diff --git a/IRaCIS.Core.Application/Service/Document/TrialEmailNoticeConfigService.cs b/IRaCIS.Core.Application/Service/Document/TrialEmailNoticeConfigService.cs
index 46bae4d87..69d9280d6 100644
--- a/IRaCIS.Core.Application/Service/Document/TrialEmailNoticeConfigService.cs
+++ b/IRaCIS.Core.Application/Service/Document/TrialEmailNoticeConfigService.cs
@@ -19,6 +19,7 @@ using IRaCIS.Core.Infra.EFCore.Common;
 using IRaCIS.Core.Infrastructure;
 using Microsoft.AspNetCore.Hosting;
 using Microsoft.AspNetCore.Mvc;
+using Microsoft.Extensions.Logging;
 using Microsoft.Extensions.Options;
 using Spire.Doc;
 using System.Linq.Dynamic.Core;
@@ -1283,9 +1284,24 @@ x.ReadingTableQuestionTrial.QuestionMark == QuestionMark.LesionNumber && x.Readi
                         break;
 
                     case CriterionType.PCWG3:
-                        var questionAnsewer = await _readingGlobalTaskInfoRepository.Where(t => t.TaskId == visitTaskId && t.TrialReadingQuestion.QuestionType == QuestionType.SiteVisitForTumorEvaluation).FirstNotNullAsync();
+                        var questionAnsewer = await _readingGlobalTaskInfoRepository.Where(t => t.TaskId == visitTaskId && t.TrialReadingQuestion.QuestionType == QuestionType.SiteVisitForTumorEvaluation).FirstOrDefaultAsync();
+                        if (questionAnsewer != null&& questionAnsewer.Answer.IsNotNullOrEmpty())
+                        {
+                            answer = questionAnsewer.Answer;
+                        }
+                        else
+                        {
+                            var visittaskList=await _visitTaskRepository.Where(t => t.Id == visitTaskId ).Select(x=>x.RelatedVisitTaskIdList).FirstOrDefaultAsync();
 
-                        answer = questionAnsewer.Answer;
+                            var task = await _visitTaskRepository.Where(x => visittaskList.Contains(x.Id) && x.ReadingCategory == ReadingCategory.Visit).OrderByDescending(x => x.VisitTaskNum).FirstOrDefaultAsync();
+                            if (task != null)
+                            {
+                                answer= await _readingTaskQuestionAnswerRepository.Where(t => t.VisitTaskId == task.Id && t.ReadingQuestionTrial.QuestionType == QuestionType.SiteVisitForTumorEvaluation)
+                                    .Select(t => t.Answer).FirstOrDefaultAsync();
+                            }
+                        }
+                         
+                    
 
                         break;
 
diff --git a/IRaCIS.Core.Application/Service/Reading/Dto/ReadingImageTaskViewModel.cs b/IRaCIS.Core.Application/Service/Reading/Dto/ReadingImageTaskViewModel.cs
index a462dbfd6..0af8e743f 100644
--- a/IRaCIS.Core.Application/Service/Reading/Dto/ReadingImageTaskViewModel.cs
+++ b/IRaCIS.Core.Application/Service/Reading/Dto/ReadingImageTaskViewModel.cs
@@ -1215,7 +1215,7 @@ namespace IRaCIS.Core.Application.Service.Reading.Dto
         /// <summary>
         /// 问题Id
         /// </summary>
-        public Guid QuestionId { get; set; }
+        public Guid? QuestionId { get; set; }
 
         /// <summary>
         /// InstanceId
diff --git a/IRaCIS.Core.Application/Service/Reading/ReadingImageTask/ReadingImageTaskService.cs b/IRaCIS.Core.Application/Service/Reading/ReadingImageTask/ReadingImageTaskService.cs
index 9549eae8d..ee14737c0 100644
--- a/IRaCIS.Core.Application/Service/Reading/ReadingImageTask/ReadingImageTaskService.cs
+++ b/IRaCIS.Core.Application/Service/Reading/ReadingImageTask/ReadingImageTaskService.cs
@@ -1898,6 +1898,24 @@ namespace IRaCIS.Core.Application.Service
         [HttpPost]
         public async Task<IResponseOutput> SaveTaskQuestion(ChangeDicomReadingQuestionAnswerInDto inDto, string param)
         {
+            // 当 param == -10 时，为自定义标准 需要区分  绑定  更改 标记 
+            if (param == "-10")
+            {
+                var questionMarkList = inDto.QuestionMarkInfoList.Select(x => x.QuestionId).ToList();
+                if (!(await _readingTaskQuestionMarkRepository.AnyAsync(x => x.VisitTaskId == inDto.VisitTaskId && questionMarkList.Contains(x.QuestionId))) && inDto.QuestionMarkInfoList.Count() > 0)
+                {
+                    _userInfo.AuditIdentification = "AddMark";
+                }
+                else if (await _readingTaskQuestionMarkRepository.AnyAsync(x => x.VisitTaskId == inDto.VisitTaskId && questionMarkList.Contains(x.QuestionId)))
+                {
+                    _userInfo.AuditIdentification = "UpdateMark";
+                }
+                else
+                {
+                    _userInfo.AuditIdentification = "DeleteMark";
+                }
+            }
+
             var taskinfo = await _visitTaskRepository.Where(x => x.Id == inDto.VisitTaskId).Include(x => x.TrialReadingCriterion).FirstNotNullAsync();
             try
             {
@@ -1994,7 +2012,7 @@ namespace IRaCIS.Core.Application.Service
 
             }).ToList();
             await _readingTaskQuestionAnswerRepository.AddRangeAsync(needAddAnswer);
-
+         
             if (inDto.UpdateMark)
             {
                 var questionMarkList = await _readingTaskQuestionMarkRepository.Where(x => x.VisitTaskId == inDto.VisitTaskId).Select(x => new
diff --git a/IRaCIS.Core.Infra.EFCore/Common/AuditingData.cs b/IRaCIS.Core.Infra.EFCore/Common/AuditingData.cs
index be0dbccb4..755a8a700 100644
--- a/IRaCIS.Core.Infra.EFCore/Common/AuditingData.cs
+++ b/IRaCIS.Core.Infra.EFCore/Common/AuditingData.cs
@@ -6,6 +6,7 @@ using MassTransit;
 using Microsoft.EntityFrameworkCore.ChangeTracking;
 using Microsoft.EntityFrameworkCore.ChangeTracking.Internal;
 using Newtonsoft.Json;
+using Newtonsoft.Json.Linq;
 
 
 namespace IRaCIS.Core.Infra.EFCore.Common
@@ -3093,7 +3094,7 @@ namespace IRaCIS.Core.Infra.EFCore.Common
                         //自定义特有标识
                         if (await _dbContext.ReadingQuestionCriterionTrial.AnyAsync(t => t.Id == firstEntity.ReadingQuestionCriterionTrialId && t.CriterionType == CriterionType.SelfDefine))
                         {
-                            extraIdentification = "/Self";
+                            //extraIdentification = "/Self";
 
                             //还会把病灶问题答案更新
 
@@ -3134,6 +3135,19 @@ namespace IRaCIS.Core.Infra.EFCore.Common
 
                         }
 
+                        var mark = entitys.Where(x => x.Entity.GetType() == typeof(ReadingTaskQuestionMark)).Select(x=>x.Entity as ReadingTaskQuestionMark).FirstOrDefault();
+
+                        var markName=string.Empty;
+                        if (mark != null && mark.MeasureData.IsNotNullOrEmpty())
+                        {
+                            // 解析 JSON 字符串
+                            JObject jsonObject = JObject.Parse(mark.MeasureData);
+
+                            // 提取 label 的值
+                            markName = jsonObject["data"]["label"].ToString();
+                        }
+
+
                         await InsertInspection<ReadingTaskQuestionAnswer>(cloneEntity, type, x => new InspectionConvertDTO()
                         {
                             VisitTaskId = x.VisitTaskId,
@@ -3146,6 +3160,9 @@ namespace IRaCIS.Core.Infra.EFCore.Common
 
                         }, new
                         {
+
+                            MarkName= markName,
+                            PicturePath= mark!=null?mark.PicturePath:string.Empty,
                             QuestionAnswerList = taskQuestionAnswerList.Join(quesionList,
                             t => t.ReadingQuestionTrialId,
                             u => u.QuestionId,
@@ -3160,7 +3177,7 @@ namespace IRaCIS.Core.Infra.EFCore.Common
                             }).OrderBy(t => t.ShowOrder).ToList()
                          ,
                             TableQuestionAndAnswerList = tableQuesionAndAnswerList
-                        }
+                        }, _userInfo.AuditIdentification
                              );