C.8.11 DX Modules

C.8.11.1 DX Series Module

The Digital X-Ray IODs use the General Series module described in section C.7.3.1, specialized by the DX Series Module, to describe the DICOM Series Entity described in A.1.2.3, and to define what constitutes a Series for the context of projection Digital X-Ray.

Note: In an abstract sense, a series may be viewed from the perspective of an acquisition device or a display device.

In the former case, it is convenient to group images related by commonality of acquisition parameters, such as the imaging subject’s physical relationship to the equipment (such as a patient lying in a particular position with respect to the equipment), a single acquisition initiation (such as an MR pulse sequence or spiral CT run), or a single workflow action on the part of the operator (such as the reading of a collection of CR plates from the same examination).

In the latter case, it is often convenient to organize images for viewing or browsing into series based upon other criteria such as physical or temporal proximity that may not necessarily correspond with the order or grouping in which the images were acquired.

This conflict is most apparent in the existing CR Image IOD C.8.1, where the definition of View Position at the Series Level in CR Series C.8.1.1 implies, for example, that a Lateral and PA Chest X-Ray may not be grouped into a single series. While this may be in keeping with the traditional CT and MR notions that a change in an imaging subject’s physical orientation with respect to the imaging equipment implies a new series, it is most unnatural from the point of view of a reader viewing or browsing a collection of projection radiographic images.

A similar example pertains in the case of the traditional set of views of the maxillary and mandibular dentition, in which all the images are logically grouped in one sequence, but the imaging equipment moves with respect to the imaging subject, and the size of the detector may vary between images.

Accordingly, the constraint (apparent from the CT, MR and CR IODs) that a change in position, detector, body part or laterality implies a new series has been relaxed in the DX IODs, through the use of the DX Anatomy Imaged Module and the DX Positioning Module which define Attributes at the Image level that specify these concepts with finer granularity. This approach is consistent with that used in the XA, XRF, US and NM IODs.

Images within a series are still required, if the Condition for the inclusion of the Frame of Reference Module is met, to be relative to the same Frame of Reference.

Table C.8-68 specifies the Attributes that identify and describe general information about the DX Series.

Table C.8-68DX SERIES MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Modality (0008,0060) 1 Type of equipment that originally acquired the data used to create the images in this Series. Enumerated Values: DX PX IO MG See section C.7.3.1.1.1 for further explanation.
Referenced Performed Procedure Step Sequence (0008,1111) 1C Uniquely identifies the Performed Procedure Step SOP Instance to which the Series is related (e.g. a Modality or General-Purpose Performed Procedure Step SOP Instance). Only a single Item shall be included in this sequence. Required if the Modality Performed Procedure Step SOP Class, General Purpose Performed Procedure Step SOP Class is supported.
>Include ‘SOP Instance Reference Macro' Table 10-11
Presentation Intent Type (0008,0068) 1 Identifies the intent of the images that are contained within this Series. Enumerated Values: FOR PRESENTATION FOR PROCESSING See C.8.11.1.1.1 for further explanation.

C.8.11.1.1 DX Series Attribute Descriptions

C.8.11.1.1.1 Presentation Intent Type

Presentation Intent Type (0008,0068) shall identify the intent for the purposes of display or other presentation of all Images within this Series.

Notes: 1. Since this is a Series level attribute, all Images within a Series have the same value for this Attribute.

2. The intent of this restriction is to ensure that FOR PRESENTATION and FOR PROCESSING images are placed in separate Series, so that no confusion can arise as to which images are suitable for diagnostic reading as determined by local policy.

A Series of Images intended for viewing by an observer, after application of any grayscale transformations specified in the image object such as VOI LUT, shall have an Enumerated Value of FOR PRESENTATION.

Notes: 1. These images may still be of Image Type (0008,0008) ORIGINAL rather than DERIVED despite the possibility that they may have undergone some processing, such as unsharp masking. In this case a DERIVED image would have undergone yet further processing to make it substantially different from the original. See Figure C.8-13.

2. These images may still be subjected to processing or further processing, if appropriate, depending on the application.

3. These images are intended for display on a device, without (further) processing, since that device may not be capable of image processing. The quality of the displayed image or its suitability for any purpose is beyond the scope of the DICOM Standard.

Images that have been corrected to account for characteristics of the detector but which are intended to be further processed before being displayed, shall have an Enumerated Value of FOR PROCESSING.

Note: This type is provided to allow the functions of image acquisition and image processing for presentation to be separated and yet have images conveyed between the two processes using a DICOM object. Individual sites or users may choose to substitute their own specialized processing in place of that supplied by the implementor.

Images available at this stage of processing may be useful for quality control and problem solving purposes, as well as academic research.

Images of this type may also be archived, retrieved and processed with different algorithms or parameters in order to alter the appearance of specific features for clinical purposes.

The nature of the detector correction that may have been applied before sending an image of type FOR PROCESSING is not specified. In particular, acquisitions that acquire several sets of matrices of pixel values (such as image data, gain offset and a defect map) must perform some processing (detector correction) before a DX Image object can be instantiated.

The nature of the processing that may have been applied before sending an image of type FOR PRESENTATION is also not specified.

It is expected that individual implementors will use Private Attributes to convey specifics of the processing applied that may be of use for further processing by those aware of the parameters and algorithms. The diversity of detector types and processing algorithms make it undesirable to standardize such parameters.

Whether or not the spatial locations of all pixels are preserved during the processing of the source image that resulted in the current image can be indicated by Spatial Locations Preserved (0028,135A) in a Source Image Sequence (0008,2112) reference from the FOR PRESENTATION image to a FOR PROCESSING predecessor.

If images from the same exposure exist with different Values of Presentation Intent Type (0008,0068), then they shall have different SOP Instance UIDs.

Notes: 1. Source Image Sequence (0008,2112) may be used to relate these images.

2. The SOP Class UIDs of the two images will also be different.

[pic]

Figure C.8-13 - Explanation of Presentation Intent Type

C.8.11.2 DX Anatomy Imaged Module

Table C.8-69 contains IOD Attributes that describe the anatomy contained in a DX IOD.

Table C.8-69DX ANATOMY IMAGED MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Image Laterality (0020,0062) 1 Laterality of (possibly paired) body part (as described in Anatomic Region Sequence (0008,2218)) examined. Enumerated Values: R = right L = left U = unpaired B = both left and right Note: This Attribute is mandatory, in order to ensure that images may be positioned correctly relative to one another for display. Shall be consistent with any laterality information contained in Primary Anatomic Structure Modifier Sequence (0008,2230), if present. Note: Laterality (0020,0060) is a Series level Attribute and must be the same for all Images in the Series, hence it must be absent.
Include 'General Anatomy Required Macro' Table 10-6 Defined Context ID for the Anatomic Region Sequence is 4009 for humans, and 7482 for animals. This is the anatomic region that is placed on the table or bucky for examination. Note: It is strongly recommended that Anatomic Region Sequence (0008,2218) be sent with a value, in order to ensure that images may be positioned correctly relative to one another for display.

C.8.11.2.1 DX Anatomy Imaged Attribute Descriptions

The Attributes in this Module extend the function of Body Part Examined (0018,0015) as used in other IODs, and are intended to be used to facilitate the management of images and series in terms of routing, storage and display, as well as to dictate certain Conditions on Attributes and Modules in the DX IOD.

C.8.11.3 DX Image Module

Table C.8-70 contains IOD Attributes that describe a DX Image by specializing Attributes of the General Image and Image Pixel Modules, and adding additional Attributes.

Table C.8-70DX IMAGE MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Image Type (0008,0008) 1 Image identification characteristics. See C.8.11.3.1.1 for specialization.
Samples per Pixel (0028,0002) 1 Number of samples in this image. Shall have an Enumerated Value of 1.
Photometric Interpretation (0028,0004) 1 Specifies the intended interpretation of the pixel data. Enumerated Values: MONOCHROME1 MONOCHROME2
Bits Allocated (0028,0100) 1 Number of bits allocated for each pixel sample. Enumerated Values: 8, 16
Bits Stored (0028,0101) 1 Number of bits stored for each pixel sample. Enumerated Values: 6 to 16
High Bit (0028,0102) 1 Most significant bit for pixel sample data. Shall have an Enumerated Value of one less than the value in Bit Stored (0028,0101).
Pixel Representation (0028,0103) 1 Data representation of the pixel samples. Shall have the Enumerated Value: 0000H = Unsigned Integer.
Pixel Intensity Relationship (0028,1040) 1 The relationship between the Pixel sample values and the X-Ray beam intensity. Enumerated Values: LIN = Linearly proportional to X-Ray beam intensity LOG = Logarithmically proportional to X-Ray beam intensity See C.8.11.3.1.2 for further explanation.
Pixel Intensity Relationship Sign (0028,1041) 1 The sign of the relationship between the Pixel sample values stored in Pixel Data (7FE0,0010) and the X-Ray beam intensity. Enumerated Values; 1 = Lower pixel values correspond to less X-Ray beam intensity -1 = Higher pixel values correspond to less X-Ray beam intensity See C.8.11.3.1.2 for further explanation.
Rescale Intercept (0028,1052) 1 The value b in the relationship between stored values (SV) in Pixel Data (7FE0,0010) and the output units specified in Rescale Type (0028,1054). Output units = m*SV + b. Enumerated Value: 0 See C.8.11.3.1.2 for further explanation.
Rescale Slope (0028,1053) 1 m in the equation specified by Rescale Intercept (0028,1052). Enumerated Value: 1 See C.8.11.3.1.2 for further explanation.
Rescale Type (0028,1054) 1 Specifies the output units of Rescale Slope (0028,1053) and Rescale Intercept (0028,1052). Enumerated Value: US = Unspecified See C.8.11.3.1.2 for further explanation.
Presentation LUT Shape (2050,0020) 1 Specifies an identity transformation for the Presentation LUT, other than to account for the value of Photometric Interpretation (0028,0004), such that the output of all grayscale transformations defined in the IOD containing this Module are defined to be P-Values. Enumerated Values: IDENTITY - output is in P-Values - shall be used if Photometric Interpretation (0028,0004) is MONOCHROME2. INVERSE - output after inversion is in P-Values - shall be used if Photometric Interpretation (0028,0004) is MONOCHROME1. See C.8.11.3.1.2 for further explanation.
Lossy Image Compression (0028,2110) 1 Specifies whether an Image has undergone lossy compression. Enumerated Values: 00 = Image has NOT been subjected to lossy compression. 01 = Image has been subjected to lossy compression. See C.7.6.1.1.5 for further explanation.
Lossy Image Compression Ratio (0028,2112) 1C See C.7.6.1.1.5 for further explanation. Required if Lossy Compression has been performed on the Image.
Derivation Description (0008,2111) 3 A text description of how this image was derived. See C.8.11.3.1.4 for further explanation.
Acquisition Device Processing Description (0018,1400) 3 Indicates any visual processing performed on the images prior to exchange. See C.8.11.3.1.3 for further explanation.
Acquisition Device Processing Code (0018,1401) 3 Code representing the device-specific processing associated with the image (e.g. Organ Filtering code) Note: This Code is manufacturer specific but provides useful annotation information to the knowledgeable observer.
Patient Orientation (0020,0020) 1C Patient direction of the rows and columns of the image. See C.7.6.1.1.1 for further explanation. Required if View Code Sequence (0054,0220) is not present or is present with an Item value other than (G-8300, SRT, “tissue specimen”) or (G-8310, SRT, “tissue specimen from breast”). May be present otherwise.
Calibration Image (0050,0004) 3 Indicates whether a reference object (phantom) of known size is present in the image and was used for calibration. Enumerated Values: YES NO Device is identified using the Device module. See C.7.6.12 for further explanation.
Burned In Annotation (0028,0301) 1 Indicates whether or not image contains sufficient burned in annotation to identify the patient and date the image was acquired. Enumerated Values: YES NO
VOI LUT Sequence (0028,3010) 1C Defines a sequence of VOI LUTs. See C.8.11.3.1.5 for further explanation. One or more Items shall be included in this Sequence. Required if Presentation Intent Type (0008,0068) is FOR PRESENTATION and Window Center (0028,1050) is not present. May also be present if Window Center (0028,1050) is present.
>LUT Descriptor (0028,3002) 1 Specifies the format of the LUT Data in this Sequence. See C.8.11.3.1.5 for further explanation.
>LUT Explanation (0028,3003) 3 Free form text explanation of the meaning of the LUT.
>LUT Data (0028,3006) 1 LUT Data in this Sequence.
Window Center (0028,1050) 1C Defines a Window Center for display. See C.8.11.3.1.5 for further explanation. Required if Presentation Intent Type (0008,0068) is FOR PRESENTATION and VOI LUT Sequence (0028,3010) is not present. May also be present if VOI LUT Sequence (0028,3010) is present.
Window Width (0028,1051) 1C Window Width for display. See C.8.11.3.1.5 for further explanation. Required if Window Center (0028,1050) is sent.
Window Center & Width Explanation (0028,1055) 3 Free form explanation of the meaning of the Window Center and Width. Multiple values correspond to multiple Window Center and Width values.

C.8.11.3.1 DX Image Attribute Descriptions

C.8.11.3.1.1 Image Type

Value 1 shall identify the Pixel Data Characteristics in accordance with Section C.7.6.1.1.2 where the Enumerated Values are defined to be ORIGINAL or DERIVED.

Note: DX images may still be of type ORIGINAL rather than DERIVED despite the possibility that they may have undergone some processing. In this case a DERIVED image would have undergone yet further processing to make it substantially different from the original.

Value 2 shall identify the Patient Examination Characteristics in accordance with Section C.7.6.1.1.2 where the Enumerated Values are defined to be PRIMARY or SECONDARY.

Note: DX images generally use PRIMARY value for images captured from patient exposure.

If images from the same exposure exist with different Values of Image Type, then they shall have different SOP Instance UIDs.

Note: Source Image Sequence (0008,2112) may be used to relate these images.

Value 3 (which is specific to the IOD) shall be present and have zero length (null value).

Other Values (4 and beyond) are optional and implementation specific.

C.8.11.3.1.2 Pixel Intensity Relationship and Grayscale Transformations

Pixel Intensity Relationship (0028,1040) and Pixel Intensity Relationship Sign (0028,1041) describe how the stored pixel values in Pixel Data (7FE0,0010) are related to the X-Ray beam intensity incident on the detector.

They do not define a transformation intended to be applied to the pixel data for presentation.

Note: For example, if Pixel Intensity Relationship (0028,1040) is LIN and Pixel Intensity Relationship Sign (0028,1041) is -1, then lower values of Pixel Data (7FE0,0010) indicate higher X-Ray beam intensities corresponding to less radiographically dense regions projected on the image such as through air, and higher values of Pixel Data (7FE0,0010) indicate lower X-Ray beam intensities corresponding to more radiographically dense regions projected on the image such as through bone and radio-opaque contrast agents.

The transformation to be applied to the pixel data for presentation is defined by the successive application of the conceptual Modality LUT, the VOI Attributes and the conceptual Presentation LUT. This shall result in the output of P-Values.

Rescale Slope (0028,1053) and Rescale Intercept (0028,1052) define a linear subset of a conceptual Modality LUT transformation. For IODs that include this Module, these Attributes define an identity transformation. IODs that include the DX Image Module shall not include the Modality LUT Module.

The Presentation LUT Shape (2050,0020) defines a subset of a conceptual Presentation LUT. For IODs that include this Module, this Attribute defines an identity transformation or inverse identity transformation. IODs that include the DX Image Module shall not include the Presentation LUT Module.

Photometric Interpretation (0028,0004) indicates whether lower values that are the output of the VOI Attributes should be displayed as darker or lighter. Since the output of the equivalent of a conceptual Presentation LUT is in P-Values, which are defined in PS 3.14 such that lower values correspond to lower luminance levels, then the definition of the Presentation LUT Shape (2050,0020), otherwise intended to be an identity transformation, must take into account the effect of the value specified for Photometric Interpretation (0028,0004).

Note: Regardless of the values of Pixel Intensity Relationship (0028,1040) and Pixel Intensity Relationship Sign (0028,1041), the grayscale transformations to be applied to the Pixel Data (7FE0,0010) are defined by the equivalent of the Modality LUT (Rescale Slope (0028,1053) and Rescale Intercept (0028,1052)), Value of Interest Attributes, Photometric Interpretation (0028,0004) and the equivalent of the Presentation LUT (Presentation LUT Shape (2050,0020)). However, the combination of the grayscale transformations and the description of the pixel intensity relationship, together define whether, for example, air is expected to be displayed as black or white.

C.8.11.3.1.3 Acquisition Device Processing Description

Acquisition Device Processing Description (0018,1400) provides some indication in human readable text of the digital processing on the images before exchange. Examples of this processing are: edge enhanced, subtracted, time filtered, gamma corrected, convolved (spatially filtered).

C.8.11.3.1.4 Derivation Description

If an Image is identified to be a Derived image in Image Type (0008,0008), Derivation Description (0008,2111) is an optional and implementation specific text description of the way the image was derived from an original image. As applied to DX images, it may be used to describe derivation operations such as edge enhancement, temporal filtering, digital subtraction, or other linear and non-linear transformations.

C.8.11.3.1.5 VOI Attributes

The Attributes of the VOI LUT Module (C.11.2) are specialized in the DX Image Module.

Window Center (0028,1050) and Window Width (0028,1051) specify a linear conversion (unless otherwise specified by the value of VOI LUT Function (0028,1056); see C.11.2.1.3) from the output of the (conceptual) Modality LUT values to the input to the (conceptual) Presentation LUT. Window Center contains the value that is the center of the window. Window Width contains the width of the window.

The application of the Window Center (0028,1050) and Window Width (0028,1051) shall not produce a signed result.

Note: If the Presentation LUT Shape (2050,0020) is IDENTITY, then the result of applying the Window Center (0028,1050) and Window Width (0028,1051) is P-Values.

If multiple values are present, both Attributes shall have the same number of values and shall be considered as pairs. Multiple values indicate that multiple alternative views should be presented.

The VOI LUT Sequence specifes a (potentially non-linear) conversion from the output of the (conceptual) Modality LUT values to the input to the (conceptual) Presentation LUT.

If multiple items are present in VOI LUT Sequence (0028,3010), only one shall be applied. Multiple items indicate that multiple alternative views should be presented.

If any VOI LUT Attributes are included by an Image, a Window Width and Window Center or the VOI LUT Table, but not both, shall be applied to the Image for display. Inclusion of both indicates that multiple alternative views should be presented.

The three values of the LUT Descriptor (0028,3002) describe the format of the LUT Data (0028,3006).

The first value is the number of entries in the lookup table.

The second value is the first stored pixel value mapped. This pixel value is mapped to the first entry in the LUT. All image pixel values less than the first value mapped are also mapped to the first entry in the LUT Data. An image pixel value one greater than the first value mapped is mapped to the second entry in the LUT Data. Subsequent image pixel values are mapped to the subsequent entries in the LUT Data up to an image pixel value equal to number of entries + first value mapped - 1 which is mapped to the last entry in the LUT Data. Image pixel values greater than number of entries + first value mapped are also mapped to the last entry in the LUT Data.

The third value specifies the number of bits for each entry in the LUT Data (analogous to “bits stored”). It shall be between 10-16. The LUT Data shall be stored in a format equivalent to 16 “bits allocated” and “high bit” equal to “bits stored” - 1. The third value conveys the range of LUT entry values. These unsigned LUT entry values shall range between 0 and 2 n -1, where n is the third value of the LUT Descriptor.

Notes: 1. The third value is restricted in the VOI LUT Module to 8 or 16 but is specialized here.

2. The first and second values are not specialized and are the same as in the VOI LUT Module.

The LUT Data (0028,3006) contains the LUT entry values.

C.8.11.4 DX Detector Module

Table C.8-71 contains IOD Attributes that describe a DX detector.

Table C.8-71DX DETECTOR MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Include ‘Digital X-Ray Detector Macro’ Table C.8-71b
Detector Active Time (0018,7014) 3 Time in mSec that the detector is active during acquisition of this image. Note: This activation window overlaps the time of the X-Ray exposure as defined by Exposure Time (0018,1150) and Detector Activation Offset From Exposure (0018,7016).
Detector Activation Offset From Exposure (0018,7016) 3 Offset time in mSec that the detector becomes active after the X-Ray beam is turned on during acquisition of this image. May be negative.
Field of View Shape (0018,1147) 3 Shape of the Field of View, that is the image pixels stored in Pixel Data (7FE0,0010). Enumerated Values: RECTANGLE ROUND HEXAGONAL
Field of View Dimension(s) (0018,1149) 3 Dimensions in mm of the Field of View, that is the image pixels stored in Pixel Data (7FE0,0010). If Field of View Shape (0018,1147) is: RECTANGLE: row dimension followed by column. ROUND: diameter. HEXAGONAL: diameter of a circumscribed circle.
Field of View Origin (0018,7030) 1C Offset of the TLHC of a rectangle circumscribing the Field of View, that is the image pixels stored in Pixel Data (7FE0,0010), before rotation or flipping, from the TLHC of the physical detector area measured in physical detector pixels as a row offset followed by a column offset. Required if Field of View Rotation (0018,7032) or Field of View Horizontal Flip (0018,7034) is present. See C.8.11.4.1.1 for further explanation.
Field of View Rotation (0018,7032) 1C Clockwise rotation in degrees of Field of View, that is the image pixels stored in Pixel Data (7FE0,0010), relative to the physical detector. Enumerated Values: 0, 90, 180, 270 Required if Field of View Horizontal Flip (0018,7034) is present. See C.8.11.4.1.1 for further explanation.
Field of View Horizontal Flip (0018,7034) 1C Whether or not a horizontal flip has been applied to the Field of View, that is the image pixels stored in Pixel Data (7FE0,0010), after rotation relative to the physical detector as described in Field of View Rotation (0018,7032). Enumerated Values: NO YES Required if Field of View Rotation (0018,7032) is present. See C.8.11.4.1.1 for further explanation.
Imager Pixel Spacing (0018,1164) 1 Physical distance measured at the front plane of the detector housing between the center of each image pixel specified by a numeric pair - row spacing value(delimiter) column spacing value in mm. See 10.7.1.3 for further explanation of the value order. The value of this attribute shall never be adjusted to account for correction for the effect of geometric magnification or calibration against an object of known size; Pixel Spacing (0028,0030) is specified for that purpose.
Include Basic Pixel Spacing Calibration Macro (Table 10-10)
Cassette ID (0018,1007) 3 Identifier of the cassette that contains the photostimulable phosphor plate, for CR acquisitions.
Plate ID (0018,1004) 3 Identifier of the photostimulable phosphor plate, for CR acquisitions.

Table C.8-71b contains common attributes that describe digital X-Ray detector.

Table C.8-71bDIGITAL X-RAY DETECTOR MACRO ATTRIBUTES

Attribute Name Tag Type Attribute Description
Detector Type (0018,7004) 2 The type of detector used to acquire this image. Defined Terms: DIRECT = X-Ray photoconductor SCINTILLATOR = Phosphor used STORAGE = Storage phosphor FILM = Scanned film/screen
Detector Configuration (0018,7005) 3 The physical configuration of the detector. Defined Terms: AREA = single or tiled detector SLOT = scanned slot, slit or spot
Detector Description (0018,7006) 3 Free text description of detector.
Detector Mode (0018,7008) 3 Text description of operating mode of detector (implementation specific).
Detector ID (0018,700A) 3 The ID or serial number of the detector used to acquire this image.
Date of Last Detector Calibration (0018,700C) 3 The date on which the detector used to acquire this image as identified in Detector ID (0018,700A) was last calibrated.
Time of Last Detector Calibration (0018,700E) 3 The time at which the detector used to acquire this image as identified in Detector ID (0018,700A) was last calibrated.
Exposures on Detector Since Last Calibration (0018,7010) 3 Total number of X-Ray exposures that have been made on the detector used to acquire this image as identified in Detector ID (0018,700A) since it was calibrated.
Exposures on Detector Since Manufactured (0018,7011) 3 Total number of X-Ray exposures that have been made on the detector used to acquire this image as identified in Detector ID (0018,700A) since it was manufactured.
Detector Time Since Last Exposure (0018,7012) 3 Time in Seconds since an exposure was last made on this detector prior to the acquisition of this image.
Detector Binning (0018,701A) 3 Number of active detectors used to generate a single pixel. Specified as number of row detectors per pixel then column.
Detector Manufacturer Name (0018,702A) 3 Name of the manufacturer of the detector component of the acquisition system
Detector Manufacturer’s Model Name (0018,702B) 3 Model name of the detector component of the acquisition system
Detector Conditions Nominal Flag (0018,7000) 3 Whether or not the detector is operating within normal tolerances during this image acquisition. Enumerated Values: YES NO Note: This flag is intended to indicate whether or not there may have been some compromise of the diagnostic quality of the image due to some condition such as over-temperature, etc.
Detector Temperature (0018,7001) 3 Detector temperature during exposure in degrees Celsius.
Sensitivity (0018,6000) 3 Detector sensitivity in manufacturer specific units. Notes: 1. This value is intended to provide a single location where manufacturer specific information can be found for annotation on a display or film, that has meaning to a knowledgeable observer. 2. This value is manufacturer-specific. DICOM specifies standard Attributes in Table 10-23 ‘Exposure Index Macro’ which are recommended.
Detector Element Physical Size (0018,7020) 3 Physical dimensions of each detector element that comprises the detector matrix, in mm. Expressed as row dimension followed by column. Note: This may not be the same as Detector Element Spacing (0018,7022) due to the presence of spacing material between detector elements.
Detector Element Spacing (0018,7022) 3 Physical distance between the center of each detector element, specified by a numeric pair - row spacing value(delimiter) column spacing value in mm. See 10.7.1.3 for further explanation of the value order. Note: This may not be the same as the Imager Pixel Spacing (0018,1164), and should not be assumed to describe the stored image.
Detector Active Shape (0018,7024) 3 Shape of the active area. Enumerated Value: RECTANGLE ROUND HEXAGONAL Note: This may be different from the Field of View Shape (0018,1147), and should not be assumed to describe the stored image.
Detector Active Dimension(s) (0018,7026) 3 Dimensions in mm of the active area. If Detector Active Shape(0018,7024) is: RECTANGLE: row dimension followed by column. ROUND: diameter. HEXAGONAL: diameter of a circumscribed circle. Note: This may be different from the Field of View Dimensions (0018,1149), and should not be assumed to describe the stored image.
Detector Active Origin (0018,7028) 3 Offset of the TLHC of a rectangle circumscribing the active detector area from the TLHC of a rectangle circumscribing the physical detector area, measured in physical detector pixels as a row offset followed by a column offset. See C.8.11.4.1.1 for further explanation.
Include Table 10-23 ‘Exposure Index Macro’

C.8.11.4.1 DX Detector Attribute Descriptions

C.8.11.4.1.1 Physical, Active, Field of View, Exposed and Displayed Areas

The relationship between the Physical Detector Area, the Active Detector Area, the Field of View (what is stored in the Pixel Data (7FE0,0010)), the Exposed Area (after X-Ray Collimation) and the Displayed Area is illustrated in the following diagrams.

Note: Some of these Attributes relate the image data to manufacturer specific characteristics of the detector that may be used for quality control purposes, e.g. correlation of image artifacts with a detector defect map, analysis of noise performance, etc.

The Displayed Area is defined in pixel coordinates relative to the stored image pixel values by the Attributes of the Display Shutter Module (see section C.7.6.11). If this Module is not present or supported, then the Displayed Area is equal to the Field of View.

The Exposed Area is defined in pixel coordinates relative to the stored image pixel values by the Attributes of the X-Ray Collimator Module (see section C.8.7.3).

For the Digital X-Ray IODs, the Field of View is usually rectangular in shape and usually has the same size as the stored Pixel Data (7FE0,0010). The shape and size of the Field of View and the spacing of the pixels are defined by the following Attributes:

- Field of View Shape (0018,1147),

- Field of View Dimensions (0018,1149),

- Imager Pixel Spacing (0018,1164),

- Rows (0028,0010),

- Columns (0028,0011)

In the case where the Field of View has the same size as the stored Pixel Data (7FE0,0010) the following relationships are verified:

If the Field of View Shape (0018,1147) attribute equals RECTANGLE:

- Field of View Dimensions row dimension = Imager Pixel Spacing row spacing * Rows

- Field of View Dimensions column dimension = Imager Pixel Spacing column spacing * Columns

If the Field of View Shape (0018,1147) attribute equals ROUND or HEXAGONAL:

- Field of View Dimensions diameter = Imager Pixel Spacing row spacing * Rows

- Field of View Dimensions diameter = Imager Pixel Spacing column spacing * Columns

The following Attributes define the relationship of the Field of View to the Physical Detector Area:

- Field of View Origin (0018,7030),

- Field of View Rotation (0018,7032),

- Field of View Horizontal Flip (0018,7034).

For the Digital X-Ray IODs, the Active Area, i.e. that part of the detector matrix that was activated for this exposure, is usually rectangular in shape. The shape and size of the Active Area and the size and spacing of the detectors are defined by the following Attributes:

- Detector Active Shape (0018,7024),

- Detector Active Dimensions (0018,7026),

- Detector Element Physical Size (0018,7020),

- Detector Element Spacing (0018,7022).

Notes: 1. The Detector Element Physical Size (0018,7020) and Detector Element Spacing (0018,7022) may be different if there are insensitive regions between each detector.

2. This model of description is not able to accurately describe multiple matrices of detectors that are “tiled” to produce a single image.

The following optional Attribute defines the relationship of the Active Area to the Physical Detector Area:

- Detector Active Origin (0018,7028).

In the case where the Field of View has the same size as the stored Pixel Data (7FE0,0010), the relationship between detectors and stored image pixels is defined by Detector Binning (0018,701A) which specifies how many detectors, in each of the row and column directions, contribute to (are pooled or averaged to form) a single stored image pixel.

Notes: 1. Detector Binning (0018,701A) may have values less than one if sub-sampling is used to derive an image with higher spatial resolution than the detector matrix.

2. The detector binning results in the size of a stored image pixel being different from the contributing physical detector pixels. In this case it is important to notice that the Field Of View Origin (0018,7030) is defined with respect to the center of the detector element located at the TLHC of the Field of View.

3. For images where the Field of View describes an area not equal to the size (rows and columns) of the stored Pixel Data (7FE0,0010), the Detector Binning (0018,701A) does not fully specify the relationship between the contributing physical detector pixels and the stored image pixels.

[pic]

Figure C.8-14 Explanation of Digital Detector Attributes

[pic]

[pic]

Figure C.8-15Explanation of Digital Detector Attributes

C.8.11.5 DX Positioning Module

Table C.8-72 contains IOD Attributes that describe the positioning used in acquiring Digital X-Ray Images.

Table C.8-72DX POSITIONING MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Projection Eponymous Name Code Sequence (0018,5104) 3 A Sequence that describes the radiographic method of patient, tube and detector positioning to achieve a well described projection or view. Only a single Item is permitted in this Sequence. Shall be consistent with the other Attributes in this Module, if present, but may more specifically describe the image acquisition.
>Include ‘Code Sequence Macro’ Table 8.8-1. Baseline Context ID 4012
Patient Position (0018,5100) 3 Description of imaging subject’s position relative to the equipment. See C.7.3.1.1.2 for Defined Terms and further explanation. If present, shall be consistent with Patient Gantry Relationship Code Sequence (0054,0414) and Patient Orientation Modifier Code Sequence (0054,0412).
View Position (0018,5101) 3 Radiographic view of the image relative to the imaging subject’s orientation. Shall be consistent with View Code Sequence (0054,0220). See C.8.11.5.1.1 for further explanation.
View Code Sequence (0054,0220) 3 Sequence that describes the projection of the anatomic region of interest on the image receptor. Note: It is strongly recommended that this Attribute be present, in order to ensure that images may be positioned correctly relative to one another for display. Shall be consistent with View Position (0018,5101). See C.8.11.5.1.1 for further explanation. Only a single Item is permitted in this Sequence.
>Include ‘Code Sequence Macro’ Table 8.8-1. Baseline Context ID 4010
>View Modifier Code Sequence (0054,0222) 3 View modifier. One or more Items are permitted in this Sequence.
>>Include ‘Code Sequence Macro’ Table 8.8-1. Baseline Context ID 4011
Patient Orientation Code Sequence (0054,0410) 3 Sequence that describes the orientation of the patient with respect to gravity. See C.8.11.5.1.2 for further explanation. Only a single Item is permitted in this Sequence.
>Include ‘Code Sequence Macro’ Table 8.8-1. Baseline Context ID 19
>Patient Orientation Modifier Code Sequence (0054,0412) 3 Patient Orientation Modifier. Required if needed to fully specify the orientation of the patient with respect to gravity. Only a single Item is permitted in this Sequence.
>>Include ‘Code Sequence Macro’ Table 8.8-1. Baseline Context ID 20
Patient Gantry Relationship Code Sequence (0054,0414) 3 Sequence which describes the orientation of the patient with respect to the gantry. Only a single Item is permitted in this Sequence.
>Include ‘Code Sequence Macro’ Table 8.8-1. Baseline Context ID 21
Distance Source to Patient (0018,1111) 3 Distance in mm from source to the table, support or bucky side that is closest to the Imaging Subject, as measured along the central ray of the X-Ray beam. Note: 1. This definition is less useful in terms of estimating geometric magnification than a measurement to a defined point within the Imaging Subject, but accounts for what is realistically measurable in an automated fashion in a clinical setting. 2. This measurement does not take into account any air gap between the Imaging Subject and the “front” of the table or bucky. 3. If the detector is not mounted in a table or bucky, then the actual position relative to the patient is implementation or operator defined. 4. This value is traditionally referred to as Source Object Distance (SOD). See C.8.11.7 Mammography Image Module for explanation if Positioner Type (0018,1508) is MAMMOGRAPHIC.
Distance Source to Detector (0018,1110) 3 Distance in mm from source to detector center. Note: This value is traditionally referred to as Source Image Receptor Distance (SID). See C.8.11.7 Mammography Image Module for explanation if Positioner Type (0018,1508) is MAMMOGRAPHIC.
Estimated Radiographic Magnification Factor (0018,1114) 3 Ratio of Source Image Receptor Distance (SID) over Source Object Distance (SOD).
Positioner Type (0018,1508) 2 Defined Terms: CARM COLUMN MAMMOGRAPHIC PANORAMIC CEPHALOSTAT RIGID NONE Notes: 1. The term CARM can apply to any positioner with 2 degrees of freedom of rotation of the X-Ray beam about the Imaging Subject. 2. The term COLUMN can apply to any positioner with 1 degree of freedom of rotation of the X-Ray beam about the Imaging Subject.
Positioner Primary Angle (0018,1510) 3 Position of the X-Ray beam about the patient from the RAO to LAO direction where movement from RAO to vertical is positive, if Positioner Type (0018,1508) is CARM. See C.8.7.5 XA Positioner Module for further explanation if Positioner Type (0018,1508) is CARM. See C.8.11.7 Mammography Image Module for explanation if Positioner Type (0018,1508) is MAMMOGRAPHIC.
Positioner Secondary Angle (0018,1511) 3 Position of the X-Ray beam about the patient from the CAU to CRA direction where movement from CAU to vertical is positive, if Positioner Type (0018,1508) is CARM. See C.8.7.5 XA Positioner Module for further explanation if Positioner Type (0018,1508) is CARM. See C.8.11.7 Mammography Image Module for explanation if Positioner Type (0018,1508) is MAMMOGRAPHIC.
Detector Primary Angle (0018,1530) 3 Angle of the X-Ray beam in the row direction in degrees relative to the normal to the detector plane. Positive values indicate that the X-Ray beam is tilted toward higher numbered columns. Negative values indicate that the X-Ray beam is tilted toward lower numbered columns. See C.8.7.5 XA Positioner Module for further explanation. See C.8.11.7 Mammography Image Module for explanation if Positioner Type (0018,1508) is MAMMOGRAPHIC.
Detector Secondary Angle (0018,1531) 3 Angle of the X-Ray beam in the column direction in degrees relative to the normal to the detector plane. Positive values indicate that the X-Ray beam is tilted toward lower numbered rows. Negative values indicate that the X-Ray beam is tilted toward higher numbered rows. See C.8.7.5 XA Positioner Module for further explanation. See C.8.11.7 Mammography Image Module for explanation if Positioner Type (0018,1508) is MAMMOGRAPHIC.
Column Angulation (0018,1450) 3 Angle of the X-Ray beam in degree relative to an orthogonal axis to the detector plane. Positive values indicate that the tilt is toward the head of the table. Note: The detector plane is assumed to be parallel to the table plane. Only meaningful if Positioner Type (0018,1508) is COLUMN.
Table Type (0018,113A) 3 Defined Terms: FIXED TILTING NONE
Table Angle (0018,1138) 3 Angle of table plane in degrees relative to horizontal plane [Gravity plane]. Positive values indicate that the head of the table is upward. Only meaningful if Table Type (0018,113A) is TILTING.
Body Part Thickness (0018,11A0) 3 The average thickness in mm of the body part examined when compressed, if compression has been applied during exposure.
Compression Force (0018,11A2) 3 The compression force applied to the body part during exposure, measured in Newtons.

C.8.11.5.1 DX Positioning Attribute Descriptions

C.8.11.5.1.1 View Code Sequence

View Code Sequence (0054,0220) replaces the function of View Position (0018,5101), and describes the radiographic view of the image relative to the real-world patient orientation as described in PS 3.17 annex on Explanation of Patient Orientation.

C.8.11.5.1.2 Patient Orientation Code Sequence

This Attribute is not related to Patient Orientation (0020,0020) and conveys a different concept entirely.

C.8.11.6 Mammography Series Module

Table C.8-73 specifies the Attributes which identify and describe general information about a Digital Mammography Series.

Table C.8-73MAMMOGRAPHY SERIES MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Modality (0008,0060) 1 Type of equipment that originally acquired the data used to create the images in this Series. Enumerated Value: MG See section C.7.3.1.1.1 for further explanation.
Request Attributes Sequence (0040,0275) 3 Sequence that contains attributes from the Imaging Service Request. One or more Items are permitted in this sequence.
>Include Request Attributes Macro Table 10-9 For Reason for Requested Procedure Code Sequence (0040,100A) the Baseline Context IDs are 6051 and 6055. No Baseline Context IDs are defined for other Attributes. Note: For example, Reason for Requested Procedure Code Sequence (0040,100A) may be used to convey whether the images in the Series were taken for screening or diagnostic purposes, if the information cannot be found in Reason For Performed Procedure Code Sequence (0040,1012) in the General Study Module.

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

C.8.11.8 Intra-oral Series Module

Table C.8-75 specifies the Attributes which identify and describe general information about a Digital Intra-oral X-Ray Series.

Table C.8-75INTRA-ORAL SERIES MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Modality (0008,0060) 1 Type of equipment that originally acquired the data used to create the images in this Series. Enumerated Values: IO See section C.7.3.1.1.1 for further explanation.

C.8.11.9 Intra-oral Image Module

Table C.8-76 contains IOD Attributes that describe a Digital Intra-oral X-Ray Image including its acquisition and positioning.

Table C.8-76INTRA-ORAL IMAGE MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Positioner Type (0018,1508) 1 Enumerated Values: NONE CEPHALOSTAT RIGID
Image Laterality (0020,0062) 1 Laterality of the region examined. Enumerated Values: R = right L = left B = both (i.e. midline)
Anatomic Region Sequence (0008,2218) 1 Sequence that identifies the anatomic region of interest in this image. Only a single Item shall be included in this Sequence.
>Include ‘Code Sequence Macro’ Table 8.8-1. Defined Context ID 4016.
>Anatomic Region Modifier Sequence (0008,2220) 1C Sequence that refines the anatomic region of interest in this image. Required if Primary Anatomic Structure Sequence (0008,2228) is not sent. Only a single Item shall be included in this Sequence.
>>Include ‘Code Sequence Macro’ Table 8.8-1. Defined Context ID 4017.
Primary Anatomic Structure Sequence (0008,2228) 1C Sequence that describes the primary anatomic structures of interest in this image. See C.8.11.9.1.1 for further explanation. Required if Anatomic Region Modifier Sequence (0008,2220) is not sent. One or more Items shall be included in this Sequence.
>Include ‘Code Sequence Macro’ Table 8.8-1. Defined Context ID 4018 or 4019. See C.8.11.9.1.1 for further explanation.

C.8.11.9.1 Intra-oral Image Attribute Descriptions

C.8.11.9.1.1 Primary Anatomic Structure Sequence

The Code Value (0008,0100) shall be drawn from the DICOM Content Mapping Resource, Context ID 4018, for permanent dentition, or Context ID 4019 for deciduous dentition.

These Context Groups correspond to ISO 3950-1984 that describes a designation of permanent and deciduous dentition using a two digit code, the first digit of which designates a quadrant, and the second digit a tooth.

The teeth imaged shall be listed as multiple Items in the Primary Anatomic Structure Sequence (0008,2228).

C.8.11.10 Enhanced Mammography Series Module

The Breast Tomosynthesis Image IOD uses the General Series module described in section C.7.3.1, specialized by the Enhanced Mammography Series Module, to describe the DICOM Series Entity described in A.1.2.3, and to define what constitutes a Series for the context of a Breast Tomosynthesis device.

Table C.8-76b specifies the Attributes that identify and describe general information about the Enhanced Mammography Series.

Table C.8-76bENHANCED MAMMOGRAPHY SERIES MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Modality (0008,0060) 1 Type of equipment that originally acquired the data used to create the images in this Series. Enumerated Values: MG See section C.7.3.1.1.1 for further explanation.
Referenced Performed Procedure Step Sequence (0008,1111) 1C Uniquely identifies the Performed Procedure Step SOP Instance to which the Series is related (e.g. a Modality or General-Purpose Performed Procedure Step SOP Instance). Only a single Item shall be included in this sequence. Required if the Modality Performed Procedure Step SOP Class or General Purpose Performed Procedure Step SOP Class is supported.
>Include SOP Instance Reference Macro Table 10-11
Request Attributes Sequence (0040,0275) 3 Sequence that contains attributes from the Imaging Service Request. One or more Items are permitted in this sequence.
>Include Request Attributes Macro Table 10-9 For Reason for Requested Procedure Code Sequence (0040,100A) the Baseline Context IDs are 6051 and 6055. No Baseline Context IDs are defined for other Attributes. Note: For example, Requested Procedure Code Sequence (0040,100A) may be used to convey whether the images in the Series were taken for screening or diagnostic purposes.