C.17.2 SR Document General Module

Table C.17-2 defines the general Attributes of an SR Document Instance. These Attributes identify the SR Document and provide context for the entire document.

Table C.17-2SR DOCUMENT GENERAL MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Instance Number (0020,0013) 1 A number that identifies the SR Document.
Preliminary Flag (0040,A496) 3 Indicates whether this SR Document is intended to be regarded as a preliminary or final report. Enumerated Values: PRELIMINARY - this report precedes the final report and may contain limited information; it may be time sensitive, and it is not expected to contain all the reportable findings FINAL - this report is the definitive means of communicating the results of a procedure Note: The definitions of the enumerated values are derived from the ACR Practice Guideline For Communication Of Diagnostic Imaging Findings, Revised 2005.
Completion Flag (0040,A491) 1 The estimated degree of completeness of this SR Document with respect to externally defined criteria in a manner specified in the Conformance Statement. Notes: 1. It may be desirable to make these criteria adaptable to local policies or user decisions. 2. The concept of “completeness is independent of the concept of preliminary or final; see the description of Preliminary Flag (0040,A496). Enumerated Values: PARTIAL = Partial content. COMPLETE = Complete content.
Completion Flag Description (0040,A492) 3 Explanation of the value sent in Completion Flag (0040,A491).
Verification Flag (0040,A493) 1 Indicates whether this SR Document is Verified. Enumerated Values: UNVERIFIED = Not attested to. VERIFIED = Attested to by a Verifying Observer Name (0040,A075) who is accountable for its content. A value of “VERIFIED” shall be used only when the value of Completion Flag (0040,A491) is “COMPLETE”. Note: The intent of this specification is that the "prevailing final version" of an SR Document is the version having the most recent Verification DateTime (0040,A030), Verification Flag (0040,A493) of VERIFIED and Preliminary Flag (0040,A496) of FINAL.
Content Date (0008,0023) 1 The date the document content creation started.
Content Time (0008,0033) 1 The time the document content creation started.
Verifying Observer Sequence (0040,A073) 1C The person or persons authorized to verify documents of this type and accept responsibility for the content of this document. One or more Items shall be included in this sequence. Required if Verification Flag (0040,A493) is VERIFIED. Note: In HL7 Structured Documents, the comparable attribute is the “legalAuthenticator”.
>Verifying Observer Name (0040,A075) 1 The person authorized by the Verifying Organization (0040,A027) to verify documents of this type and who accepts responsibility for the content of this document.
>Verifying Observer Identification Code Sequence (0040,A088) 2 Coded identifier of Verifying Observer. Zero or one Item shall be included in this sequence.
>>Include 'Code Sequence Macro' Table 8.8-1 No Baseline Context ID defined.
>Verifying Organization (0040,A027) 1 Organization to which the Verifying Observer Name (0040,A075) is accountable in the current interpretation procedure.
>Verification DateTime (0040,A030) 1 Date and Time of verification by the Verifying Observer Name (0040,A075).
Author Observer Sequence (0040,A078) 3 The person or device that created the clinical content of this document. This attribute sets the default Observer Context for the root of the content tree. One or more Items are permitted in this sequence.
>Include 'Identified Person or Device Macro' Table C.17-3b
Participant Sequence (0040,A07A) 3 Persons or devices related to the clinical content of this document. One or more Items are permitted in this sequence.
>Participation Type (0040,A080) 1 Participant’s role with respect to the clinical content of this document. See C.17.2.5. Defined Terms: SOURCE - Equipment that contributed to the content ENT - Data enterer (e.g., transcriptionist) ATTEST - Attestor Note: In HL7 Structured Documents, the participation comparable to Attestor is the “Authenticator”.
>Participation DateTime (0040,A082) 2 DateTime of participation with respect to the clinical content of this document.
>Include 'Identified Person or Device Macro' Table C.17-3b
Custodial Organization Sequence (0040,A07C) 3 Custodial organization for this SR Document instance. Represents the organization from which the document originates and that is in charge of maintaining the document, i.e., the steward of the original source document. Note: This may or may not be identical to the Institution identified in the Equipment Module. Only a single item is permitted in this sequence.
>Institution Name (0008,0080) 2 Name of Custodial Institution or Organization.
>Institution Code Sequence (0008,0082) 2 Coded identifier of Custodial Institution or Organization. Zero or one Item shall be included in this sequence.
>>Include 'Code Sequence Macro' Table 8.8-1 No Baseline Context ID defined.
Predecessor Documents Sequence (0040,A360) 1C Shall refer to SR SOP Instances (e.g. prior or preliminary reports) whose content has been wholly or partially included in this document with or without modification. One or more Items shall be included in this sequence. Required if this document includes content from other documents. Note: The amendment process of an existing SR Document may be described using the Purpose of Reference Code Sequence.
>Include 'Hierarchical SOP Instance Reference Macro' Table C.17-3 Defined Context ID for the Purpose of Reference Code Sequence in the Hierarchical SOP Instance Reference Macro is CID 7009.
Identical Documents Sequence (0040,A525) 1C Duplicates of this document, stored with different SOP Instance UIDs. One or more Items shall be included in this sequence. Required if this document is stored with different SOP Instance UIDs in one or more other Studies. See C.17.2.2 for further explanation.
>Include 'Hierarchical SOP Instance Reference Macro' Table C.17-3
Referenced Request Sequence (0040,A370) 1C Identifies Requested Procedures which are being fulfilled (completely or partially) by creation of this Document. One or more Items shall be included in this sequence. Required if this Document fulfills at least one Requested Procedure. May be present otherwise.
>Study Instance UID (0020,000D) 1 Unique identifier for the Study.
>Referenced Study Sequence (0008,1110) 2 Uniquely identifies the Study SOP Instance. Zero or one Item shall be included in this sequence.
>> Include ‘SOP Instance Reference Macro' Table 10-11
>Accession Number (0008,0050) 2 A departmental IS generated number which identifies the order for the Study.
>Issuer of Accession Number Sequence (0008,0051) 3 Identifier of the Assigning Authority that issued the Accession Number. Only a single Item is permitted in this sequence.
>>Include HL7v2 Hierarchic Designator Macro Table 10-17
>Placer Order Number/Imaging Service Request (0040,2016) 2 The order number assigned to the Imaging Service Request by the party placing the order.
>Order Placer Identifier Sequence (0040,0026) 3 Identifier of the Assigning Authority that issued the Placer Order Number. Only a single Item is permitted in this sequence.
>>Include HL7v2 Hierarchic Designator Macro Table 10-17
>Filler Order Number/Imaging Service Request (0040,2017) 2 The order number assigned to the Imaging Service Request by the party filling the order.
>Order Filler Identifier Sequence (0040,0027) 3 Identifier of the Assigning Authority that issued the Filler Order Number. Only a single Item is permitted in this sequence.
>>Include HL7v2 Hierarchic Designator Macro Table 10-17
>Requested Procedure ID (0040,1001) 2 Identifier of the related Requested Procedure
>Requested Procedure Description (0032,1060) 2 Institution-generated administrative description or classification of Requested Procedure.
>Requested Procedure Code Sequence (0032,1064) 2 A sequence that conveys the requested procedure. Zero or one Item shall be included in this sequence.
>>Include 'Code Sequence Macro' Table 8.8-1 No Baseline Context ID Number is specified.
>Reason for the Requested Procedure (0040,1002) 3 Reason for requesting this procedure.
>Reason for Requested Procedure Code Sequence (0040,100A) 3 Coded Reason for requesting this procedure. One or more Items are permitted in this sequence.
>>Include 'Code Sequence Macro' Table 8.8-1 No Baseline Context ID Number is specified.
Performed Procedure Code Sequence (0040,A372) 2 A Sequence that conveys the codes of the performed procedures pertaining to this SOP Instance. Zero or more Items shall be included in this sequence.
>Include 'Code Sequence Macro' Table 8.8-1 No Baseline Context ID Number is specified.
Current Requested Procedure Evidence Sequence (0040,A375) 1C Full set of Composite SOP Instances, of which the creator is aware, which were created to satisfy the current Requested Procedure(s) for which this SR Document is generated or that are referenced in the content tree. One or more Items shall be included in this sequence. Required if the creator is aware of Composite Objects acquired in order to satisfy the Requested Procedure(s) for which the SR Document is or if instances are referenced in the content tree. May be present otherwise. See C.17.2.3 for further explanation.
>Include 'Hierarchical SOP Instance Reference Macro' Table C.17-3
Pertinent Other Evidence Sequence (0040,A385) 1C Other Composite SOP Instances that are considered to be pertinent evidence by the creator of this SR Document. This evidence must have been acquired in order to satisfy Requested Procedures other than the one(s) for which this SR Document is generated. One or more Items shall be included in this sequence. Required if pertinent evidence from other Requested Procedures needs to be recorded. See C.17.2.3 for further explanation.
>Include 'Hierarchical SOP Instance Reference Macro' Table C.17-3
Referenced Instance Sequence (0008,114A) 1C Sequence specifying SOP Instances significantly related to the current SOP Instance. Such referenced Instances may include equivalent documents or renderings of this document. One or more Items shall be included in this sequence. Required if the identity of a CDA Document equivalent to the current SOP Instance is known at the time of creation of this SOP Instance (see C.17.2.6). May be present otherwise.
>Include ‘SOP Instance Reference Macro' Table 10-11
>Purpose of Reference Code Sequence (0040,A170) 1 Code describing the purpose of the reference to the Instance(s). Only a single Item shall be included in this sequence.
>>Include 'Code Sequence Macro' Table 8.8-1 Defined CID 7006.

C.17.2.1 Hierarchical SOP Instance Reference Macro

Table C.17-3 specifies the Attributes that reference a list of SOP Instances.

Table C.17-3

HIERARCHICAL SOP INSTANCE REFERENCE MACRO ATTRIBUTES

Attribute Name Tag Type Attribute Description
Study Instance UID (0020,000D) 1 Unique identifier for the Study
Referenced Series Sequence (0008,1115) 1 Sequence of Items where each Item includes the Attributes of a Series containing referenced Composite Object(s). One or more Items shall be included in this sequence
>Include ‘Hierarchical Series Reference Macro’ Table C.17-3a

Table C.17-3a specifies the Attributes that reference a Series of SOP Instances.

Table C.17-3a

HIERARCHICAL SERIES REFERENCE MACRO ATTRIBUTES

Series Instance UID (0020,000E) 1 Unique identifier of a Series that is part of this Study and contains the referenced Composite Object(s).
Retrieve AE Title (0008,0054) 3 Title of the DICOM Application Entity where the Composite Object(s) may be retrieved on the network.
Retrieve Location UID (0040, E011) 3 Unique identifier of the system where the Composite Object(s) may be retrieved on the network.
Storage Media File-Set ID (0088,0130) 3 The user or implementation specific human readable identifier that identifies the Storage Media on which the Composite Object (s) reside.
Storage Media File-Set UID (0088,0140) 3 Uniquely identifies the Storage Media on which the Composite Object (s) reside.
Referenced SOP Sequence (0008,1199) 1 References to Composite Object SOP Class/SOP Instance pairs that are part of the Study defined by Study Instance UID and the Series defined by Series Instance UID (0020,000E). One or more Items shall be included in this sequence.
>Include ‘SOP Instance Reference Macro' Table 10-11
>Purpose of Reference Code Sequence (0040,A170) 3 Describes the purpose for which the reference is made. One or more Items are permitted in this sequence.
>>Include ‘Code Sequence Macro’ Table 8.8-1 Baseline Context ID may be specified in Macro invocation.
>Referenced Digital Signature Sequence (0400,0402) 3 Sequence of references to Digital Signatures in the referenced SOP Instance. One or more Items are permitted in this sequence. Note: The Attributes in this sequence can be used to detect if the referenced SOP Instance has been altered.
>>Digital Signature UID (0400,0100) 1 The Unique Identifier of a Digital Signature held in the referenced SOP Instance.
>>Signature (0400,0120) 1 The Signature Value identified by the Digital Signature UID within the Referenced SOP Instance UID.
>Referenced SOP Instance MAC Sequence (0400,0403) 3 A MAC Calculation from data in the referenced SOP Instance that can be used as a data integrity check. Only a single Item is permitted in this Sequence. Note: This Attribute may be used in place of the Referenced Digital Signature Sequence Attribute (0400,0402), particularly if the SOP Instance does not have appropriate Digital Signatures that can be referenced.
>>MAC Calculation Transfer Syntax UID (0400,0010) 1 The Transfer Syntax UID used to encode the values of the Data Elements included in the MAC calculation. When computing the MAC, only Transfer Syntaxes that explicitly include the VR and use Little Endian encoding shall be used. Notes: 1. Certain Transfer Syntaxes, particularly those that are used with compressed data, allow the fragmentation of the pixel data to change. If such fragmentation changes, Digital Signatures generated with such Transfer Syntaxes could become invalid. 2. This does not constrain the transfer syntax used to transmit the object.
>>MAC Algorithm (0400,0015) 1 The algorithm used in generating the MAC. Defined Terms: RIPEMD160 MD5 SHA1 SHA256 SHA384 SHA512 Note: Digital Signature Security Profiles (see PS 3.15) may require the use of a restricted subset of these terms.
>>Data Elements Signed (0400,0020) 1 A list of Data Element Tags in the order they appear at the top level of the referenced SOP Instance that identify the Data Elements used in creating the MAC. See Section C.12.1.1.3.1.1.
>>MAC (0400,0404) 1 The MAC generated as described in Section 12.2.1.1, but unencrypted and without inclusion of fields from the Digital Signatures Sequence. See Section C.12.1.1.3.1.2.

C.17.2.2 Identical Documents Sequence

If identical copies of an SR Document are to be included in multiple Studies then the entire SR Document shall be duplicated with appropriate changes for inclusion into the different Studies (i.e. Study Instance UID, Series Instance UID, SOP Instance UID, Identical Documents Sequence etc.). The Identical Documents Sequence Attribute in each SOP Instance shall contain references to all other duplicate SOP Instances.

Note: If an SR Document contains an Identical Documents Sequence then it will not be further duplicated without producing a new complete set of duplicate SOP Instances with re-generated Identical Documents Sequences. This is a consequence of the rules for modification of SR Document content in PS3.4. For example, if there are two identical reports and an application is creating a third identical report, then the first two reports must be re-generated in order that their Identical Documents Sequence will reference the new duplicate document and all other identical documents.

If a new SR Document is created using content from an SR Document that contains an Identical Documents Sequence and is part of the same Requested Procedure, then the new SR Document shall only contain a new Identical Documents Sequence if the new SR Document is duplicated. The Predecessor Documents Sequence in all the new SR Documents shall contain references to the original SR Document and all its duplicates as well as any other documents from which content is included.

Note: It is up to an implementation to decide whether a new SR Document is duplicated across multiple Studies. This may require user input to make the decision.

C.17.2.3 Current Requested Procedure Evidence Sequence and Pertinent Other Evidence Sequence

The intent of the Current Requested Procedure Evidence Sequence (0040,A375) is to reference all evidence created in order to satisfy the current Requested Procedure(s) for this SR Document. This shall include, but is not limited to, all current evidence referenced in the content tree.

For a completed SR Document satisfying (i.e., being the final report for) the current Requested Procedure(s), this sequence shall list the full set of Composite SOP Instances created for the current Requested Procedure(s). For other SOP Instances that include the SR Document General Module, this sequence shall contain at minimum the set of Composite SOP Instances from the current Requested Procedure(s) that are referenced in the content tree.

The Pertinent Other Evidence Sequence (0040,A385) attribute is used to reference all other evidence considered pertinent for this SR Document that is not listed in the Current Requested Procedure Evidence Sequence (0040,A375).

This requires that the same SOP Instance shall not be referenced in both of these Sequences.

For the purposes of inclusion in the Current Requested Procedure Evidence Sequence (0040,A375) and the Pertinent Other Evidence Sequence (0040,A385), the set of Composite SOP Instances is defined to include not only the images and waveforms referenced in the content tree, but also all presentation states, real world value maps and other accompanying composite instances that are referenced from the content items.

C.17.2.4 Identified Person or Device Macro

Table C.17-3b defines the Attributes that identify a person or a device participating as an observer for the context of an SR Instance. This macro contains content equivalent to TID 1002 (see PS3.16).

Table C.17-3bIdentified Person or Device Macro Attributes

Attribute Name Tag Type Attribute Description
Observer Type (0040,A084) 1 Enumerated Values: PSN - Person DEV - Device
Person Name (0040,A123) 1C Name of the person observer for this document Instance. Required if Observer Type value is PSN.
Person Identification Code Sequence (0040,1101) 2C Coded identifier of person observer. Zero or one Item shall be included in this sequence. Required if Observer Type value is PSN.
>Include 'Code Sequence Macro' Table 8.8-1 No Baseline Context ID defined
Station Name (0008,1010) 2C Name of the device observer for this document instance. Required if Observer Type value is DEV.
Device UID (0018,1002) 1C Unique identifier of device observer. Required if Observer Type value is DEV.
Manufacturer (0008,0070) 1C Manufacturer of the device observer. Required if Observer Type value is DEV.
Manufacturer’s Model Name (0008,1090) 1C Model Name of the device observer. Required if Observer Type value is DEV.
Institution Name (0008,0080) 2 Institution or organization to which the identified person is responsible or accountable, or which manages the identified device.
Institution Code Sequence (0008,0082) 2 Institution or organization to which the identified person is responsible or accountable, or which manages the identified device. Zero or one Item shall be included in this Sequence.
>Include 'Code Sequence Macro' Table 8.8-1 No Baseline Context ID defined

C.17.2.5 Verifying Observer, Author Observer, and Participant Sequences

The Verifying Observer Sequence (0040,A073), Author Observer Sequence (0040,A078), and Participant Sequence (0040,A07A) identify significant contributors to the SR document. The Author creates the clinical content of the document. The Verifying Observer verifies and accepts legal responsibility for the content. Other participants may include an Attestor, a person identified as a Participant who “signs” an SR document, but who does not have legal authority to verify the clinical content. E.g., an SR document may be authored and attested by a resident, and then verified by a staff physician; or a document may be authored by a CAD device and attested by a technologist, and then verified by a physician; or a technologist working with a measurement software package may be the author, the package is a Source participant, and the final content is verified by a physician.

An individual shall not be identified in both the Verifying Observer Sequence (as the legal authenticator) and in the Participant Sequence as an Attestor. An individual may be identified in both the Author Observer Sequence and either the Verifying Observer Sequence or the Participant Sequence.

The participation DateTime for the Verifying Observer is conveyed in Verification DateTime (0040,A030) within the Verifying Observer Sequence, for the Author Observer in the Observation DateTime (0040,A032) in the main Data Set (see C.17.3), and for other participants in Participation DateTime (0040,A082) within the Participant Sequence.

C.17.2.6 Equivalent CDA Document

The Referenced Instance Sequence (0008,114A) with a Purpose of Reference Code Sequence value of (121331, DCM, “Equivalent CDA Document”) identifies an HL7 Clinical Document Architecture (CDA) Document that contains clinical content equivalent to this SR Document SOP Instance. This referenced CDA Document may be a source document that was transformed to create this SR Document, or it may be a transcoding of the content created simultaneously for both the SR Document and the CDA Document.

Notes: 1. Reference to a CDA Document created as a transcoding of the SR Document subsequent to the creation of the SR SOP Instance would not be encodable in that SOP Instance.

2. There is no requirement that the transform or transcoding between DICOM SR and HL7 CDA be reversible. In particular, some attributes of the DICOM Patient, Study, and Series IEs have no corresponding standard encoding in the HL7 CDA Header, and vice versa. Such data elements, if transcoded, may need to be encoded in implementation-dependent “local markup” (in HL7 CDA) or private data elements (in DICOM SR) in an implementation-dependent manner; some such data elements may not be transcoded at all. It is a responsibility of the transforming application to ensure clinical equivalence.

3. Due to the inherent differences between DICOM SR and HL7 CDA, a transcoded document should have a different UID than the source document.

The Referenced SOP Instance UID (0008,1155) in Items of this Sequence is mapped to the native HL7 Instance Identifier through the HL7 Structured Document Reference Sequence (0040,A390) of the SOP Common Module (see Section C.12.1).