C.8.11.7 Mammography Image Module

Table C.8-74 contains IOD Attributes that describe a Digital Mammography X-Ray Image including its acquisition and positioning.

Table C.8-74MAMMOGRAPHY IMAGE MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Image Type (0008,0008) 1 Image identification characteristics. See C.8.11.7.1.4 for specialization.
Positioner Type (0018,1508) 1 Enumerated Values: MAMMOGRAPHIC NONE
Distance Source to Detector (0018,1110) 3 Distance in mm from source to detector center on the chest wall line Notes: 1. This value is traditionally referred to as Source Image Distance (SID). 2. See C.8.11.7.1.1.
Distance Source to Patient (0018,1111) 3 Distance in mm from source to the bucky side that is closest to the Imaging Subject, as measured along the X-Ray beam vector. Notes: 1. This value is traditionally referred to as Source Object Distance (SOD). 2. See notes for this attribute in C.8.11.5 DX Positioning Module. 3. See C.8.11.7.1.1 for description of X-Ray beam vector.
Positioner Primary Angle (0018,1510) 3 Position in degrees of the X-Ray beam vector in the coronal anatomical plane as if the patient were standing where movement of the X-Ray source from right to vertical is positive, and vertical is zero.
Positioner Secondary Angle (0018,1511) 3 Position in degrees of the X-Ray beam vector in the sagittal anatomical plane as if the patient were standing where movement of the X-Ray source from anterior to posterior is positive, and vertical is zero.
Image Laterality (0020,0062) 1 Laterality of the region examined. Enumerated Values: R = right L = left B = both (e.g. cleavage)
Organ Exposed (0040,0318) 1 Organ to which Organ Dose (0040,0316) applies. Enumerated Value: BREAST Note: In the Mammography IOD, Organ Dose (0040,0316) refers to the mean glandular dose.
Breast Implant Present (0028,1300) 3 Whether or not the imaged breast contains a breast implant regardless of the visibility of a breast implant in the Pixel Data. Enumerated Values: YES NO Note: The value is expected to be YES for all images acquired on a breast that contains a breast implant, even when a breast implant is displaced during image acquisition.
Partial View (0028,1350) 3 Indicates whether this image is a partial view, that is a subset of a single view of the breast. Enumerated Values: YES, NO If this Attribute is absent, then the image may or may not be a partial view. Note: This may occur when a breast is larger than the active area of the detector. If this Attribute is present, its value shall be NO if there is a View Modifier Code Sequence (0054,0222) Item of value (R-102D6, SRT, “Magnification”) or (R-102D7, SRT, “Spot Compression”). Note: SRT is the preferred designator for SNOMED, but SNM3 is allowed for backward compatibility. See PS 3.16.
Partial View Description (0028,1351) 3 Free text description of the portion of the breast captured in a partial view image. This Attribute shall not be present if there is a View Modifier Code Sequence (0054,0222) Item of value (R-102D6, SRT, “Magnification”) or (R-102D7, SRT, “Spot Compression”). Note: SRT is the preferred designator for SNOMED, but SNM3 is allowed for backward compatibility. See PS 3.16.
Partial View Code Sequence (0028,1352) 3 Sequence that describes the portion or section of the breast captured in a partial view image. Only one or two Items are permitted in this sequence. See C.8.11.7.1.3. If this Attribute is absent, then the image may or may not be a partial view. This Attribute shall not be present if there is a View Modifier Code Sequence (0054,0222) Item of value (R-102D6, SRT, “Magnification”) or (R-102D7, SRT, “Spot Compression”). Note: SRT is the preferred designator for SNOMED, but SNM3 is allowed for backward compatibility. See PS 3.16.
>Include ‘Code Sequence Macro’ (Table 8.8-1). Defined CID 4005.
Include 'General Anatomy Mandatory Macro' Table 10-5 Defined Context ID for the Anatomic Region Sequence is CID 4013.
View Code Sequence (0054,0220) 1 Sequence that describes the projection of the anatomic region of interest on the image receptor. Only a single Item shall be included in this Sequence.
>Include ‘Code Sequence Macro’ Table 8.8-1. Defined CID 4014.
>View Modifier Code Sequence (0054,0222) 2 View modifier. Zero or more Items shall be included in this Sequence.
>>Include ‘Code Sequence Macro’ Table 8.8-1. Defined CID 4015.

C.8.11.7.1 Mammography Image Attribute Descriptions

C.8.11.7.1.1 Mammography X-Ray Beam and X-Ray Beam Vector Definition

Figure C.8-8 shows the X-Ray beam for a digital mammography system. The X-Ray beam vector is defined from the Focal Spot to the center of the chest wall line of the Image Detection device.

[pic]

Figure C.8-8

C.8.11.7.1.2 Detector Primary and Secondary Angles

Detector Angles are defined in a fashion similar to the positioner angles, except that the angle of the x-ray beam vector is relative to the detector plane rather than the patient plane. Zero degrees is referenced to the normal of the detector plane pointing toward the x-ray source. The valid range of the Detector Angles is -90 to + 90 degrees.

The Primary Axis of rotation is defined along the line in the column direction of the detector plane which intersects the x-ray beam vector. The Detector Primary Angle is defined in the plane perpendicular to the Primary Axis of rotation at the point where the x-ray beam vector intersects the detector plane, with zero degrees in the direction normal to the detector plane and +90 in the direction of the higher numbered columns of the detector in that plane. The valid range of Detector Primary Angle is -90 to +90 degrees.

The Secondary Axis is in the detector plane and is perpendicular to the Primary Axis at the intersection of the beam vector with the detector plane (i.e., it is along the row direction). The Detector Secondary Angle is defined in the plane perpendicular to the Secondary Axis at the point where the x-ray beam vector intersects the detector plane, with zero degrees in the direction normal to the detector plane. +90 degrees corresponds to the direction of the lower numbered rows of the detector in that plane. The Detector Secondary Angle range is -90 to + 90 degrees.

C.8.11.7.1.3 Partial View Code Sequence

Combinations of coded terms may be used in the Partial View Code Sequence (0028,1352) to express the breast section imaged. Figure C.8.11.7-2 shows examples for the right and left FB, XCC, XCCL and XCCM views, and Figure C.8.11.7-3 shows examples for the right and left ML, MLO, LM, LMO, SIO and ISO views.

Partial View Code Sequence Items (Code Meaning) Partial View Images (A, B, C, D, E)
A) item 1 = Lateral B) item 1 = Medial [pic]
A) item 1 = Posterior B) item 1 = Anterior [pic]
A) item 1 = Lateral, item 2 = Posterior B) item 1 = Medial, item 2 = Posterior C) item1 = Anterior [pic]
A) item 1 = Lateral, item 2 = Posterior B) item 1 = Medial, item 2 = Posterior C) item 1 = Lateral, item 2 = Anterior D) item 1 = Medial, item 2 = Anterior [pic]
A) item 1 = Lateral, item 2 = Posterior B) item 1 = Central, item 2 = Posterior C) item 1 = Medial, item 2 = Posterior D) item 1 = Lateral, item 2 = Anterior E) item 1 = Medial, item 2 = Anterior [pic]

Note: If six images are required, then the “Central, Anterior” combination would be added.

Figure C.8.11.7-2 - CC, FB, XCCL and XCCM partial views

Partial View Code Sequence Items (Code Meaning) Partial View Images (A, B, C, D, E)
A) item 1 = Superior B) item 1 = Inferior [pic]
A) item 1 = Posterior B) item 1 = Anterior [pic]
A) item 1 = Superior, item 2 = Posterior B) item1 = Inferior, item 2 = Posterior C) item 1 = Anterior [pic]
A) item 1 = Superior, item 2 = Posterior B) item 1 = Inferior, item 2 = Posterior C) item 1 = Superior, item 2 = Anterior D) item 1 = Inferior, item 2 = Anterior [pic]
A) item 1 = Superior, item 2 = Posterior B) item 1 = Central, item 2 = Posterior C) item 1 = Inferior, item 2 = Posterior D) item 1 = Superior, item 2 = Anterior E) item 1 = Inferior, item 2 = Anterior [pic]

Note: If six images are required, then the “Central, Anterior” combination would be added.

Figure C.8.11.7-3 - ML, MLO, LM, LMO, SIO and ISO partial views

C.8.11.7.1.4 Image Type

Image Type (0008,0008) Value 1 and Value 2 shall identify the Pixel Data Characteristics in accordance with Section C.8.11.3.1.1.

Value 3 shall be present and have zero length (null value), except when used to identify a stereotactic mammography image.

Note: In a previous version of PS 3.3, Value 3 was required to be zero length (null value). If Value 3 is zero length, the image may or may not be a stereotactic mammography image, if the Instance was created before these terms were defined.

The Enumerated Values for Value 3 of stereotactic mammography images are listed in Table C.8-74a:

Table C.8-74a

Image Type (0008,0008) Value 3 for stereotactic mammography

Enumerated Value Definition ACR MQCM Equivalent
STEREO_SCOUT A localizer image for a stereotactic acquisition. …SC
STEREO_MINUS The paired image obtained with the X-Ray source angle decreased from the scout position, to determine positioning coordinates prior to needle positioning. …ST-
STEREO_PLUS The paired image obtained with the X-Ray source angle increased from the scout position, to determine positioning coordinates prior to needle positioning. …ST+
PREFIRE_MINUS The paired image obtained with the X-Ray source angle decreased from the scout position, with the biopsy needle in position prior to needle deployment. …PRF-
PREFIRE_PLUS The paired image obtained with the X-Ray source angle increased from the scout position, with the biopsy needle in position prior to needle deployment. …PRF+
POSTFIRE_MINUS The paired image obtained with the X-Ray source angle decreased from the scout position, with the biopsy needle in position following needle deployment through the targeted lesion. …POF-
POSTFIRE_PLUS The paired image obtained with the X-Ray source angle increased from the scout position, with the biopsy needle in position following needle deployment through the targeted lesion. …POF+
POSTBIOPSY_MINUS The image obtained following tissue acquisition with the X-Ray source angle decreased from the scout position. …POB-
POSTBIOPSY_PLUS The image obtained following tissue acquisition with the X-Ray source angle increased from the scout position. …POB+
POSTBIOPSY The image obtained following tissue acquisition with the X-Ray source in the scout position. …POB