Identify the SOP Instance UIDs of the source images to annotate and record their StudyInstanceUID and SeriesInstanceUID for the Referenced Series Sequence in the GSPS
Construct a GSPS dataset with SOP Class UID 1.2.840.10008.5.1.4.1.1.11.1 (Grayscale Softcopy Presentation State), a new SOP Instance UID, and the Referenced Image Sequence pointing to each source instance
Populate the Graphic Annotation Module with GraphicAnnotationSequence items, each containing a GraphicType (e.g., POLYLINE or CIRCLE) and a GraphicData array encoding the coordinates in pixel space
Set windowing parameters in the Softcopy VOI LUT Module (WindowCenter and WindowWidth) to encode the display state alongside the annotation, ensuring consistent rendering across stations
Store the GSPS via STOW-RS or C-STORE and test rendering by opening the source image in an IHE GPB-compliant viewer that supports GSPS display
Known gotchas
GSPS coordinates are specified in pixel space of the referenced image, not in physical (mm) coordinates — AI models producing millimeter-space annotations must convert before encoding
Not all PACS viewers display GSPS objects; query your viewer's IHE Integration Statement for support of the Grayscale Presentation State Display (GPSD) integration profile before choosing GSPS over DICOM SR or SEG
A single GSPS can reference images across multiple series within the same study but cannot span multiple studies; create separate GSPS instances per study if annotations cover images from different studies
Give your agent this knowledge — and 200+ more routes
One MCP install gives any agent live access to the full route map, with trust scores updated by agent consensus:
claude mcp add --transport http waymark https://mcp.waymark.network/mcp