C.12.1.1.4 Encrypted Attribute Descriptions

C.12.1.1.4.1 Encrypted Attributes Sequence

Each Item of the Encrypted Attributes Sequence (0400,0500) contains an encrypted DICOM dataset containing a single instance of the Encrypted Attributes Data Set (Table C.12-7). It also contains encrypted content-encryption keys for one or more recipients. The encoding is based on the Enveloped-data Content Type of the Cryptographic Message Syntax defined in RFC 2630. It allows to encrypt the embedded Data Set for an arbitrary number of recipients using any of the three key management techniques supported by RFC 2630:

A recipient decodes the embedded Encrypted Attributes Data Set by decrypting one of the encrypted content-encryption keys, decrypting the encrypted dataset with the recovered content-encryption key, and then decoding the DICOM dataset using the Transfer Syntax specified in Encrypted Content Transfer Syntax UID (0400,0510).

Multiple Items may be present in the Encrypted Attributes Sequence. The different Items may contain Encrypted Attributes Data Sets with the same or different sets of Attributes and may contain encrypted content-encryption keys for the same or different sets of recipients. However, if the same Attribute is contained in more than one embedded Encrypted Attributes Data Set, the value of the Attribute must be identical in all embedded Encrypted Attributes Data Sets in which the Attribute is contained.

Note: If the Encrypted Attributes Sequence contains more than one Item, and a recipient holds the key for more than one of the items, the recipient may either decode any single one or more of the embedded Data Sets at its own discretion. Since the same Attribute is required to have the same value in all embedded Encrypted Attributes Data Sets, it is safe to “overlay” multiple embedded Encrypted Attributes Data Sets in an arbitrary order upon decoding.

C.12.1.1.4.2 Encrypted Content

The Encrypted Content (0400,0520) Attribute contains an Enveloped-data content type of the cryptographic message syntax defined in RFC 2630. The encrypted content of the Enveloped-data content type is an instance of the Encrypted Attributes Data Set as shown in Table C.12-7 (i.e., it is a Sequence with a single Item), encoded with the Transfer Syntax specified by the Encrypted Content Transfer Syntax UID (0400,0510) Attribute. Figure C.12-2 shows an example of how the Encrypted Content is encoded. The exact use of this Data Set is defined in the Attribute Confidentiality Profiles in PS 3.15.

Since the de-identified SOP Instance is a significantly altered version of the original Data Set, it is a new SOP Instance, with a SOP Instance UID that differs from the original Data Set.

Note: 1. Content encryption may require that the content (the DICOM Data Set) be padded to a multiple of some block size. This shall be performed according to the Content-encryption Process defined in RFC-2630.

2. Any standard or private Transfer Syntax may be specified in Encrypted Content Transfer Syntax UID (0400,0510) unless encoding is performed in accordance with an Attribute Confidentiality Profile that specifies additional restrictions. In general, an application entity decoding the Encrypted Attributes Sequence may not assume any particular Transfer Syntax or set of Transfer Syntaxes to be used with Encrypted Content Transfer Syntax UID (0400,0510).

3. For certain applications it might be necessary to “blacken” (remove) identifying information that is burned in to the image pixel data. The Encrypted Attributes Data Set does not specify a means of restoring the original image information without the complete image pixel data being encoded inside the Modified Attributes Sequence (0400,0550). If access to the original, unmodified pixel data is required and the image pixel data cannot be replicated inside the Modified Attributes Sequence (0400,0550) due to resource considerations, the SOP Instance UID may be used to locate the original SOP Instance from which the de-identified version was derived.

4. There is no guarantee that the original SOP Instance can be reconstructed from the data in Encrypted Content. If access to the original data is required, the (de-encrypted) UIDs may be used to locate the original SOP Instance from which the de-identified version was derived.

Table C.12-7ENCRYPTED ATTRIBUTES DATA SET ATTRIBUTES

Attribute Name Tag Type Attribute Description
Modified Attributes Sequence (0400,0550) 1 Sequence of Items containing all Attributes that were removed or replaced by “dummy values” in the main dataset during de-identification of the SOP instance. Upon reversal of the de-identification process, the Attributes are copied back into the main dataset, replacing any dummy values that might have been created. Only a single Item shall be included in this sequence.
> Any Attribute from the main dataset that was modified or removed during the de-identification process. 3

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Figure C.12-2 Example encoding of Encrypted Attributes Data Set (Informative)