Virtually all specimens in a clinical laboratory are associated with a container, and specimens and containers are both important in imaging (see “Definitions”, above). In most clinical laboratory situations there is a one to one relationship between specimens and containers. In fact, pathologists and LIS systems routinely consider a specimen and its container as single entity; e.g. the slide (a container) and the tissue sections (the specimen) are considered a single unit.
However, there are legitimate use cases in which a laboratory may place two or more specimens in the same container (see Section NN.4 for examples). Therefore, the DICOM Specimen Module distinguishes between a Specimen ID and a Container ID. However, in situations where there is only one specimen per container, the value of the Specimen ID and Container ID may be the same (as assigned by the LIS).
Some Laboratory Information System may, in fact, not support multiple specimens in a container, i.e., they manage only a single identifier used for the combination of specimen and container. This is not contrary to the DICOM Standard; images produced under such a system will simply always assert that there is only one specimen in each container. However, a pathology image display application that shows images from a variety of sources must be able to distinguish between container and specimen IDs, and handle the 1:N relationship.
In allowing for one container to have multiple specimens, the Specimen Module asserts that it is the Container, not the Specimen, that is the unique target of the image. In other words, one Container ID is required in the Specimen Module, and multiple Specimen IDs are allowed in the Specimen Sequence. See Figure NN.3-1.
Figure NN.3-1 Extension of DICOM E-R Model for Specimens
If there is more than one specimen in a container, there must be a mechanism to identify and locate each specimen. When there is more than one specimen in a container, the Module allows various approaches to specify their locations. The Specimen Localization Content Item Sequence (0040,0620), through its associated Template 8004, allows the specimen to be localized by a distance in three dimensions from a reference point on the container, by a textual description of a location or physical attribute such as a colored ink, or by its location as shown in a referenced image of the container. The referenced image may use an overlay, burned-in annotation, or an associated Presentation State SOP Instance to specify the location of the specimen.