A.34 Waveform Information Object Definitions

A.34.1 Waveform IOD Entity-Relationship Model

The Waveform E-R Model is shown in Figure A.34-1. This model applies to a variety of Waveform IODs.

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Figure A.34-1DICOM Waveform IOD Information Model

A.34.2 Basic Voice Audio Information Object Definition

A.34.2.1 Basic Voice Audio IOD Description

The Basic Voice Audio IOD is the specification of a digitized sound that has been acquired or created by an audio modality or by an audio acquisition function within an imaging modality. A typical use is report dictation.

A.34.2.2 Basic Voice Audio IOD Entity-Relationship Model

The E-R Model in Section A.34.1 of this Part applies to the Basic Voice Audio IOD.

A.34.2.3 Basic Voice Audio IOD Module Table

Table A.34.2-1Basic Voice Audio IOD Modules

IE Module Reference Usage
Patient Patient C.7.1.1 M
Clinical Trial Subject C.7.1.3 U
Study General Study C.7.2.1 M
Patient Study C.7.2.2 U
Clinical Trial Study C.7.2.3 U
Series General Series C.7.3.1 M
Clinical Trial Series C.7.3.2 U
Frame of Reference Synchronization C.7.4.2 U
Equipment General Equipment C.7.5.1 M
Waveform Waveform Identification C.10.8 M
Waveform C.10.9 M
Acquisition Context C.7.6.14 M
Waveform Annotation C.10.10 U
SOP Common C.12.1 M

A.34.2.4 Basic Voice Audio IOD Content Constraints

A.34.2.4.1 Modality

The value of Modality (0008,0060) shall be AU.

A.34.2.4.2 Waveform Sequence

The number of Waveform Sequence (5400,0100) Items shall be one.

A.34.2.4.3 Number of Waveform Channels

The value of the Number of Waveform Channels (003A,0005) in the Waveform Sequence Item shall be 1 or 2.

A.34.2.4.4 Sampling Frequency

The value of the Sampling Frequency (003A,001A) in the Waveform Sequence Item shall be 8000.

A.34.2.4.5 Waveform Sample Interpretation

The value of the Waveform Sample Interpretation (5400,1006) in the Waveform Sequence Item shall be UB, MB, or AB.

A.34.3 12-Lead Electrocardiogram Information Object Definition

A.34.3.1 12-Lead ECG IOD Description

The 12-Lead Electrocardiogram (12-Lead ECG) IOD is the specification of digitized electrical signals from the patient cardiac conduction system collected on the body surface, which has been acquired by an ECG modality or by an ECG acquisition function within an imaging modality.

A.34.3.2 12-Lead ECG IOD Entity-Relationship Model

The E-R Model in Section A.34.1 of this Part applies to the 12-Lead ECG IOD.

A.34.3.3 12-Lead ECG IOD Module Table

Table A.34.3-112-Lead ECG IOD Modules

IE Module Reference Usage
Patient Patient C.7.1.1 M
Clinical Trial Subject C.7.1.3 U
Study General Study C.7.2.1 M
Patient Study C.7.2.2 U
Clinical Trial Study C.7.2.3 U
Series General Series C.7.3.1 M
Clinical Trial Series C.7.3.2 U
Frame of Reference Synchronization C.7.4.2 U
Equipment General Equipment C.7.5.1 M
Waveform Waveform Identification C.10.8 M
Waveform C.10.9 M
Acquisition Context C.7.6.14 M
Waveform Annotation C.10.10 C - required if annotation is present
SOP Common C.12.1 M

A.34.3.4 12-Lead ECG IOD Content Constraints

A.34.3.4.1 Modality

The value of Modality (0008,0060) shall be ECG.

A.34.3.4.2 Acquisition Context Module

For SOP Instances of ECG acquired in the cardiac catheterization lab, the Defined Template for Acquisition Context Sequence (0040,0555) is TID 3403. For routine resting or stress ECG, the Defined Template for Acquisition Context Sequence (0040,0555) is TID 3401.

A.34.3.4.3 Waveform Sequence

The number of Waveform Sequence (5400,0100) Items shall be between 1 and 5, inclusive.

A.34.3.4.4 Number of Waveform Channels

The value of the Number of Waveform Channels (003A,0005) in each Waveform Sequence Item shall be between 1 and 13, inclusive. The total number of channels encoded across all Items shall not exceed 13.

Note: This specialization provides for up to five Waveform Sequence Items (multiplex groups), with a total of 13 channels. This allows, for instance, encoding of four sets of three simultaneously recorded channels, the sets being acquired sequentially, plus one continuous channel for the duration of the other sets. This can be used to emulate the behavior of classical 12-lead ECG strip chart recorders with 4x3 presentation, plus a continuous lead II recording (see figure).

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Multiplex Group 1 - leads I, II, III; time offset 0; duration 2.5 sMultiplex Group 2 - leads aVR, aVL, aVF; time offset 2.5 s; duration 2.5 sMultiplex Group 3 - leads V1, V2, V3; time offset 5.0 s; duration 2.5 sMultiplex Group 4 - leads V4, V5, V6; time offset 7.5 s; duration 2.5 sMultiplex Group 5 - lead II; time offset 0; duration 9.84 s

FIGURE A.34.3-1 12-Lead ECG Example (Informative)

A.34.3.4.5 Number of Waveform Samples

The value of the Number of Waveform Samples (003A,0010) in each Waveform Sequence Item shall be less than or equal to 16384.

Note: This allows over 16 seconds per channel at the maximum sampling frequency; if longer recordings are required, the General ECG IOD may be used.

A.34.3.4.6 Sampling Frequency

The value of the Sampling Frequency (003A,001A) in each Waveform Sequence Item shall be between 200 and 1000, inclusive.

A.34.3.4.7 Channel Source

The Baseline Context ID for the Channel Source Sequence (003A,0208) in each Channel Definition Sequence Item shall be CID 3001.

A.34.3.4.8 Waveform Sample Interpretation

The value of the Waveform Sample Interpretation (5400,1006) in each Waveform Sequence Item shall be SS.

A.34.3.4.9 Waveform Annotation Module

The Defined Context ID for the Concept Name Code Sequence (0040,A043) in the Waveform Annotation Sequence (0040,B020) shall be CID 3335. This Context Group supports the annotation of suppressed pacemaker spikes in the ECG waveform.

A.34.4 General Electrocardiogram Information Object Definition

A.34.4.1 General ECG IOD Description

The General Electrocardiogram (ECG) IOD is the specification of digitized electrical signals from the patient cardiac conduction system collected on the body surface, which has been acquired by an ECG modality or by an ECG acquisition function within an imaging modality.

A.34.4.2 General ECG IOD Entity-Relationship Model

The E-R Model in Section A.34.1 of this Part applies to the General ECG IOD.

A.34.4.3 General ECG IOD Module Table

Table A.34.4-1General ECG IOD Modules

IE Module Reference Usage
Patient Patient C.7.1.1 M
Clinical Trial Subject C.7.1.3 U
Study General Study C.7.2.1 M
Patient Study C.7.2.2 U
Clinical Trial Study C.7.2.3 U
Series General Series C.7.3.1 M
Clinical Trial Series C.7.3.2 U
Frame of Reference Synchronization C.7.4.2 U
Equipment General Equipment C.7.5.1 M
Waveform Waveform Identification C.10.8 M
Waveform C.10.9 M
Acquisition Context C.7.6.14 M
Waveform Annotation C.10.10 C - required if annotation is present
SOP Common C.12.1 M

A.34.4.4 General ECG IOD Content Constraints

A.34.4.4.1 Modality

The value of Modality (0008,0060) shall be ECG.

A.34.4.4.2 Waveform Sequence

The number of Waveform Sequence (5400,0100) Items shall be between 1 and 4, inclusive.

A.34.4.4.3 Number of Waveform Channels

The value of the Number of Waveform Channels (003A,0005) in each Waveform Sequence Item shall be between 1 and 24, inclusive.

A.34.4.4.4 Sampling Frequency

The value of the Sampling Frequency (003A,001A) in each Waveform Sequence Item shall be between 200 and 1000, inclusive.

A.34.4.4.5 Channel Source

The Defined Context ID for the Channel Source Sequence (003A,0208) in each Channel Definition Sequence Item shall be CID 3001.

Note: Terms from other Context Groups may also be used for extended specification of the Channel Source, as declared in the Conformance Statement for an application (see PS3.2).

A.34.4.4.6 Waveform Sample Interpretation

The value of the Waveform Sample Interpretation (5400,1006) in each Waveform Sequence Item shall be SS.

A.34.4.4.7 Waveform Annotation Module

The Defined Context ID for the Concept Name Code Sequence (0040,A043) in the Waveform Annotation Sequence (0040,B020) shall be CID 3335. This Context Group supports the annotation of suppressed pacemaker spikes in the ECG waveform.

A.34.5 Ambulatory Electrocardiogram Information Object Definition

A.34.5.1 Ambulatory ECG IOD Description

The Ambulatory Electrocardiogram (ECG) IOD is the specification of digitized electrical signals from the patient cardiac conduction system collected on the body surface, which has been acquired by an ambulatory electrocardiography (Holter) device.

Note: The duration of acquisition represented in one SOP Instance is not specifically constrained, and is limited only by the maximum size of the Waveform Data attribute.

A.34.5.2 Ambulatory ECG IOD Entity-Relationship Model

The E-R Model in Section A.34.1 of this Part applies to the Ambulatory ECG IOD.

A.34.5.3 Ambulatory ECG IOD Module Table

Table A.34.5-1Ambulatory ECG IOD Modules

IE Module Reference Usage
Patient Patient C.7.1.1 M
Clinical Trial Subject C.7.1.3 U
Study General Study C.7.2.1 M
Patient Study C.7.2.2 U
Clinical Trial Study C.7.2.3 U
Series General Series C.7.3.1 M
Clinical Trial Series C.7.3.2 U
Frame of Reference Synchronization C.7.4.2 U
Equipment General Equipment C.7.5.1 M
Waveform Waveform Identification C.10.8 M
Waveform C.10.9 M
Acquisition Context C.7.6.14 U
Waveform Annotation C.10.10 C - required if annotation is present
SOP Common C.12.1 M

A.34.5.4 Ambulatory ECG IOD Content Constraints

A.34.5.4.1 Modality

The value of Modality (0008,0060) shall be ECG.

A.34.5.4.2 Waveform Sequence

The number of Waveform Sequence (5400,0100) Items shall be be 1.

A.34.5.4.3 Number of Waveform Channels

The value of the Number of Waveform Channels (003A,0005) in the Waveform Sequence Item shall be between 1 and 12, inclusive.

A.34.5.4.5 Sampling Frequency

The value of the Sampling Frequency (003A,001A) in each Waveform Sequence Item shall be between 50 and 1000, inclusive.

A.34.5.4.6 Channel Source

The Defined Context ID for the Channel Source Sequence (003A,0208) in each Channel Definition Sequence Item shall be CID 3001.

A.34.5.4.7 Waveform Sample Interpretation

The value of the Waveform Sample Interpretation (5400,1006) in each Waveform Sequence Item shall be SB or SS.

A.34.6 Hemodynamic Information Object Definition

A.34.6.1 Hemodynamic IOD Description

The Hemodynamic IOD is the specification of digitized pressure, electrical, and other signals from the patient circulatory system, which has been acquired by a hemodynamic modality.

Note: The duration of acquisition represented in one SOP Instance is not specifically constrained, and is limited only by the maximum size of the Waveform Data attribute.

A.34.6.2 Hemodynamic IOD Entity-Relationship Model

The E-R Model in Section A.34.1 of this Part applies to the Hemodynamic IOD.

A.34.6.3 Hemodynamic IOD Module Table

Table A.34.6-1Hemodynamic IOD Modules

IE Module Reference Usage
Patient Patient C.7.1.1 M
Clinical Trial Subject C.7.1.3 U
Study General Study C.7.2.1 M
Patient Study C.7.2.2 U
Clinical Trial Study C.7.2.3 U
Series General Series C.7.3.1 M
Clinical Trial Series C.7.3.2 U
Frame of Reference Synchronization C.7.4.2 C - Required if Waveform Originality (003A,0004) is ORIGINAL; may be present otherwise
Equipment General Equipment C.7.5.1 M
Waveform Waveform Identification C.10.8 M
Waveform C.10.9 M
Acquisition Context C.7.6.14 M
Waveform Annotation C.10.10 C - required if annotation is present
SOP Common C.12.1 M

A.34.6.4 Hemodynamic IOD Content Constraints

A.34.6.4.1 Modality

The value of Modality (0008,0060) shall be HD.

A.34.6.4.2 Acquisition Context Module

The Defined Template for Acquisition Context Sequence (0040,0555) is TID 3403.

A.34.6.4.3 Waveform Sequence

The number of Waveform Sequence (5400,0100) Items shall be between 1 and 4, inclusive.

A.34.6.4.4 Number of Waveform Channels

The value of the Number of Waveform Channels (003A,0005) in each Waveform Sequence Item shall be between 1 and 8, inclusive.

A.34.6.4.5 Sampling Frequency

The value of the Sampling Frequency (003A,001A) in each Waveform Sequence Item shall be less than or equal to 400.

A.34.6.4.7 Channel Source

The Defined Context ID for the Channel Source Sequence (003A,0208) in each Channel Definition Sequence Item shall be CID 3003, CID 3001 for surface ECG channels, or CID 3090 for time synchronization channels. The Channel Source Code Value shall encode at minimum the metric (measured physical quality) and function (measurement or stimulus); unless otherwise specifically encoded, the default function shall be “measurement”.

The Channel Source Modifiers Sequence (003A,0209) in each Channel Definition Sequence Item shall be used to specify additional qualifiers of the semantics of the waveform source, including technique and anatomic location, if not encoded by the Channel Source Code Value. Technique, with terms from Defined Context ID 3241, shall be specified in Channel Source Modifiers Sequence Items prior to the cardiac anatomic location(s), with terms from Defined Context ID 3010, 3014, and 3019. If technique is pullback, the sequence of anatomic locations shall be specified in ordered Channel Source Modifiers Sequence Items (e.g., initial, transitional, and final locations).

Note: Terms from other Context Groups may also be used for extended specification of the Channel Source, as declared in the Conformance Statement for an application (see PS3.2).

A.34.6.4.8 Waveform Sample Interpretation

The value of the Waveform Sample Interpretation (5400,1006) in each Waveform Sequence Item shall be SS.

A.34.6.4.9 Waveform Annotation Module

The Defined Context ID for the Concept Name Code Sequence (0040,A043) in the Waveform Annotation Sequence (0040,B020) shall be CID 3337.

A.34.7 Basic Cardiac Electrophysiology Information Object Definition

A.34.7.1 Basic Cardiac EP IOD Description

The Basic Cardiac Electrophysiology IOD is the specification of digitized electrical signals from the patient cardiac conduction system collected in the heart, which has been acquired by an EP modality.

Note: The duration of acquisition represented in one SOP Instance is not specifically constrained, and is limited only by the maximum size of the Waveform Data attribute.

A.34.7.2 Basic Cardiac EP IOD Entity-Relationship Model

The E-R Model in Section A.34.1 of this Part applies to the Cardiac EP IOD.

A.34.7.3 Basic Cardiac EP IOD Module Table

Table A.34.7-1Basic Cardiac EP IOD Modules

IE Module Reference Usage
Patient Patient C.7.1.1 M
Clinical Trial Subject C.7.1.3 U
Study General Study C.7.2.1 M
Patient Study C.7.2.2 U
Clinical Trial Study C.7.2.3 U
Series General Series C.7.3.1 M
Clinical Trial Series C.7.3.2 U
Frame of Reference Synchronization C.7.4.2 C - Required if Waveform Originality (003A,0004) value is ORIGINAL; may be present otherwise
Equipment General Equipment C.7.5.1 M
Waveform Waveform Identification C.10.8 M
Waveform C.10.9 M
Acquisition Context C.7.6.14 M
Waveform Annotation C.10.10 C - required if annotation is present
SOP Common C.12.1 M

A.34.7.4 Basic Cardiac EP IOD Content Constraints

A.34.7.4.1 Modality

The value of Modality (0008,0060) shall be EPS.

A.34.7.4.2 Acquisition Context Module

The Defined Template for Acquisition Context Sequence (0040,0555) is TID 3450.

A.34.7.4.3 Waveform Sequence

The number of Waveform Sequence (5400,0100) Items shall be between 1 and 4, inclusive.

A.34.7.4.4 Sampling Frequency

The value of the Sampling Frequency (003A,001A) in each Waveform Sequence Item shall be less than or equal to 20000.

A.34.7.4.5 Channel Source

The Defined Context ID for the Channel Source Sequence (003A,0208) in each Channel Definition Sequence Item shall be CID 3011. The Channel Source Code Value shall encode at minimum the anatomic location of the channel source.

The Channel Source Modifiers Sequence (003A,0209) in each Channel Definition Sequence Item shall be used to specify additional qualifiers of the semantics of the waveform source, including metric (measured physical quality), function (measurement or stimulus), and technique from Defined Context ID 3240, and anatomic location qualifiers from Defined Context ID 3019, if not encoded by the Channel Source Code Value. If not explicitly encoded, the default metric and function shall be “voltage measurement”. If a differential signal is used, that shall be indicated in a Modifier Item, and the positive pole and negative pole identified in the subsequent two modifiers.

Notes: 1. Terms from other Context Groups may also be used for extended specification of the Channel Source, as declared in the Conformance Statement for an application (see PS3.2).

2. A differential signal from the high right atrium , where electrode 1 on the catheter is the positive pole and electrode 3 the negative pole, could be specified by coded terms meaning: Channel Source: “High Right Atrium” Channel Source Modifiers: “Differential”, “E1”, “E3” (Implicit default modifier: “Voltage Measurement”)

A.34.7.4.6 Waveform Sample Interpretation

The value of the Waveform Sample Interpretation (5400,1006) in each Waveform Sequence Item shall be SS.

A.34.7.4.7 Waveform Annotation Module

The Defined Context ID for the Concept Name Code Sequence (0040,A043) in the Waveform Annotation Sequence (0040,B020) shall be CID 3339.

A.34.8 Arterial Pulse Waveform Information Object Definition

A.34.8.1 Arterial Pulse Waveform IOD Description

The Arterial Pulse Waveform IOD is the specification of digitized electrical signals from the patient arterial system collected through pulse oximetry or other means by a Pulse modality or by a Pulse acquisition function within an imaging modality.

A.34.8.2 Arterial Pulse Waveform IOD Entity-Relationship Model

The E-R Model in Section A.34.1 of this Part applies to the Arterial Pulse Waveform IOD.

A.34.8.3 Arterial Pulse Waveform IOD Module Table

Table A.34.8-1ARTERIAL PULSE WAVEFORM IOD MODULES

IE Module Reference Usage
Patient Patient C.7.1.1 M
Clinical Trial Subject C.7.1.3 U
Study General Study C.7.2.1 M
Patient Study C.7.2.2 U
Clinical Trial Study C.7.2.3 U
Series General Series C.7.3.1 M
Clinical Trial Series C.7.3.2 U
Frame of Reference Synchronization C.7.4.2 M
Equipment General Equipment C.7.5.1 M
Enhanced General Equipment C.7.5.2 M
Waveform Waveform Identification C.10.8 M
Waveform C.10.9 M
Acquisition Context C.7.6.14 M
Waveform Annotation C.10.10 C - Required if annotation is present
SOP Common C.12.1 M

A.34.8.4 Arterial Pulse Waveform IOD Content Constraints

A.34.8.4.1 Modality

The value of Modality (0008,0060) shall be HD (hemodynamic waveform).

A.34.8.4.2 Waveform Sequence

The number of Waveform Sequence (5400,0100) Items shall be 1.

A.34.8.4.3 Number of Waveform Channels

The value of the Number of Waveform Channels (003A,0005) in the Waveform Sequence Item shall be 1.

A.34.8.4.4 Sampling Frequency

The value of the Sampling Frequency (003A,001A) in each Waveform Sequence Item shall be less than or equal to 600 Hz.

A.34.8.4.5 Channel Source

The Defined Context ID for the Channel Source Sequence (003A,0208) in each Channel Definition Sequence Item shall be CID 3004.

A.34.8.4.6 Waveform Sample Interpretation

The value of the Waveform Sample Interpretation (5400,1006) in each Waveform Sequence Item shall be SB or SS.

A.34.9 Respiratory Waveform Information Object Definition

A.34.9.1 Respiratory Waveform IOD Description

The Respiratory Waveform IOD is the specification of digitized electrical signals from the patient respiratory system, which has been acquired by a Respiratory modality or by a Respiratory acquisition function within an imaging modality.

A.34.9.2 Respiratory Waveform IOD Entity-Relationship Model

The E-R Model in Section A.34.1 of this Part applies to the Respiratory Waveform IOD.

A.34.9.3 Respiratory Waveform IOD Module Table

Table A.34.9-1RESPIRATORY WAVEFORM IOD MODULES

IE Module Reference Usage
Patient Patient C.7.1.1 M
Clinical Trial Subject C.7.1.3 U
Study General Study C.7.2.1 M
Patient Study C.7.2.2 U
Clinical Trial Study C.7.2.3 U
Series General Series C.7.3.1 M
Clinical Trial Series C.7.3.2 U
Frame of Reference Synchronization C.7.4.2 M
Equipment General Equipment C.7.5.1 M
Enhanced General Equipment C.7.5.2 M
Waveform Waveform Identification C.10.8 M
Waveform C.10.9 M
Acquisition Context C.7.6.14 M
Waveform Annotation C.10.10 C - Required if annotation is present
SOP Common C.12.1 M

A.34.9.4 Respiratory Waveform IOD Content Constraints

A.34.9.4.1 Modality

The value of Modality (0008,0060) shall be RESP.

A.34.9.4.2 Waveform Sequence

The number of Waveform Sequence (5400,0100) Items shall be 1.

A.34.9.4.3 Number of Waveform Channels

The value of the Number of Waveform Channels (003A,0005) in the Waveform Sequence Item shall be 1.

A.34.9.4.4 Sampling Frequency

The value of the Sampling Frequency (003A,001A) in each Waveform Sequence Item shall be less than or equal to 100 Hz.

A.34.9.4.5 Channel Source

The Defined Context ID for the Channel Source Sequence (003A,0208) in each Channel Definition Sequence Item shall be CID 3005.

A.34.9.4.6 Waveform Sample Interpretation

The value of the Waveform Sample Interpretation (5400,1006) in each Waveform Sequence Item shall be SB or SS.

A.34.10 General Audio Waveform Information Object Definition

A.34.10.1 General Audio Waveform IOD Description

The General Audio Waveform IOD is the specification of one or two channel digitized audio signals.

A.34.10.2 General Audio Waveform IOD Entity-Relationship Model

The E-R Model in Section A.34.1 of this Part applies to the General Audio Waveform IOD.

A.34.10.3 General Audio Waveform IOD Module Table

Table A.34.10-1GENERAL AUDIO WAVEFORM IOD MODULES

IE Module Reference Usage
Patient Patient C.7.1.1 M
Clinical Trial Subject C.7.1.3 U
Study General Study C.7.2.1 M
Patient Study C.7.2.2 U
Clinical Trial Study C.7.2.3 U
Series General Series C.7.3.1 M
Clinical Trial Series C.7.3.2 U
Frame of Reference Synchronization C.7.4.2 M
Equipment General Equipment C.7.5.1 M
Enhanced General Equipment C.7.5.2 M
Waveform Waveform Identification C.10.8 M
Waveform C.10.9 M
Acquisition Context C.7.6.14 M
Waveform Annotation C.10.10 C - Required if annotation is present
SOP Common C.12.1 M

A.34.10.4 General Audio Waveform IOD Content Constraints

A.34.10.4.1 Modality

The value of Modality (0008,0060) shall be AU (audio).

A.34.10.4.2 Waveform Sequence

The number of Waveform Sequence (5400,0100) Items shall be 1.

A.34.10.4.3 Number of Waveform Channels

The value of the Number of Waveform Channels (003A,0005) in the Waveform Sequence Item shall be 1 or 2.

A.34.10.4.4 Sampling Frequency

The value of the Sampling Frequency (003A,001A) in each Waveform Sequence Item shall be less than or equal to 44,100 Hz.

A.34.10.4.5 Channel Source

The Defined Context ID for the Channel Source Sequence (003A, 0208) in each Channel Definition Sequence Item shall be CID 3000.

A.34.10.4.6 Waveform Sample Interpretation

The value of the Waveform Sample Interpretation (5400,1006) in each Waveform Sequence Item shall be SB or SS.