diff --git a/IRaCIS.Core.Application/Service/Reading/Dto/ReadingCalculateViewModel.cs b/IRaCIS.Core.Application/Service/Reading/Dto/ReadingCalculateViewModel.cs
index 27f6de674..bc8a4fb2f 100644
--- a/IRaCIS.Core.Application/Service/Reading/Dto/ReadingCalculateViewModel.cs
+++ b/IRaCIS.Core.Application/Service/Reading/Dto/ReadingCalculateViewModel.cs
@@ -15,7 +15,7 @@ namespace IRaCIS.Core.Application.Service.Reading.Dto
     {
         public Guid VisitTaskId { get; set; }
 
-        public Guid QuestionId { get; set; }
+        public Guid TableQuestionId { get; set; }
 
         public decimal RowIndex { get; set; }
 
diff --git a/IRaCIS.Core.Application/Service/Reading/Dto/ReadingImageTaskViewModel.cs b/IRaCIS.Core.Application/Service/Reading/Dto/ReadingImageTaskViewModel.cs
index a96001111..7cb17a3f7 100644
--- a/IRaCIS.Core.Application/Service/Reading/Dto/ReadingImageTaskViewModel.cs
+++ b/IRaCIS.Core.Application/Service/Reading/Dto/ReadingImageTaskViewModel.cs
@@ -1000,17 +1000,17 @@ namespace IRaCIS.Core.Application.Service.Reading.Dto
         /// <summary>
         /// InstanceId
         /// </summary>
-        public Guid InstanceId { get; set; }
+        public Guid? InstanceId { get; set; }
 
         /// <summary>
         /// SeriesId
         /// </summary>
-        public Guid SeriesId { get; set; }
+        public Guid? SeriesId { get; set; }
 
         /// <summary>
         /// StudyId
         /// </summary>
-        public Guid StudyId { get; set; }
+        public Guid? StudyId { get; set; }
 
         /// <summary>
         /// MarkTool
@@ -1031,6 +1031,9 @@ namespace IRaCIS.Core.Application.Service.Reading.Dto
         /// MeasureData
         /// </summary>
         public string MeasureData { get; set; } = string.Empty;
+
+
+        public Guid? FirstAddTaskId { get; set; }
     }
     public class GetReadingQuestionAndAnswerInDto
     {
diff --git a/IRaCIS.Core.Application/Service/Reading/ReadingImageTask/ReadingImageTaskService.cs b/IRaCIS.Core.Application/Service/Reading/ReadingImageTask/ReadingImageTaskService.cs
index eea64c0c0..0a4ffb4e8 100644
--- a/IRaCIS.Core.Application/Service/Reading/ReadingImageTask/ReadingImageTaskService.cs
+++ b/IRaCIS.Core.Application/Service/Reading/ReadingImageTask/ReadingImageTaskService.cs
@@ -829,6 +829,9 @@ namespace IRaCIS.Application.Services
                 .ToListAsync();
 
 
+
+
+
             var taskInfo = await _visitTaskRepository.Where(x => x.Id == inDto.VisitTaskId).ProjectTo<VisitTaskDto>(_mapper.ConfigurationProvider).FirstNotNullAsync();
 
             if (taskInfo.IsConvertedTask &&taskInfo.BeforeConvertedTaskId!=null)
@@ -845,6 +848,26 @@ namespace IRaCIS.Application.Services
 
                 x.OrderMarkName = x.OrderMark + x.RowIndexNum.GetLesionMark();
             });
+
+            var questionMark = await _readingTaskQuestionMarkRepository.Where(x => x.VisitTaskId == inDto.VisitTaskId).
+                Select(x => new GetTableAnswerRowInfoOutDto()
+                {
+                    FristAddTaskId = x.FirstAddTaskId.Value,
+                    Id = x.Id,
+                    InstanceId = x.InstanceId,
+                    MeasureData = x.MeasureData,
+                    NumberOfFrames = x.NumberOfFrames,
+                    PicturePath = x.PicturePath,
+                    VisitTaskId = x.VisitTaskId,
+                    StudyId = x.StudyId,
+                    SeriesId = x.StudyId,
+                }).ToListAsync();
+
+            questionMark.ForEach(x => {
+
+                x.IsFirstChangeTask = x.VisitTaskId == inDto.VisitTaskId;
+            });
+            result.AddRange(questionMark);
             return result;
         }
 
@@ -1535,6 +1558,13 @@ namespace IRaCIS.Application.Services
             }).ToList();
             await _readingTaskQuestionAnswerRepository.AddRangeAsync(needAddAnswer);
 
+
+            var questionMarkList = await _readingTaskQuestionMarkRepository.Where(x => x.VisitTaskId == inDto.VisitTaskId).Select(x => new
+            {
+                x.QuestionId,
+                x.FirstAddTaskId,
+
+            }).ToListAsync();
             await _readingTaskQuestionMarkRepository.BatchDeleteNoTrackingAsync(x => x.VisitTaskId == inDto.VisitTaskId);
 
             var datetime = DateTime.Now;
@@ -1551,8 +1581,8 @@ namespace IRaCIS.Application.Services
                 QuestionId = x.QuestionId,
                 SeriesId = x.SeriesId,
                 StudyId = x.StudyId,
-                CreateTime = datetime
-
+                CreateTime = datetime,
+                FirstAddTaskId= questionMarkList.Where(y=>y.QuestionId==x.QuestionId).Select(x=>x.FirstAddTaskId).FirstOrDefault() ?? inDto.VisitTaskId,
             }).ToList();
             await _readingTaskQuestionMarkRepository.AddRangeAsync(markList);
             await _readingTaskQuestionAnswerRepository.SaveChangesAsync();
diff --git a/IRaCIS.Core.Application/Service/ReadingCalculate/LuganoCalculateService.cs b/IRaCIS.Core.Application/Service/ReadingCalculate/LuganoCalculateService.cs
index 531bf8f93..1def50633 100644
--- a/IRaCIS.Core.Application/Service/ReadingCalculate/LuganoCalculateService.cs
+++ b/IRaCIS.Core.Application/Service/ReadingCalculate/LuganoCalculateService.cs
@@ -23,6 +23,7 @@ namespace IRaCIS.Core.Application.Service.ReadingCalculate
         private readonly IRepository<VisitTask> _visitTaskRepository;
         private readonly IRepository<ReadingQuestionCriterionTrial> _readingQuestionCriterionTrialRepository;
         private readonly IRepository<ReadingTableQuestionTrial> _readingTableQuestionTrialRepository;
+        private readonly IRepository<ReadingTaskQuestionMark> _readingTaskQuestionMarkRepository;
         private readonly IRepository<ReadingTableAnswerRowInfo> _readingTableAnswerRowInfoRepository;
         private readonly IRepository<ReadingQuestionTrial> _readingQuestionTrialRepository;
         private readonly IRepository<OrganInfo> _organInfoRepository;
@@ -36,6 +37,7 @@ namespace IRaCIS.Core.Application.Service.ReadingCalculate
             IRepository<VisitTask> visitTaskRepository,
             IRepository<ReadingQuestionCriterionTrial> readingQuestionCriterionTrialRepository,
             IRepository<ReadingTableQuestionTrial> readingTableQuestionTrialRepository,
+               IRepository<ReadingTaskQuestionMark> readingTaskQuestionMarkRepository,
             IRepository<ReadingTableAnswerRowInfo> readingTableAnswerRowInfoRepository,
             IRepository<ReadingQuestionTrial> readingQuestionTrialRepository,
             IRepository<OrganInfo> organInfoRepository,
@@ -49,6 +51,7 @@ namespace IRaCIS.Core.Application.Service.ReadingCalculate
             this._visitTaskRepository = visitTaskRepository;
             this._readingQuestionCriterionTrialRepository = readingQuestionCriterionTrialRepository;
             this._readingTableQuestionTrialRepository = readingTableQuestionTrialRepository;
+            this._readingTaskQuestionMarkRepository = readingTaskQuestionMarkRepository;
             this._readingTableAnswerRowInfoRepository = readingTableAnswerRowInfoRepository;
             this._readingQuestionTrialRepository = readingQuestionTrialRepository;
             this._organInfoRepository = organInfoRepository;
@@ -880,6 +883,47 @@ namespace IRaCIS.Core.Application.Service.ReadingCalculate
                          QuestionMark.State,
                     };
 
+               
+
+                    var rowIndexList = copyTableAnswers.Select(x => x.RowIndex).Distinct().ToList();
+                    // 找到靶病灶问题Id
+                   var  questionId=await _readingQuestionTrialRepository.Where(x => x.ReadingQuestionCriterionTrialId == taskinfo.TrialReadingCriterionId && x.LesionType == LesionType.TargetLesion).Select(x => x.Id).FirstNotNullAsync();
+
+                    foreach (var item in rowIndexList)
+                    {
+                        var lowPPD =await this.GetLowPPDInfo(new GetPPDInfoInDto() { 
+                        
+                        VisitTaskId= visitTaskId,
+                        QuestionId= questionId,
+                        RowIndex=item
+                        });
+
+                        copyTableAnswers.Where(x => x.RowIndex == item).ForEach(x =>
+                        {
+
+
+                            switch (x.QuestionMark)
+                            {
+                                case QuestionMark.LowPPDLDi:
+                                    x.Answer = lowPPD.LowPPDLDi.ToString();
+                                    break;
+                                case QuestionMark.LowPPDSDi:
+                                    x.Answer = lowPPD.LowPPDSDi.ToString();
+                                    break;
+                                case QuestionMark.NadirPPD:
+                                    x.Answer = lowPPD.NadirPPD.ToString();
+                                    break;
+                                case QuestionMark.LowPPDVisit:
+                                    x.Answer = lowPPD.LowPPDVisit.ToString();
+                                    break;
+
+
+                            }
+
+
+                        });
+                    }
+
                     var tableAnswers = copyTableAnswers.Select(x => new ReadingTableQuestionAnswer
                     {
                         Id = NewId.NextGuid(),
@@ -893,10 +937,20 @@ namespace IRaCIS.Core.Application.Service.ReadingCalculate
                     });
 
 
+                    var questionMarkList = await _readingTaskQuestionMarkRepository.Where(x => x.VisitTaskId == LastVisitTaskId).Select(x => new ReadingTaskQuestionMark()
+                    {
+                        VisitTaskId= visitTaskId,
+                        FirstAddTaskId=x.FirstAddTaskId,
+                        QuestionId=x.QuestionId,
 
 
+                    }).ToListAsync();
+                    questionMarkList.ForEach(x => {
+                        x.Id = NewId.NextGuid();
+                    });
                     var addList = _mapper.Map<List<ReadingTableAnswerRowInfo>>(tableRowAnswers);
 
+                    await _readingTaskQuestionMarkRepository.AddRangeAsync(questionMarkList);
                     await _readingTableAnswerRowInfoRepository.AddRangeAsync(addList);
                     await _readingTableQuestionAnswerRepository.AddRangeAsync(tableAnswers);
                     await _readingTableQuestionAnswerRepository.SaveChangesAsync();
diff --git a/IRaCIS.Core.Domain/Reading/ReadingFormAnswer/ReadingTaskQuestionMark.cs b/IRaCIS.Core.Domain/Reading/ReadingFormAnswer/ReadingTaskQuestionMark.cs
index 858c66eb8..16d607564 100644
--- a/IRaCIS.Core.Domain/Reading/ReadingFormAnswer/ReadingTaskQuestionMark.cs
+++ b/IRaCIS.Core.Domain/Reading/ReadingFormAnswer/ReadingTaskQuestionMark.cs
@@ -33,40 +33,38 @@ namespace IRaCIS.Core.Domain.Models
 		/// <summary>
         /// InstanceId
         /// </summary>
-		[Required]
-		public Guid InstanceId { get; set; }
+		public Guid? InstanceId { get; set; }
 	
 		/// <summary>
         /// SeriesId
         /// </summary>
-		[Required]
-		public Guid SeriesId { get; set; }
+		public Guid? SeriesId { get; set; }
 	
 		/// <summary>
         /// StudyId
         /// </summary>
-		[Required]
-		public Guid StudyId { get; set; }
+
+		public Guid? StudyId { get; set; }
 	
 		/// <summary>
         /// MarkTool
         /// </summary>
-		public string MarkTool { get; set; }
-	
-		/// <summary>
+		public string MarkTool { get; set; } = string.Empty;
+
+        /// <summary>
         /// PicturePath
         /// </summary>
-		public string PicturePath { get; set; }
-	
-		/// <summary>
+        public string PicturePath { get; set; } = string.Empty;
+
+        /// <summary>
         /// NumberOfFrames
         /// </summary>
-		public int? NumberOfFrames { get; set; }
+        public int? NumberOfFrames { get; set; } 
 
-		/// <summary>
-		/// MeasureData
-		/// </summary>
-		[Required]
+        /// <summary>
+        /// MeasureData
+        /// </summary>
+        [Required]
 		public string MeasureData { get; set; } = string.Empty;
 
         /// <summary>
@@ -79,6 +77,8 @@ namespace IRaCIS.Core.Domain.Models
         /// </summary>
         public Guid CreateUserId { get; set; }
 
+        public Guid? FirstAddTaskId { get; set; }
+
     }