C.17.3.2 Content Item Attributes

Each Content Item contains:

- name/value pair, consisting of

- a single Concept Name Code Sequence (0040,A043) that is the name of a name/value pair or a heading,

- a value (text, codes, etc.),

- references to images, waveforms or other composite objects, with or without coordinates,

- relationships to other Items, either

- by-value through nested Content Sequences, or

- by-reference.

C. Content Item Value Type

The value of the name/value pair is encoded with one of the Value Types defined in Table C.17.3-7 (the choice of which may be constrained by the IOD in which this Module is contained). The Value Type (0040,A040) attribute explicitly conveys the type of Content Item value encoding.


Value Type Concept Name Concept Value Description
TEXT Type of text, e.g. "Findings", or name of identifier, e.g. “Lesion ID” Textual expression of the concept Free text, narrative description of unlimited length. May also be used to provide a label or identifier value.
NUM Type of numeric value or measurement, e.g. "BPD" Numeric value and associated Unit of Measurement Numeric value fully qualified by coded representation of the measurement name and unit of measurement.
CODE Type of code, e.g. "Findings" Coded expression of the concept Categorical coded value. Representation of nominal or non-numeric ordinal values.
DATETIME Type of DateTime, e.g. "Date/Time of onset" Concatenated date and time Date and time of occurrence of the type of event denoted by the Concept Name.
DATE Type of Date, e.g. "Birth Date" Calendar date Date of occurrence of the type of event denoted by the Concept Name.
TIME Type of Time, e.g "Start Time" Time of day Time of occurrence of the type of event denoted by the Concept Name.
UIDREF Type of UID, e.g "Study Instance UID" Unique Identifier Unique Identifier (UID) of the entity identified by the Concept Name.
PNAME Role of person, e.g., "Recording Observer" Name of person Person name of the person whose role is described by the Concept Name.
COMPOSITE Purpose of Reference Reference to UIDs of Composite SOP Instances A reference to one Composite SOP Instance which is not an Image or Waveform.
IMAGE Purpose of Reference Reference to UIDs of Image Composite SOP Instances A reference to one Image. IMAGE Content Item may convey a reference to a Softcopy Presentation State associated with the Image.
WAVEFORM Purpose of Reference Reference to UIDs of Waveform Composite SOP Instances A reference to one Waveform.
SCOORD Purpose of Reference Listing of spatial coordinates Spatial coordinates of a geometric region of interest in the DICOM image coordinate system. The IMAGE Content Item from which spatial coordinates are selected is denoted by a SELECTED FROM relationship.
SCOORD3D Purpose of reference Listing of spatial 3D coordinates 3D spatial coordinates (x,y,z) of a geometric region of interest in a Reference Coordinate System.
TCOORD Purpose of Reference Listing of temporal coordinates Temporal Coordinates (i.e. time or event-based coordinates) of a region of interest in the DICOM waveform coordinate system. The WAVEFORM or IMAGE or SCOORD Content Item from which Temporal Coordinates are selected is denoted by a SELECTED FROM relationship.
CONTAINER Document Title or document section heading. Concept Name conveys the Document Title (if the CONTAINER is the Document Root Content Item) or the category of observation. The content of the CONTAINER. The value of a CONTAINER Content Item is the collection of Content Items that it contains. CONTAINER groups Content Items and defines the heading or category of observation that applies to that content. The heading describes the content of the CONTAINER Content Item and may map to a document section heading in a printed or displayed document.

Note: It is recommended that drawings and sketches, sometimes used in reports, be represented byIMAGE Content Items that reference separate SOP Instances (e.g., 8-bit, MONOCHROME2, Secondary Capture, or Multi-frame Single Bit Secondary Capture).

C. Concept Name Code Sequence

The Concept Name Code Sequence (0040,A043) conveys the name of the concept whose value is expressed by the value attribute or set of attributes. Depending on the Value Type (0040,A040), the meaning of the Concept Name Code Sequence may reflect specifics of the use of the particular data type (see Table C.17.3-7).

C. Continuity of Content

See Section C.

C. Content Sequence and Relationship Type

The Content Sequence (0040,A730) provides the hierarchical structuring of the Content Tree (see C.17.3.1) by recursively nesting Content Items. A parent (or source) Content Item has an explicit relationship to each child (or target) Content Item, conveyed by the Relationship Type (0040,A010) attribute.

Table C.17.3-8 describes the Relationship Types between Source Content Items and the Target Content Items.


Relationship Type Description Definition and Example
CONTAINS Contains Source Item contains Target Content Item. E.g.: CONTAINER "History" {CONTAINS: TEXT “mother had breast cancer”, CONTAINS: IMAGE}
HAS OBS CONTEXT Has Observation Context Target Content Items shall convey any specialization of Observation Context needed for unambiguous documentation of the Source Content Item. E.g: CONTAINER "Report" {HAS OBS CONTEXT: PNAME “Recording Observer” = “Smith^John^^Dr^”}
HAS CONCEPT MOD Has Concept Modifier Used to qualify or describe the Concept Name of the Source Content item, such as to create a post-coordinated description of a concept, or to further describe a concept. E.g. CODE "Chest X-Ray" {HAS CONCEPT MOD: CODE "View = PA and Lateral"} E.g. CODE "Breast" {HAS CONCEPT MOD: TEXT "French Translation" = "Sein"} E.g. CODE "2VCXRPALAT" {HAS CONCEPT MOD: TEXT "Further Explanation" = "Chest X-Ray, Two Views, Postero-anterior and Lateral"}
HAS PROPERTIES Has Properties Description of properties of the Source Content Item. E.g: CODE "Mass" {HAS PROPERTIES: CODE “anatomic location”, HAS PROPERTIES: CODE “diameter”, HAS PROPERTIES: CODE “margin”, ...}.
HAS ACQ CONTEXT Has Acquisition Context The Target Content Item describes the conditions present during data acquisition of the Source Content Item. E.g: IMAGE {HAS ACQ CONTEXT: CODE “contrast agent”, HAS ACQ CONTEXT: CODE “position of imaging subject”, ...}.
INFERRED FROM Inferred From Source Content Item conveys a measurement or other inference made from the Target Content Items. Denotes the supporting evidence for a measurement or judgment. E.g: CODE "Malignancy" {INFERRED FROM: CODE "Mass", INFERRED FROM: CODE "Lymphadenopathy",...}. E.g: NUM: "BPD” = “5mm" {INFERRED FROM: SCOORD}.
SELECTED FROM Selected From Source Content Item conveys spatial or temporal coordinates selected from the Target Content Item(s). E.g: SCOORD "POLYLINE1,1 5,10 5,10 1,10 1,1" {SELECTED FROM: IMAGE}. E.g: TCOORD "SEGMENT 60-200mS" {SELECTED FROM: WAVEFORM}.

C. Referenced Content Item Identifier

Content Items are identified by their position in the Content Item tree. They have an implicit order as defined by the order of the Sequence Items. When a Content Item is the target of a by-reference relationship, its position is specified in the Referenced Content Item Identifier (0040,DB73) in a Content Sequence Item subsidiary to the source Content Item.

Note: Figure C.17.3-3 illustrates an SR content tree and identifiers associated with each Content Item:


Figure C.17.3-3 Use of Position as SR Content Item Identifier (Informative)