measurement and its unit, a finding and its code, a piece of text, a reference to an image — and declares how it relates to the item above it: contains, has properties, inferred from. The nesting therefore carries meaning of its own, expressing which observation belongs to which finding and what each one was derived from.

What makes the content usable by software is that the concepts and most of the values are coded rather than written out. They are drawn from controlled vocabularies — DICOM’s own, SNOMED CT for anatomy and findings, UCUM for units — and standard templates, each identified by a TID, fix which items a given kind of report is expected to contain. A measurement recorded that way can be extracted, compared across examinations and fed into a database without anyone parsing sentences.

Two kinds of item make an SR useful in a viewer. Image references tie an observation to the exact image it was made on, and spatial coordinates — SCOORD within the plane of an image, SCOORD3D in the frame of reference — tie it to a position, so a viewer can take you to the measurement rather than just telling you it exists.

SR comes in several flavors, from the deliberately limited Basic Text SR to Comprehensive 3D SR, which differ in the value types and references they are allowed to use, alongside specialized ones for CAD findings and radiation dose. Every SR also records how far it got: a completion flag (partial or complete) and a verification flag, which says whether a responsible observer has signed off on the content — worth a glance before a finding is acted upon.

SR is what carries the measurements produced by CAD and AI tools, ultrasound machines and dose monitoring systems. What a reader sees is a structured document, not a rendered page: the layout is the viewer’s decision, not the file’s, so two viewers may legitimately present the same SR differently, or surface less of it, depending on the templates they recognize. A report encapsulated as a PDF is not an SR — it displays, but nothing inside it can be read by software.

In Weasis, see DICOM SR viewer.