C.8.8 Radiotherapy Modules

This Section describes Radiotherapy-specific modules.

Modules defined here make reference to “IEC” coordinate systems and standards. These standards are defined in IEC Standard 61217, “Radiotherapy Equipment - Coordinates, Movements and Scales” (Reference CEI/IEC 61217: 1996).

Note: IEC document 62C/269/CDV “Amendment to IEC 61217: Radiotherapy Equipment - Coordinates, movements and scales” also defines a patient-based coordinate system, and specifies the relationship between the DICOM Patient Coordinate System (see Section C.7.6.2.1.1) and the IEC PATIENT Coordinate System. Rotating the IEC PATIENT Coordinate System described in IEC 62C/269/CDV (1999) by 90 degrees counter-clockwise (in the negative direction) about the x-axis yields the DICOM Patient Coordinate System, i.e. (X DICOM , Y DICOM , Z DICOM ) = (X IEC , -Z IEC , Y IEC ). Refer to the latest IEC documentation for the current definition of the IEC PATIENT Coordinate System.

Many of the dosimetry concepts referred to in this document can be found in ICRU Report 50, Prescribing, Recording, and Reporting Photon Beam Therapy, International Commission on Radiation Units and Measurements, 1993.

C.8.8.1 RT Series Module

There exist significant differences in the manner in which RT objects as compared to diagnostic objects. An RT object can be one of several types, and a series of a given object type may be created over a temporal span of several weeks. The RT Series Module has been created to satisfy the requirements of the standard DICOM Query/Retrieve model while including only those attributes relevant to the identification and selection of radiotherapy objects.

Table C.8-37 - RT SERIES MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Modality (0008,0060) 1 Type of equipment that originally acquired the data. Enumerated Values: RTIMAGE = RT Image RTDOSE = RT Dose RTSTRUCT = RT Structure Set RTPLAN = RT Plan RTRECORD = RT Treatment Record See C.8.8.1.1.
Series Instance UID (0020,000E) 1 Unique identifier of the series.
Series Number (0020,0011) 2 A number that identifies this series.
Series Description (0008,103E) 3 Description of the series.
Series Description Code Sequence (0008,103F) 3 A coded description of the Series. Only a single Item is permitted in this sequence.
>Include Code Sequence Macro Table 8.8-1 No Baseline Context ID is defined.
Operators’ Name (0008,1070) 2 Name(s) of the operator(s) supporting the Series.
Referenced Performed Procedure Step Sequence (0008,1111) 3 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). One or more items are permitted in this sequence.
>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 No Baseline Context ID is defined
Include Performed Procedure Step Summary Macro Table 10-16 No Baseline Context ID is defined

C.8.8.1.1 Modality

The Enumerated Value for Modality (0008,0060) shall determined by the IOD:

RTIMAGE if RT Image IOD,

RTDOSE if RT Dose IOD,

RTSTRUCT if RT Structure Set IOD,

RTPLAN if RT Plan IOD or RT Ion Plan IOD,

RTRECORD if RT Beams Treatment Record IOD, RT Ion Beams Treatment Record IOD, RT Brachy Treatment Record IOD, or RT Treatment Summary Record IOD.

Note: DICOM specifies that a given series shall contain objects of only one Modality, and shall be created by a single device (described in the General Equipment Module). However, in general there may be many series defined for a given modality/device pair. Note that a radiotherapy series is generally created over an extended time interval (unlike in radiology, where all images in an image series are generally created together).

C.8.8.2 RT Image Module

Table C.8-38 contains attributes that describe RT-specific characteristics of a projection image. The image described by these attributes must be a radiotherapy image acquired or calculated using a conical imaging geometry.

Table C.8-38—RT IMAGE MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Samples per Pixel (0028,0002) 1 Number of samples (planes) in this image. See C.8.8.2.6.1 for specialization.
Photometric Interpretation (0028,0004) 1 Specifies the intended interpretation of the pixel data. See C.8.8.2.6.2 for specialization.
Bits Allocated (0028,0100) 1 Number of bits allocated for each pixel sample. Each sample shall have the same number of bits allocated. See C.8.8.2.6.3 for specialization.
Bits Stored (0028,0101) 1 Number of bits stored for each pixel sample. Each sample shall have the same number of bits stored. See C.8.8.2.6.4 for specialization.
High Bit (0028,0102) 1 Most significant bit for each pixel sample. Each sample shall have the same high bit. See C.8.8.2.6.5 for specialization.
Pixel Representation (0028,0103) 1 Data representation of the pixel samples. Each sample shall have the same pixel representation. See C.8.8.2.6.6 for specialization.
Pixel Intensity Relationship (0028,1040) 3 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) 1C The sign of the relationship between the Pixel sample values stored in Pixel Data (7FE0,0010) and the X-Ray beam intensity. Required if Pixel Intensity Relationship (0028,1040) is present. 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.
RT Image Label (3002,0002) 1 User-defined label for RT Image.
RT Image Name (3002,0003) 3 User-defined name for RT Image.
RT Image Description (3002,0004) 3 User-defined description of RT Image.
Image Type (0008,0008) 1 Image identification characteristics (see Section C.7.6.1.1.2). RT Images shall use one of the following Defined Terms for Value 3: DRR = digitally reconstructed radiograph PORTAL = digital portal image or portal film image SIMULATOR = conventional simulator image RADIOGRAPH = radiographic image BLANK = image pixels set to background value FLUENCE = fluence map
Conversion Type (0008,0064) 2 Describes the kind of image conversion. Defined Terms: DV = Digitized Video DI = Digital Interface DF = Digitized Film WSD = Workstation
Reported Values Origin (3002,000A) 2C Describes the origin of the parameter values reported in the image. Required if Value 3 of Image Type (0008,0008) is SIMULATOR or PORTAL. Enumerated Values: OPERATOR = manually entered by operator PLAN = planned parameter values ACTUAL = electronically recorded
RT Image Plane (3002,000C) 1 Describes whether or not image plane is normal to beam axis. Enumerated Values: NORMAL = image plane normal to beam axis NON_NORMAL = image plane non-normal to beam axis
X-Ray Image Receptor Translation (3002,000D) 3 Position in (x,y,z) coordinates of origin of IEC X-RAY IMAGE RECEPTOR System in the IEC GANTRY coordinate system (mm). See Note 2.
X-Ray Image Receptor Angle (3002,000E) 2 X-Ray Image Receptor Angle i.e. orientation of IEC X-RAY IMAGE RECEPTOR coordinate system with respect to IEC GANTRY coordinate system (degrees). See C.8.8.2.2.
RT Image Orientation (3002,0010) 2C The direction cosines of the first row and the first column with respect to the IEC X-RAY IMAGE RECEPTOR coordinate system. Required if RT Image Plane (3002,000C) is NON_NORMAL. May be present otherwise.
Image Plane Pixel Spacing (3002,0011) 2 Physical distance (in mm) between the center of each image pixel, specified by a numeric pair - adjacent row spacing (delimiter) adjacent column spacing. See C.8.8.2.3 and 10.7.1.3 for further explanation.
RT Image Position (3002,0012) 2 The x and y coordinates (in mm) of the upper left hand corner of the image, in the IEC X-RAY IMAGE RECEPTOR coordinate system. This is the center of the first pixel transmitted. See C.8.8.2.7.
Radiation Machine Name (3002,0020) 2 User-defined name identifying radiation machine used in acquiring or computing image (i.e. name of conventional simulator, electron accelerator, X-Ray device, or machine modeled when calculating DRR).
Primary Dosimeter Unit (300A,00B3) 2 Measurement unit of machine dosimeter. Enumerated Values: MU = Monitor Unit MINUTE = minute
Radiation Machine SAD (3002,0022) 2 Radiation source to Gantry rotation axis distance of radiation machine used in acquiring or computing image (mm).
Radiation Machine SSD (3002,0024) 3 Source to patient surface distance (in mm) of radiation machine used in acquiring or computing image.
RT Image SID (3002,0026) 2 Distance from radiation machine source to image plane (in mm) along radiation beam axis. See C.8.8.2.3.
Source to Reference Object Distance (3002,0028) 3 Source to reference object distance (in mm), as used for magnification calculation of RADIOGRAPH and SIMULATOR images.
Referenced RT Plan Sequence (300C,0002) 3 Introduces sequence of one Class/Instance pair describing RT Plan associated with image. Only a single item is permitted in this sequence.
>Include ‘SOP Instance Reference Macro' Table 10-11
Referenced Beam Number (300C,0006) 3 Uniquely identifies the corresponding N-segment treatment beam specified by Beam Number (300A,00C0) within Beam Sequence in RT Beams Module within the RT Plan referenced in Referenced RT Plan Sequence (300C,0002).
Referenced Fraction Group Number (300C,0022) 3 Identifier of Fraction Group within RT Plan referenced in Referenced RT Plan Sequence (300C,0002).
Fraction Number (3002,0029) 3 Fraction Number of fraction during which image was acquired, within Fraction Group referenced by Referenced Fraction Group Number (300C,0022) within RT Plan referenced in Referenced RT Plan Sequence (300C,0002).
Start Cumulative Meterset Weight (300C,0008) 3 Cumulative Meterset Weight within Beam referenced by Referenced Beam Number (300C,0006) at which image acquisition starts.
End Cumulative Meterset Weight (300C,0009) 3 Cumulative Meterset Weight within Beam referenced by Referenced Beam Number (300C,0006) at which image acquisition ends.
Exposure Sequence (3002,0030) 3 Introduces sequence of Exposure parameter sets, corresponding to exposures used in generating the image. One or more items are permitted in this sequence. See C.8.8.2.4.
>Referenced Frame Number (0008,1160) 1C Identifies corresponding image frame in multi-frame image. Required if there is more than one item in Exposure Sequence (3002,0030), and image is a multi-frame image.
>KVP (0018,0060) 2C Peak kilo voltage output (kV) of X-Ray generator used to acquire image. Required if Value 3 of Image Type (0008,0008) is PORTAL, SIMULATOR or RADIOGRAPH.
>Primary Fluence Mode Sequence (3002,0050) 3 Sequence defining whether the primary fluence of the treatment beam uses a non-standard fluence-shaping. Only a single Item is permitted in this sequence.
>>Fluence Mode (3002,0051) 1 Describes whether the fluence shaping is the standard mode for the beam or an alternate. Enumerated Values: STANDARD = Uses standard fluence-shaping NON_STANDARD = Uses a non-standard fluence-shaping mode
>>Fluence Mode ID (3002,0052) 1C Identifier for the specific fluence-shaping mode. Required if Fluence Mode (3002,0051) has value NON_STANDARD.
>X-Ray Tube Current (0018,1151) 2C Imaging device X-Ray Tube Current (mA). Required if Value 3 of Image Type (0008,0008) is SIMULATOR or RADIOGRAPH. May be present otherwise.
>Exposure Time (0018,1150) 2C Time of X-Ray exposure (msec). Required if Value 3 of Image Type (0008,0008) is SIMULATOR or RADIOGRAPH. May be present otherwise.
>Meterset Exposure (3002,0032) 2C Treatment machine Meterset duration over which image has been acquired, specified in Monitor units (MU) or minutes as defined by Primary Dosimeter Unit (300A,00B3). Required if Value 3 of Image Type (0008,0008) is PORTAL.
>Diaphragm Position (3002,0034) 3 Positions of diaphragm jaw pairs (in mm) in IEC BEAM LIMITING DEVICE coordinate axis in the IEC order X1, X2, Y1, Y2.
>Beam Limiting Device Sequence (300A,00B6) 3 Introduces sequence of beam limiting device (collimator) jaw or leaf (element) positions for given exposure. One or more items are permitted in this sequence.
>>RT Beam Limiting Device Type (300A,00B8) 1 Type of beam limiting device (collimator). Enumerated Values: X = symmetric jaw pair in IEC X direction Y = symmetric jaw pair in IEC Y direction ASYMX = asymmetric jaw pair in IEC X direction ASYMY = asymmetric pair in IEC Y direction MLCX = multileaf (multi-element) jaw pair in IEC X direction MLCY = multileaf (multi-element) jaw pair in IEC Y direction
>>Source to Beam Limiting Device Distance (300A,00BA) 3 Radiation source to beam limiting device (collimator) distance (mm).
>>Number of Leaf/Jaw Pairs (300A,00BC) 1 Number of leaf (element) or jaw pairs (equal to 1 for standard beam limiting device jaws).
>>Leaf Position Boundaries (300A,00BE) 2C Boundaries (in mm) of beam limiting device (collimator) leaves (elements) in IEC BEAM LIMITING DEVICE coordinate axis appropriate to RT Beam Limiting Device Type (300A,00B8), i.e. X-axis for MLCY, Y-axis for MLCX. Contains N+1 values, where N is the Number of Leaf/Jaw Pairs (300A,00BC), starting from Leaf (Element) Pair 1. Required if RT Beam Limiting Device Type (300A,00B8) is MLCX or MLCY.
>>Leaf/Jaw Positions (300A,011C) 1 Positions of beam limiting device (collimator) leaf or jaw (element) pairs (in mm) in IEC BEAM LIMITING DEVICE coordinate axis appropriate to RT Beam Limiting Device Type (300A,00B8), e.g. X-axis for MLCX, Y-axis for MLCY). Contains 2N values, where N is the Number of Leaf/Jaw Pairs (300A,00BC), in IEC leaf (element) subscript order 101, 102, ... 1N, 201, 202, ... 2N.
>Gantry Angle (300A,011E) 3 Treatment machine gantry angle, i.e. orientation of IEC GANTRY coordinate system with respect to IEC FIXED REFERENCE coordinate system (degrees).
>Gantry Pitch Angle (300A,014A) 3 Gantry Pitch Angle. i.e. the rotation of the IEC GANTRY coordinate system about the X-axis of the IEC GANTRY coordinate system (degrees). See C.8.8.25.6.5.
>Beam Limiting Device Angle (300A,0120) 3 Treatment machine beam limiting device (collimator) angle, i.e. orientation of IEC BEAM LIMITING DEVICE coordinate system with respect to IEC GANTRY coordinate system (degrees).
>Patient Support Angle (300A,0122) 3 Patient Support angle, i.e. orientation of IEC PATIENT SUPPORT coordinate system with respect to IEC FIXED REFERENCE coordinate system (degrees).
>Table Top Pitch Angle (300A,0140) 3 Table Top Pitch Angle, i.e. the rotation of the IEC TABLE TOP coordinate system about the X-axis of the IEC TABLE TOP coordinate system (degrees). See C.8.8.25.6.2.
>Table Top Roll Angle (300A,0144) 3 Table Top Roll Angle, i.e. the rotation of the IEC TABLE TOP coordinate system about the Y-axis of the IEC TABLE TOP coordinate system (degrees). See C.8.8.25.6.2.
>Table Top Vertical Position (300A,0128) 3 Table Top Vertical position in IEC TABLE TOP coordinate system (mm).
>Table Top Longitudinal Position (300A,0129) 3 Table Top Longitudinal position in IEC TABLE TOP coordinate system (mm).
>Table Top Lateral Position (300A,012A) 3 Table Top Lateral position in IEC TABLE TOP coordinate system (mm).
>Applicator Sequence (300A,0107) 3 Introduces sequence of Applicators associated with Beam. Only a single item is permitted in this sequence.
>>Applicator ID (300A,0108) 1 User or machine supplied identifier for Applicator.
>>Applicator Type (300A,0109) 1 Type of Applicator. Defined Terms: ELECTRON_SQUARE = square electron applicator ELECTRON_RECT = rectangular electron applicator ELECTRON_CIRC = circular electron applicator ELECTRON_SHORT = short electron applicator ELECTRON_OPEN = open (dummy) electron applicator PHOTON_SQUARE = square photon applicator PHOTON _RECT = rectangular photon applicator PHOTON _CIRC = circular photon applicator INTRAOPERATIVE = intraoperative (custom) applicator STEREOTACTIC = stereotactic applicator (deprecated)
>>Applicator Geometry Sequence (300A,0431) 3 Describes the applicator aperture geometry. Only a single Item is permitted in this sequence.
>>>Applicator Aperture Shape (300A,0432) 1 Aperture shape of the applicator. Defined terms: SYM_SQUARE: A square-shaped aperture symmetrical to the central axis. SYM_RECTANGLE: A rectangular-shaped aperture symmetrical to the central axis. SYM_CIRCULAR: A circular-shaped aperture symmetrical to the central axis.
>>>Applicator Opening (300A,0433) 1C Opening (in mm) of the applicator's aperture in IEC BEAM LIMITING DEVICE coordinate system. In case of square-shaped applicator contains the length of the sides of the square. In case of circular-shaped applicators, contains the diameter of the circular aperture. Required if Applicator Aperture Shape (300A,0432) is SYM_SQUARE or SYM_CIRCULAR.
>>>Applicator Opening X (300A,0434) 1C Opening (in mm) of the applicator's aperture in IEC BEAM LIMITING DEVICE coordinate system in X-Direction. Required if Applicator Aperture Shape (300A,0432) is SYM_RECTANGLE.
>>>Applicator Opening Y (300A,0435) 1C Opening (in mm) of the applicator's aperture in IEC BEAM LIMITING DEVICE coordinate system in Y-Direction. Required if Applicator Aperture Shape (300A,0432) is SYM_RECTANGLE.
>> Source to Applicator Mounting Position Distance (300A,0436) 3 Radiation source to applicator mounting position distance (in mm) for current applicator.
>>Applicator Description (300A,010A) 3 User-defined description for Applicator.
>General Accessory Sequence (300A,0420) 3 Sequence of General Accessories associated with the beam producing this image. One or more items are permitted in this sequence.
>>General Accessory Number (300A,0424) 1 Identification Number of the General Accessory. The value shall be unique within the sequence.
>>General Accessory ID (300A,0421) 1 User or machine supplied identifier for General Accessory.
>>General Accessory Description (300A,0422) 3 User supplied description of General Accessory.
>>General Accessory Type (300A,0423) 3 Specifies the type of accessory. Defined Terms: GRATICULE = Accessory tray with a radio-opaque grid IMAGE_DETECTOR = Image acquisition device positioned in the beam line RETICLE = Accessory tray with radio-transparent markers or grid
>>Accessory Code (300A,00F9) 3 Machine-readable identifier for this accessory
>Number of Blocks (300A,00F0) 1 Number of shielding blocks associated with Beam.
>Block Sequence (300A,00F4) 2C Introduces sequence of blocks associated with Beam. Required if Number of Blocks (300A,00F0) is non-zero. Zero or more items shall be included in this sequence.
>>Block Tray ID (300A,00F5) 3 User-supplied identifier for block tray.
>>Source to Block Tray Distance (300A,00F6) 2 Radiation Source to attachment edge of block tray assembly (mm).
>>Block Type (300A,00F8) 1 Type of block. Enumerated Values: SHIELDING = blocking material is inside contour APERTURE = blocking material is outside contour
>>Block Divergence (300A,00FA) 2 Indicates presence or otherwise of geometrical divergence Enumerated Values: PRESENT = block edges are shaped for beam divergence ABSENT = block edges are not shaped for beam divergence
>>Block Mounting Position (300A,00FB) 3 Indicates on which side of the Block Tray the block is mounted. Enumerated Values: PATIENT_SIDE = the block is mounted on the side of the Block Tray which is towards the patient. SOURCE_SIDE = the block is mounted on the side of the Block Tray which is towards the radiation source.
>>Block Number (300A,00FC) 1 Identification Number of the Block. The value of Block Number (300A,00FC) shall be unique within the Beam in which it is created.
>>Block Name (300A,00FE) 3 User-defined name for block.
>>Material ID (300A,00E1) 2 User-supplied identifier for material used to manufacture Block.
>>Block Thickness (300A,0100) 3 Physical thickness of block (in mm) parallel to radiation beam axis.
>>Block Number of Points (300A,0104) 2 Number of (x,y) pairs defining the block edge.
>>Block Data (300A,0106) 2 A data stream of (x,y) pairs which comprise the block edge. The number of pairs shall be equal to Block Number of Points (300A,0104), and the vertices shall be interpreted as a closed polygon. Coordinates are projected onto the machine isocentric plane in the IEC BEAM LIMITING DEVICE coordinate system (mm).
Fluence Map Sequence (3002,0040) 1C A Sequence of data describing the fluence map attributes for a radiotherapy beam. Only a single item shall be included in this sequence. Required if the third value of Image Type (0008,0008) is FLUENCE.
>Fluence Data Source (3002,0041) 1 Source of fluence data. Enumerated Values: CALCULATED = Calculated by a workstation MEASURED=Measured by exposure to a film or detector.
>Fluence Data Scale (3002,0042) 3 The meterset corresponding with a fluence map cell value of 1.0 expressed in units specified by Primary Dosimeter Units (300A,00B3). This is the meterset value used for treatment, not the meterset used to expose the film as defined by Meterset Exposure (3002,0032).
Gantry Angle (300A,011E) 3 Treatment machine gantry angle, i.e. orientation of IEC GANTRY coordinate system with respect to IEC FIXED REFERENCE coordinate system (degrees).
Gantry Pitch Angle (300A,014A) 3 Gantry Pitch Angle. i.e. the rotation of the IEC GANTRY coordinate system about the X-axis of the IEC GANTRY coordinate system (degrees). See C.8.8.25.6.5.
Beam Limiting Device Angle (300A,0120) 3 Treatment machine beam limiting device (collimator) angle, i.e. orientation of IEC BEAM LIMITING DEVICE coordinate system with respect to IEC GANTRY coordinate system (degrees).
Patient Support Angle (300A,0122) 3 Patient Support angle, i.e. orientation of IEC PATIENT SUPPORT coordinate system with respect to IEC FIXED REFERENCE coordinate system (degrees).
Table Top Eccentric Axis Distance (300A,0124) 3 Distance (positive) from the IEC PATIENT SUPPORT vertical axis to the IEC TABLE TOP ECCENTRIC vertical axis (mm).
Table Top Eccentric Angle (300A,0125) 3 Table Top (non-isocentric) angle, i.e. orientation of IEC TABLE TOP ECCENTRIC coordinate system with respect to IEC PATIENT SUPPORT system (degrees).
Table Top Pitch Angle (300A,0140) 3 Table Top Pitch Angle, i.e. the rotation of the IEC TABLE TOP coordinate system about the X-axis of the IEC TABLE TOP coordinate system (degrees). See C.8.8.25.6.2.
Table Top Roll Angle (300A,0144) 3 Table Top Roll Angle, i.e. the rotation of the IEC TABLE TOP coordinate system about the Y-axis of the IEC TABLE TOP coordinate system (degrees). See C.8.8.25.6.2.
Table Top Vertical Position (300A,0128) 3 Table Top Vertical position in IEC TABLE TOP coordinate system (mm).
Table Top Longitudinal Position (300A,0129) 3 Table Top Longitudinal position in IEC TABLE TOP coordinate system (mm).
Table Top Lateral Position (300A,012A) 3 Table Top Lateral position in IEC TABLE TOP coordinate system (mm).
Isocenter Position (300A,012C) 3 Isocenter coordinates (x,y,z), in mm. Specifies the location of the machine isocenter in the patient-based coordinate system associated with the Frame of Reference. It allows transformation from the equipment-based IEC coordinate system to the patient-based coordinate system.
Patient Position (0018,5100) 1C Patient position descriptor relative to the patient support device. Required if Isocenter Position (300A,012C) is present. May be present otherwise. See Section C.8.8.12.1.2 for Defined Terms and further explanation. Note: The orientation of the patient relative to the patient support device is denoted in the same manner as in the RT Patient Setup module. It defines the relation of the patient-based DICOM coordinate system identified by the frame of reference module of the RT Image to the IEC coordinate system and together with the Isocenter Position (300A,012C) allows the RT Image to be placed into the patient frame of reference. It also allows a system using an RT Image to verify that the patient is setup in a similar position relative to the patient support device.

Notes: 1. The numeric beam data parameters recorded with the RT Image correspond to the parameters as they were known at the time the image was created or taken. The parameters may or may not correspond to an actual RT Plan instance that is created for a patient. If the Reported Values Origin (3002,000A) has an enumerated value of OPERATOR or ACTUAL and there is an RT Plan reference present, the numeric beam data parameters may or may not be the same in the two objects.

2. The Z coordinate of the X-Ray Image Receptor Translation (3002,000D) will be equal to the Radiation Machine SAD (3002,0022) minus the RT Image SID (3002,0026). If the image receptor is further from the beam source than the machine isocenter, the Z coordinate will be negative (see IEC 61217).

C.8.8.2.1 Multi-frame image data

In either multiple exposure multi-frame images or cine images, only the attributes inside of the Exposure Sequence (3002,0030) shall differ between frames. For example, attributes such as beam limiting device (collimator) leaf (element) positions and block information may change, whereas attributes such as gantry and beam limiting device (collimator) angle shall not change.

C.8.8.2.2 X-Ray Image Receptor Angle

The X-Ray Image Receptor Angle (3002,000E) specifies the rotation of the image receptor device in the IEC X-RAY IMAGE RECEPTOR PLANE. A positive angle corresponds to a counter-clockwise rotation of the X-Ray Image Receptor as viewed from the radiation source in the IEC GANTRY coordinate system. The normal (non-rotated) value for this parameter is zero degrees.

C.8.8.2.3 Image Plane Pixel Spacing and RT Image SID

The Image Plane Pixel Spacing (3002,0011) attribute shall always be defined on the image plane, i.e. at the radiation machine source to image plane distance specified by RT Image SID (3002,0026). For images where the source-image distance is undefined or unknown (e.g. DRR images), RT Image SID (3002,0026) shall equal Radiation Machine SAD (3002,0022) and Image Plane Pixel Spacing (3002,0011) shall be defined on this common plane.

C.8.8.2.4 Exposure Sequence

The Exposure Sequence (3002,0030) allows specification of imaging parameters and aperture definitions for single exposure images (single item sequence) , integrated images (multiple item sequence) or multiple exposures (multiple item sequence). An integrated image is a single-frame image (no Cine or Multi-frame Module present) with multiple items in the Exposure Sequence. A Referenced Frame Number (0008,1160) is not provided. A multiple exposure image can be expressed as a multi-frame image containing either a single frame, or more than one frame. Referenced Frame Number (0008,1160) shall be specified for each Exposure Sequence item for multiple exposure images expressed using more than one frame.

Many of the attributes referring to beam parameters can be present both inside the Exposure Sequence (3002,0030) and outside the sequence. When a specific attribute is present inside the sequence, that attribute shall supersede the attribute found outside the Exposure Sequence (3002,0030). For any item in the sequence, if the attribute is not present, the value of the attribute (if specified) outside the sequence shall be used.

C.8.8.2.5 Single frame and multi-frame images

If the Multi-frame Module is present and the Cine Module is not present then the Frame Increment Pointer (0028,0009) shall have the Enumerated Value of 00200013 (Instance Number). If the Multi-frame Module and Cine Module are both present then the Frame Increment Pointer (0028,0009) shall have an Enumerated Value of either 00181063 (Frame Time) or 00181065 (Frame Time Vector).

C.8.8.2.6 Image Pixel Module Attributes

C.8.8.2.6.1 Samples per Pixel

For RT Images, Samples per Pixel (0028,0002) shall have the Enumerated Value of 0001H.

C.8.8.2.6.2 Photometric Interpretation

For RT Images, Photometric Interpretation (0028,0004) shall have the Enumerated Value of MONOCHROME2.

C.8.8.2.6.3 Bits Allocated

For RT Images, Bits Allocated (0028,0100) shall have an Enumerated Value of 8 or 16.

C.8.8.2.6.4 Bits Stored

For RT Images, Bits Stored (0028,0101) shall have an Enumerated Value of:

8 when Bits Allocated (0028,0100) is 8

12-16 when Bits Allocated (0028,0100) is 16

C.8.8.2.6.5 High Bit

For RT Images, High Bit (0028,0102) shall have the Enumerated Value of one less than the value sent in Bits Stored (0028,0101).

C.8.8.2.6.6 Pixel Representation

For RT Images, Pixel Representation (0028,0103) shall have the Enumerated Value of 0000H (unsigned integer).

C.8.8.2.7 RT Image Plane, Position and Orientation

When RT Image Plane (3002,000C) is NORMAL and RT Image Orientation (3002,0010) is not provided, the orientation is defined as follows: The image viewing direction goes from the radiation source to the image (i.e. in the sense of a beam’s eye view, or along the negative Zr direction of the IEC X-RAY IMAGE RECEPTOR coordinate system). The direction of rows goes along the positive Xr direction and the direction of the columns goes along the negative Yr direction of the IEC X-RAY IMAGE RECEPTOR coordinate system. Other interpretations shall be documented in an implementation's conformance statement.

C.8.8.3 RT Dose Module

The RT Dose module is used to convey 2D or 3D radiation dose data generated from treatment planning systems or similar devices. The attributes defined within the module support dose for a single radiation beam (potentially comprised of multiple segments, as delivered in a dynamic treatment) or a group of beams comprising either a fraction group (see C.8.8.13) or a complete treatment plan (potentially the sum of multiple fraction groups).

The RT Dose module provides the mechanism to transmit a 3D array of dose data as a set of 2D dose planes that may or may not be related to CT or MR image planes. This mechanism works via the DICOM Multi-Frame module which is required if multi-frame pixel data are sent.

Table C.8-39—RT DOSE MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Samples per Pixel (0028,0002) 1C Number of samples (planes) in this image. See C.8.8.3.4.1 for specialization. Required if Pixel Data (7FE0,0010) is present.
Photometric Interpretation (0028,0004) 1C Specifies the intended interpretation of the pixel data. See C.8.8.3.4.2 for specialization. Required if Pixel Data (7FE0,0010) is present.
Bits Allocated (0028,0100) 1C Number of bits allocated for each pixel sample. Each sample shall have the same number of bits allocated. See C.8.8.3.4.3 for specialization. Required Pixel Data (7FE0,0010) is present.
Bits Stored (0028,0101) 1C Number of bits stored for each pixel sample. Each sample shall have the same number of bits stored. See C.8.8.3.4.4 for specialization. Required if Pixel Data (7FE0,0010) is present.
High Bit (0028,0102) 1C Most significant bit for each pixel sample. Each sample shall have the same high bit. See C.8.8.3.4.5 for specialization. Required if Pixel Data (7FE0,0010) is present.
Pixel Representation (0028,0103) 1C Data representation of the pixel samples. Each sample shall have the same pixel representation. See C.8.8.3.4.6 for specialization. Required Pixel Data (7FE0,0010) is present.
Dose Units (3004,0002) 1 Units used to describe dose. Enumerated Values: GY = Gray RELATIVE = dose relative to implicit reference value
Dose Type (3004,0004) 1 Type of dose. Defined Terms: PHYSICAL = physical dose EFFECTIVE = physical dose after correction for biological effect using user-defined modeling technique ERROR = difference between desired and planned dose
Instance Number (0020,0013) 3 A number that identifies this object instance.
Dose Comment (3004,0006) 3 User-defined comments for dose data.
Normalization Point (3004,0008) 3 Coordinates (x, y, z) of normalization point in the patient based coordinate system described in C.7.6.2.1.1 (mm). See C.8.8.3.1.
Dose Summation Type (3004,000A) 1 Type of dose summation. Defined Terms: PLAN = dose calculated for entire RT Plan MULTI_PLAN = dose calculated for 2 or more RT Plans FRACTION = dose calculated for a single Fraction Group within RT Plan BEAM = dose calculated for one or more Beams within RT Plan BRACHY = dose calculated for one or more Brachy Application Setups within RT Plan CONTROL_POINT = dose calculated for one or more Control Points within a Beam
Referenced RT Plan Sequence (300C,0002) 1C Sequence describing RT Plan associated with dose. Required if Dose Summation Type (3004,000A) is PLAN, MULTI_PLAN, FRACTION, BEAM, BRACHY or CONTROL_POINT. Only a single item shall be included in this sequence, unless Dose Summation Type (3004,000A) is MULTI_PLAN, in which case two or more items shall be included in this sequence. See Note 1.
>Include ‘SOP Instance Reference Macro' Table 10-11
>Referenced Fraction Group Sequence (300C,0020) 1C Introduces sequence of one Fraction Group containing beams or brachy application setups contributing to dose. Required if Dose Summation Type (3004,000A) is FRACTION, BEAM, BRACHY or CONTROL_POINT. Only a single item shall be included in this sequence. See Note 1.
>>Referenced Fraction Group Number (300C,0022) 1 Uniquely identifies Fraction Group specified by Fraction Group Number (300A,0071) in Fraction Group Sequence of RT Fraction Scheme Module within RT Plan referenced in Referenced RT Plan Sequence (300C,0002).
>>Referenced Beam Sequence (300C,0004) 1C Introduces sequence of Beams in current Fraction Group contributing to dose. Required if Dose Summation Type (3004,000A) is BEAM or CONTROL_POINT. One or more items shall be included in this sequence.
>>>Referenced Beam Number (300C,0006) 1 Uniquely identifies Beam specified by Beam Number (300A,00C0) in Beam Sequence of RT Beams Module within RT Plan referenced in Referenced RT Plan Sequence (300C,0002).
>>>Referenced Control Point Sequence (300C,00F2) 1C Sequence defining the Control Points in current Beam contributing to dose. Required if Dose Summation Type (3004,000A) is CONTROL_POINT. Only a single item shall be included in this sequence.
>>>>Referenced Start Control Point Index (300C,00F4) 1 Identifies Control Point specified by Control Point Index (300A,0112) within Beam referenced by Referenced Beam Number (300C,0006). This is the first of the two Control Points from which the Dose contribution to the Control Point can be calculated.
>>>>Referenced Stop Control Point Index (300C,00F6) 1 Identifies Control Point specified by Control Point Index (300A,0112) within Beam referenced by Referenced Beam Number (300C,0006). This is the second of the two Control Points from which the Dose contribution to the Control Point can be calculated. The Control Point Index (300A,0112) referenced by Referenced Stop Control Point Index (300C,00F6) shall be the Control Point Index (300A,0112) immediately following the Control Point Index (300A,0112) referenced by Referenced Start Control Point Index (300C,00F4) within the Referenced Beam Number (300C,0006).
>>Referenced Brachy Application Setup Sequence (300C,000A) 1C Introduces sequence of Brachy Application Setups in current Fraction Group contributing to dose. Required if Dose Summation Type (3004,000A) is BRACHY. One or more items shall be included in this sequence.
>>>Referenced Brachy Application Setup Number (300C,000C) 1 Uniquely identifies Brachy Application Setup specified by Brachy Application Setup Number (300A,0234) in Brachy Application Setup Sequence (300A,0230) of RT Brachy Application Setups Module within RT Plan referenced in Referenced RT Plan Sequence (300C,0002).
Grid Frame Offset Vector (3004,000C) 1C An array which contains the dose image plane offsets (in mm) of the dose image frames in a multi-frame dose. Required if multi-frame pixel data are present and Frame Increment Pointer (0028,0009) points to Grid Frame Offset Vector (3004,000C). See C.8.8.3.2.
Dose Grid Scaling (3004,000E) 1C Scaling factor that when multiplied by the dose grid data found in the Pixel Data (7FE0,0010) attribute of the Image Pixel Module, yields grid doses in the dose units as specified by Dose Units (3004,0002). Required if Pixel Data (7FE0,0010) is present.
Tissue Heterogeneity Correction (3004,0014) 3 Specifies a list of patient heterogeneity characteristics used for calculating dose. This Atttibute shall be multi-valued if beams used to compute the dose have differing correction techniques. Enumerated Values: IMAGE = image data ROI_OVERRIDE = one or more ROI densities override image or water values where they exist WATER = entire volume treated as water equivalent

Note: In order to prevent misrepresentation of the dose summation:

  1. If the Dose Summation Type (3004, 000A) is PLAN, then only a single instance of RT Plan is referenced and the dose will be for the entire plan (i.e. it is not viable to combine only certain fraction groups of different plans).

  2. If the Dose Summation Type (3004,000A) is MULTI_PLAN, then 2 or more instances of RT Plan may be referenced. As above, each reference will be for the entire plan.

  3. If the Dose Summation Type (3004,000A) is FRACTION, then only a single instance of RT PLAN and a single Fraction Group are referenced (i.e. component beams or brachy application setups are not referenced).

C.8.8.3.1 Normalization Point

The Normalization Point (3004,0008) aids in the interpretation and subsequent use of the transmitted data. If used, it shall be a point receiving dose contributions from all referenced components of the dose summation.

C.8.8.3.2 Grid Frame Offset Vector

Grid Frame Offset Vector (3004,000C) shall be provided if a dose distribution is sent as a multi-frame image. Values of the Grid Frame Offset Vector (3004,000C) shall vary monotonically and are to be interpreted as follows:

a. If Grid Frame Offset Vector (3004,000C) is present and its first element is zero, this attribute contains an array of n elements indicating the plane location of the data in the right-handed image coordinate system, relative to the position of the first dose plane transmitted, i.e., the point at which the Image Position (Patient) (0020,0032) attribute is defined, with positive offsets in the direction of the cross product of the row and column directions.

b. If Grid Frame Offset Vector (3004,000C) is present, its first element is equal to the third element of Image Position (Patient) (0020,0032), and Image Orientation (Patient) (0020,0037) has the value (1,0,0,0,1,0), then Grid Frame Offset Vector contains an array of n elements indicating the plane location (patient z coordinate) of the data in the patient coordinate system.

In future implementations, use of option a) is strongly recommended.

This attribute is conditional since the RT Dose module may be included even if pixel doses are not being transmitted, or the image may be a single-frame image. If the Multi-frame Module is present, Frame Increment Pointer (0028,0009) shall have the Enumerated Value of 3004000C (Grid Frame Offset Vector).

Note: Option (a) can represent a rectangular-parallelepiped dose grid with any orientation with respect to the patient, while option (b) can only represent a rectangular-parallelepiped dose grid whose planes are in the transverse patient dimension and whose x- and y-axes are parallel to the patient x- and y-axes.

Example: Figure C.8.8.3-1 shows an example of plane positions for a dose grid with transverse planes.

[pic]

Figure C.8.8.3-1 Dose Grid Frame Example

For this example, Table C.8.39b gives the values of elements in the Grid Frame Offset Vector (3004,000C) for both relative (option (a)) and absolute (option (b)) interpretations, under the following conditions:

1. The value of Image Orientation (Patient) (0020,0037) is (1,0,0,0,1,0). I.e., the dose grid is transverse with x- and y-axes parallel to the patient x- and y-axes;

2. The value of Image Position (Patient) (0020,0032), i.e. the position of the first element of the dose grid, is (4, 5, 6); and

3. The spacing between adjacent dose grid planes is 2mm (uniform).

Table C.8-39b. Values of Dose Grid Frame Offset Vector underRelative (a) and Absolute (b) Interpretations

Grid Frame Offset Vector Element Option (a) Relative Coordinates Option (b) Absolute Coordinates
Z1 0 6
Z2 2 8
Z3 4 10
ZN 2(N-1) 6 + 2(N-1)

C.8.8.3.3 Dose Units

Dose Units are specified in both the RT Dose and RT Dose ROI modules. The attribute Dose Type present in the RT Dose module shall apply to all doses present in the RT Dose IOD.

C.8.8.3.4 Image Pixel Module Attributes

C.8.8.3.4.1 Samples per Pixel

For RT Doses, Samples per Pixel (0028,0002) shall have the Enumerated Value of 1.

C.8.8.3.4.2 Photometric Interpretation

For RT Doses, Photometric Interpretation (0028,0004) shall have the Enumerated Value of MONOCHROME2.

C.8.8.3.4.3 Bits Allocated

For RT Doses, Bits Allocated (0028,0100) shall have an Enumerated Value of 16 or 32.

C.8.8.3.4.4 Bits Stored

For RT Doses, Bits Stored (0028,0101) shall have an Enumerated Value equal to Bits Allocated (0028,0100).

C.8.8.3.4.5 High Bit

For RT Doses, High Bit (0028,0102) shall have the Enumerated Value of one less than the value sent in Bits Stored (0028,0101).

C.8.8.3.4.6 Pixel Representation

For RT Doses, Pixel Representation (0028,0103) is specified to use the following Enumerated Values:

0001H = two’s complement integer, when Dose Type (3004,0004) = ERROR

0000H = unsigned integer, otherwise.

C.8.8.4 RT DVH Module

The RT DVH module provides for the inclusion of differential or cumulative dose volume histogram data. The data contained within this module may supplement dose data in the RT Dose and/or RT Dose ROI modules, or it may be present in the absence of other dose data.

Table C.8-40—RT DVH MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Referenced Structure Set Sequence (300C,0060) 1 Introduces sequence of one class/instance pair describing Structure Set containing structures which are used to calculate Dose-Volume Histograms (DVHs). Only a single item shall be included in this sequence. See C.8.8.4.1.
>Include ‘SOP Instance Reference Macro' Table 10-11
DVH Normalization Point (3004,0040) 3 Coordinates (x, y, z) of common DVH normalization point in the patient based coordinate system described in C.7.6.2.1.1 (mm).
DVH Normalization Dose Value (3004,0042) 3 Dose Value at DVH Normalization Point (3004,0040) used as reference for individual DVHs when Dose Units (3004,0002) is RELATIVE.
DVH Sequence (3004,0050) 1 Introduces sequence of DVHs. One or more items shall be included in this sequence.
>DVH Referenced ROI Sequence (3004,0060) 1 Introduces sequence of referenced ROIs used to calculate DVH. One or more items shall be included in this sequence.
>>Referenced ROI Number (3006,0084) 1 Uniquely identifies ROI used to calculate DVH specified by ROI Number (3006,0022) in Structure Set ROI Sequence (3006,0020) in Structure Set Module within RT Structure Set referenced by referenced RT Plan in Referenced RT Plan Sequence (300C,0002) in RT Dose Module.
>>DVH ROI Contribution Type (3004,0062) 1 Specifies whether volume within ROI is included or excluded in DVH. See C.8.8.4.2. Enumerated Values: INCLUDED, EXCLUDED.
>DVH Type (3004,0001) 1 Type of DVH. Enumerated Values: DIFFERENTIAL = differential dose-volume histogram CUMULATIVE = cumulative dose-volume histogram NATURAL = natural dose volume histogram
>Dose Units (3004,0002) 1 Dose axis units. Enumerated Values: GY = Gray RELATIVE = dose relative to reference value specified in DVH Normalization Dose Value (3004,0042)
>Dose Type (3004,0004) 1 Type of dose. Defined Terms: PHYSICAL = physical dose EFFECTIVE = physical dose after correction for biological effect using user-defined modeling technique ERROR = difference between desired and planned dose
>DVH Dose Scaling (3004,0052) 1 Scaling factor that when multiplied by the dose bin widths found in DVH Data (3004,0058), yields dose bin widths in the dose units as specified by Dose Units (3004,0002).
>DVH Volume Units (3004,0054) 1 Volume axis units. Defined Terms: CM3 = cubic centimeters PERCENT = percent PER_U= volume per u with u(dose)=dose-3/2. See C.8.8.4.3.
>DVH Number of Bins (3004,0056) 1 Number of bins n used to store DVH Data (3004,0058).
>DVH Data (3004,0058) 1 A data stream describing the dose bin widths Dn and associated volumes Vn in DVH Volume Units (3004,0054) in the order D1V1, D2V2, ... DnVn. Note: DVH Data arrays may not be properly encoded if Explicit-VR transfer syntax is used and the VL of this attribute exceeds 65534 bytes.
>DVH Minimum Dose (3004,0070) 3 Minimum calculated dose to ROI(s) described by DVH Referenced ROI Sequence (3004,0060).
>DVH Maximum Dose (3004,0072) 3 Maximum calculated dose to ROI(s) described by DVH Referenced ROI Sequence (3004,0060).
>DVH Mean Dose (3004,0074) 3 Mean calculated dose to ROI(s) described by DVH Referenced ROI Sequence (3004,0060).

C.8.8.4.1 Referenced Structure Set Sequence

The Referenced Structure Set Sequence (300C,0060) is required for direct cross-reference of the dose bin data with the corresponding ROI(s) from which they were derived. ROIs referenced by the DVH Referenced ROI Sequence (3004,0050) shall only contain contours with a Contour Geometric Type (3006,0042) of POINT or CLOSED_PLANAR.

C.8.8.4.2 DVH ROI Contribution Type

The volume used to calculate the DVH shall be the geometric union of ROIs where DVH ROI Contribution Type (3004,0062) is INCLUDED, minus the geometric union of ROIs where DVH ROI Contribution Type (3004,0062) is EXCLUDED.

C.8.8.4.3 DVH Volume Units

The unit PER_U is defined in: Anderson, LL: “A “natural” volume-dose histogram for brachytherapy”, Medical Physics 13(6) pp 898-903, 1986.

C.8.8.5 Structure Set Module

A structure set defines a set of areas of significance. Each area can be associated with a Frame of Reference and zero or more images. Information that can be transferred with each region of interest (ROI) includes geometrical and display parameters, and generation technique.

Table C.8-41—STRUCTURE SET MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Structure Set Label (3006,0002) 1 User-defined label for Structure Set.
Structure Set Name (3006,0004) 3 User-defined name for Structure Set.
Structure Set Description (3006,0006) 3 User-defined description for Structure Set.
Instance Number (0020,0013) 3 A number that identifies this object instance.
Structure Set Date (3006,0008) 2 Date at which Structure Set was last modified.
Structure Set Time (3006,0009) 2 Time at which Structure Set was last modified.
Referenced Frame of Reference Sequence (3006,0010) 3 Introduces sequence of items describing Frames of Reference in which the ROIs are defined. One or more items are permitted in this sequence. See C.8.8.5.1.
>Frame of Reference UID (0020,0052) 1 Uniquely identifies Frame of Reference within Structure Set.
>Frame of Reference Relationship Sequence (3006,00C0) 3 Introduces sequence of transforms that relate other Frames of Reference to this Frame of Reference. One or more items are permitted in this sequence.
>>Related Frame of Reference UID (3006,00C2) 1 Frame of Reference Coordinate System to be transformed to the current Frame of Reference.
>>Frame of Reference Transformation Type (3006,00C4) 1 Type of Transformation. Defined Terms: HOMOGENEOUS
>>Frame of Reference Transformation Matrix (3006,00C6) 1 Four-by-four transformation Matrix from Related Frame of Reference to current Frame of Reference. Matrix elements shall be listed in row-major order. See C.8.8.5.2.
>>Frame of Reference Transformation Comment (3006,00C8) 3 Comment regarding the transformation between the related and current Frames of Reference.
>RT Referenced Study Sequence (3006,0012) 3 Introduces sequence of Studies containing series to be referenced. One or more items are permitted in this sequence.
>>Include ‘SOP Instance Reference Macro' Table 10-11
>>RT Referenced Series Sequence (3006,0014) 1 Introduces sequence of items describing series of images within the referenced study which are used in defining the Structure Set. One or more items shall be included in this sequence.
>>>Series Instance UID (0020,000E) 1 Unique identifier for the series containing the images.
>>>Contour Image Sequence (3006,0016) 1 Introduces sequence of items describing images in a given series used in defining the Structure Set (typically CT or MR images). One or more items shall be included in this sequence.
>>>>Include ‘Image SOP Instance Reference Macro’ Table 10-3
Structure Set ROI Sequence (3006,0020) 3 Introduces sequence of ROIs for current Structure Set. One or more items are permitted in this sequence.
>ROI Number (3006,0022) 1 Identification number of the ROI. The value of ROI Number (3006,0022) shall be unique within the Structure Set in which it is created.
>Referenced Frame of Reference UID (3006,0024) 1 Uniquely identifies Frame of Reference in which ROI is defined, specified by Frame of Reference UID (0020,0052) in Referenced Frame of Reference Sequence (3006,0010).
>ROI Name (3006,0026) 2 User-defined name for ROI.
>ROI Description (3006,0028) 3 User-defined description for ROI.
>ROI Volume (3006,002C) 3 Volume of ROI (cubic centimeters).
>ROI Generation Algorithm (3006,0036) 2 Type of algorithm used to generate ROI. Defined Terms: AUTOMATIC = calculated ROI SEMIAUTOMATIC = ROI calculated with user assistance MANUAL = user-entered ROI
>ROI Generation Description (3006,0038) 3 User-defined description of technique used to generate ROI.
>Derivation Code Sequence (0008,9215) 3 A coded description of how this ROI was derived. One or more items are permitted in this Sequence. See C.8.8.5.3 for further explanation.
>>Include ‘Code Sequence Macro’ Table 8.8-1 Enumerated Value (113085, DCM, "Spatial resampling").

C.8.8.5.1 Frames of Reference

The Referenced Frame of Reference Sequence (3006,0010) describes a set of frames of reference in which some or all of the ROIs are expressed. Since the Referenced Frame of Reference UID (3006,0024) is required for each ROI, each frame of reference used to express the coordinates of an ROI shall be listed in the Referenced Frame of Reference Sequence (3006,0010) once and only once.

Notes: 1.As an example, a set of ROIs defined using a single image series would list the image series in a single Referenced Frame of Reference Sequence (3006,0010) item, providing the UID for this referenced frame of reference (obtained from the source images), and listing all pertinent images in the Contour Image Sequence (3006,0016).

2. As an example, a set of ROIs containing ROIs referencing more than one frame of reference would list the referenced images in two or more different Referenced Frame of Reference Sequence (3006,0010) items, providing in each case the UID for this referenced frame of reference (obtained from the source images), and listing all pertinent images in the Contour Image Sequence (3006,0016). Each ROI would then reference the appropriate Frame of Reference UID (0020,0052).

C.8.8.5.2 Frame of Reference Transformation Matrix

In a rigid body system, two coordinate systems can be related using a single 4 x 4 transformation matrix to describe any rotations and/or translations necessary to transform coordinates from the related coordinate system (frame of reference) to the primary system. The equation performing the transform from a point (X’,Y’,Z’) in the related coordinate system to a point (X,Y,Z) in the current coordinate system can be shown as follows, where for homogeneous transforms M 41 = M 42 = M 43 = 0 and M 44 = 1:

X M 11 M 12 M 13 M 14 X’

Y = M 21 M 22 M 23 M 24 x Y’

Z M 31 M 32 M 33 M 34 Z’

1 M 41 M 42 M 43 M 44 1

C.8.8.5.3 ROI Derivation Sequence

If an ROI is created by re-sampling an existing ROI that is either (a) present in a different Frame of Reference (FoR) and has been resampled to align with the image series referenced by the current structure set, or (b) present in the same FoR, but its contours are referenced to a different image series, it is useful to be able to identify that the ROI is resampled. The Derivation Code Sequence (0008,9215) shall be used with code (113085, DCM, "Spatial resampling") to indicate the resampled ROI.

C.8.8.6 ROI Contour Module

In general, a ROI can be defined by either a sequence of overlays or a sequence of contours. This module, if present, is used to define the ROI as a set of contours. Each ROI contains a sequence of one or more contours, where a contour is either a single point (for a point ROI) or more than one point (representing an open or closed polygon).

Table C.8-42—ROI CONTOUR MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
ROI Contour Sequence (3006,0039) 1 Introduces sequence of Contour Sequences defining ROIs. One or more items shall be included in this sequence.
>Referenced ROI Number (3006,0084) 1 Uniquely identifies the referenced ROI described in the Structure Set ROI Sequence (3006,0020).
>ROI Display Color (3006,002A) 3 RGB triplet color representation for ROI, specified using the range 0-255.
>Contour Sequence (3006,0040) 3 Introduces sequence of Contours defining ROI. One or more items are permitted in this sequence.
>>Contour Number (3006,0048) 3 Identification number of the contour. The value of Contour Number (3006,0048) shall be unique within the Contour Sequence (3006,0040) in which it is defined. No semantics or ordering shall be inferred from this attribute.
>>Attached Contours (3006,0049) 3 List of Contour Number (3006,0048) defining lower-numbered contour(s) to which the current contour is connected.
>>Contour Image Sequence (3006,0016) 3 Introduces sequence of images containing the contour. One or more items are permitted in this sequence.
>>>Include ‘Image SOP Instance Reference Macro’ Table 10-3
>>Contour Geometric Type (3006,0042) 1 Geometric type of contour. See C.8.8.6.1. Enumerated Values: POINT = single point OPEN_PLANAR = open contour containing coplanar points OPEN_NONPLANAR = open contour containing non-coplanar points CLOSED_PLANAR = closed contour (polygon) containing coplanar points
>>Contour Slab Thickness (3006,0044) 3 Thickness of slab (in mm) represented by contour, where the Contour Data (3006,0050) defines a plane in the center of the slab, offset by the Contour Offset Vector (3006,0045) if it is present. See C.8.8.6.2.
>>Contour Offset Vector (3006,0045) 3 Vector (x,y,z) in the the patient based coordinate system described in C.7.6.2.1.1 which is normal to plane of Contour Data (3006,0050), describing direction and magnitude of the offset (in mm) of each point of the central plane of a contour slab from the corresponding original point of Contour Data (3006,0050). See C.8.8.6.2.
>>Number of Contour Points (3006,0046) 1 Number of points (triplets) in Contour Data (3006,0050).
>>Contour Data (3006,0050) 1 Sequence of (x,y,z) triplets defining a contour in the patient based coordinate system described in C.7.6.2.1.1 (mm). See C.8.8.6.1 and C.8.8.6.3. Note: Contour Data may not be properly encoded if Explicit-VR transfer syntax is used and the VL of this attribute exceeds 65534 bytes.

C.8.8.6.1 Contour Geometric Type

A contour can be one of the following geometric types:

- A Contour Geometric Type (3006,0042) of POINT indicates that the contour is a single point, defining a specific location of significance.

- A Contour Geometric Type (3006,0042) of OPEN_PLANAR indicates that the last vertex shall not be connected to the first point, and that all points in Contour Data (3006,0050) shall be coplanar.

- A Contour Geometric Type (3006,0042) of OPEN_NONPLANAR indicates that the last vertex shall not be connected to the first point, and that the points in Contour Data (3006,0050) may be non-coplanar. Contours having a Geometric Type (3006,0042) of OPEN_NONPLANAR can be used to represent objects best described by a single, possibly non-coplanar curve, such as a brachytherapy applicator.

- A Contour Geometric Type (3006,0042) of CLOSED_PLANAR indicates that the last point shall be connected to the first point, where the first point is not repeated in the Contour Data (3006,0050). All points in Contour Data (3006,0050) shall be coplanar.

C.8.8.6.2 Contour Slab Thickness

A set of Contour slabs may define a multi-slab Volume of Interest. Contour Slab Thickness (3006,0044) shall specify the thickness of a slab, the central plane of which shall be defined by the set of points offset from Contour Data (3006,0050) by the value of Contour Offset Vector (3006,0045). One contour slab may contain one to many sets of Contour Data (3006,0050) that may define regions of one complex Volume of Interest. If no valid value of Contour Slab Thickness (3006,0044) is sent, then the offset value shall be (0,0,0) and the original Contour Data (3006,0050) shall define the central plane of the Contour slab.

C.8.8.6.3 Representing Inner and Outer Contours on an Image

When a single ROI describes an excluded inner volume, this can be encoded with a single contour, using a “keyhole” technique. In this method, an arbitrarily narrow channel is used to connect the outer contour to the inner contour, so that it is drawn as a single contour. An example of such a structure is shown in Figure C.8.8.6-1

Points in space lying along the path defined by the contour are considered to be inside the ROI.

[pic]

Figure C.8.8.6-1Example of ROI with excluded inner volume

C.8.8.7 RT Dose ROI Module

RT Dose ROI provides ancillary dose-related information to the ROI data defined within the Structure Set and ROI Contour modules, which may be included in the RT Dose IOD composite object. These modules in combination provide for the definition of dose data in the form of isodose curves or named or unnamed dose points. Isodose curves in radiation oncology are simply contours identifying a set of points with the same dose value.

Table C.8-43—RT DOSE ROI MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
RT Dose ROI Sequence (3004,0010) 1 Introduces sequence of items specifying dose levels for isodose curves or dose points described in the ROI module. One or more items shall be included in this sequence. See C.8.8.7.1.
>Referenced ROI Number (3006,0084) 1 Uniquely identifies the referenced ROI within the current RT Dose. See Note 1 and C.8.8.7.2.
>Dose Units (3004,0002) 1 Units used for ROI Dose. Enumerated Values: GY = Gray RELATIVE = dose relative to implicit reference value
>Dose Value (3004,0012) 1 Dose value for ROI, in units defined by Dose Units (3004,0002). See C.8.8.7.3.

Notes: 1. The Structure Set ROI Sequence (3006,0020) defining the dose point and surfaces is defined in the Structure Set module. The ROI Number (3006,0022) attribute is unique within the Structure Set ROI Sequence, and is referenced from the RT Dose ROI module using Referenced ROI Number (3006,0084).

2. The RT Dose ROI module defines the attributes that describe references to ROIs contained within the associated Structure Set and RT ROI Contour modules. Note that the RT Dose module table specifies that either all or none of the modules Structures Set, ROI Contour, and RT Dose ROI must be present in the RT Dose IOD.

C.8.8.7.1 Contour Geometric Type of Referenced ROI

ROIs referenced in the RT Dose ROI Module shall have a Contour Geometric Type (3006,0042) of POINT, OPEN_PLANAR or CLOSED_PLANAR.

C.8.8.7.2 Referenced ROI Number

There shall be a one-to-one correspondence between Referenced ROI Number (3006,0084) and the sequence of ROIs defined in the Structure Set and ROI Contour modules. The RT Dose ROI module shall only contain references to structures which are dose-related (i.e. dose points and isodose curves).

C.8.8.7.3 Dose Value

Dose Value (3004,0012) shall be the dose value corresponding to the referenced isodose curve, named dose point, or unnamed dose point.

C.8.8.8 RT ROI Observations Module

The RT ROI Observations module specifies the identification and interpretation of an ROI specified in the Structure Set and ROI Contour modules.

Table C.8-44—RT ROI OBSERVATIONS MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
RT ROI Observations Sequence (3006,0080) 1 Introduces sequence of observations related to ROIs defined in the ROI Module. One or more items shall be included in this sequence.
>Observation Number (3006,0082) 1 Identification number of the Observation. The value of Observation Number (3006,0082) shall be unique within the RT ROI Observations Sequence (3006,0080).
>Referenced ROI Number (3006,0084) 1 Uniquely identifies the referenced ROI described in the Structure Set ROI Sequence (3006,0020).
>ROI Observation Label (3006,0085) 3 User-defined label for ROI Observation.
>ROI Observation Description (3006,0088) 3 User-defined description for ROI Observation.
>RT Related ROI Sequence (3006,0030) 3 Introduces sequence of significantly related ROIs, e.g. CTVs contained within a PTV. One or more items are permitted in this sequence.
>>Referenced ROI Number (3006,0084) 1 Uniquely identifies the related ROI described in the Structure Set ROI Sequence (3006,0020).
>>RT ROI Relationship (3006,0033) 3 Relationship of referenced ROI with respect to referencing ROI. Defined Terms: SAME = ROIs represent the same entity ENCLOSED = referenced ROI completely encloses referencing ROI ENCLOSING = referencing ROI completely encloses referenced ROI
>RT ROI Identification Code Sequence (3006,0086) 3 Introduces sequence containing Code used to identify ROI. Only a single Item is permitted in this sequence. Baseline Context ID Number = 96. See Section 5.3 for further explanation.
>>Include ‘Code Sequence Macro’ Table 8.8-1 Baseline CID 96.
>Related RT ROI Observations Sequence (3006,00A0) 3 Introduces sequence of related ROI Observations. One or more items are permitted in this sequence.
>>Observation Number (3006,0082) 1 Uniquely identifies a related ROI Observation.
>RT ROI Interpreted Type (3006,00A4) 2 Type of ROI. See C.8.8.8.1. Defined Terms: EXTERNAL = external patient contour PTV = Planning Target Volume (as defined in ICRU50) CTV = Clinical Target Volume (as defined in ICRU50) GTV = Gross Tumor Volume (as defined in ICRU50) TREATED_VOLUME = Treated Volume (as defined in ICRU50) IRRAD_VOLUME = Irradiated Volume (as defined in ICRU50) BOLUS = patient bolus to be used for external beam therapy AVOIDANCE = region in which dose is to be minimized ORGAN = patient organ MARKER = patient marker or marker on a localizer REGISTRATION = registration ROI ISOCENTER = treatment isocenter to be used for external beam therapy CONTRAST_AGENT = volume into which a contrast agent has been injected CAVITY = patient anatomical cavity BRACHY_CHANNEL = brachytherapy channel BRACHY_ACCESSORY = brachytherapy accessory device BRACHY_SRC_APP = brachytherapy source applicator BRACHY_CHNL_SHLD = brachytherapy channel shield SUPPORT = external patient support device FIXATION = external patient fixation or immobilisation device DOSE_REGION = ROI to be used as a dose reference CONTROL = ROI to be used in control of dose optimization and calculation
>ROI Interpreter (3006,00A6) 2 Name of person performing the interpretation.
>Material ID (300A,00E1) 3 User-supplied identifier for ROI material.
>ROI Physical Properties Sequence (3006,00B0) 3 Introduces sequence describing physical properties associated with current ROI interpretation. One or more items are permitted in this sequence.
>>ROI Physical Property (3006,00B2) 1 Physical property specified by ROI Physical Property Value (3006,00B4). Defined Terms: REL_MASS_DENSITY = mass density relative to water REL_ELEC_DENSITY = electron density relative to water EFFECTIVE_Z = effective atomic number EFF_Z_PER_A = ratio of effective atomic number to mass (AMU-1) REL_STOP_RATIO = linear stopping power ratio relative to water ELEM_FRACTION = elemental composition of the material
>>ROI Elemental Composition Sequence (3006,00B6) 1C The elemental composition of the ROI and the atomic mass fraction of the elements in the ROI. Required if ROI Physical Property (3006,00B2) equals ELEM_FRACTION. One or more items shall be included in this sequence.
>>>ROI Elemental Composition Atomic Number (3006,00B7) 1 The atomic number of the element for which the ROI Elemental Composition Sequence (3006,00B6) is sent.
>>>ROI Elemental Composition Atomic Mass Fraction (3006,00B8) 1 The fractional weight of the element for which the ROI Elemental Composition Sequence (3006,00B6) is sent. The sum of all ROI Elemental Composition Atomic Mass Fractions (3006,00B8) sent in the ROI Elemental Composition Sequence (3006,00B6) shall equal 1.0 within acceptable limits of floating point precision.
>>ROI Physical Property Value (3006,00B4) 1 User-assigned value for physical property.

C.8.8.8.1 RT ROI Interpreted Type

RT ROI Interpreted Type (3006,00A4) shall describe the class of ROI (e.g. CTV, PTV). Individual instances of each class of structure (e.g. CTV1, CTV2) can be distinguished using ROI Observation Label (3006,0085).

C.8.8.9 RT General Plan Module

Table C.8-45—RT GENERAL PLAN MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
RT Plan Label (300A,0002) 1 User-defined label for treatment plan.
RT Plan Name (300A,0003) 3 User-defined name for treatment plan.
RT Plan Description (300A,0004) 3 User-defined description of treatment plan.
Instance Number (0020,0013) 3 A number that identifies this object instance.
RT Plan Date (300A,0006) 2 Date treatment plan was last modified.
RT Plan Time (300A,0007) 2 Time treatment plan was last modified.
Treatment Protocols (300A,0009) 3 Planned treatment protocols.
Plan Intent (300A,000A) 3 Intent of this plan. Defined Terms: CURATIVE = curative therapy on patient PALLIATIVE = palliative therapy on patient PROPHYLACTIC = preventative therapy on patient VERIFICATION = verification of patient plan using phantom MACHINE_QA= Quality assurance of the delivery machine (independently of a specific patient) RESEARCH = Research project SERVICE = Machine repair or maintenance operation
Treatment Sites (300A,000B) 3 Planned treatment sites.
RT Plan Geometry (300A,000C) 1 Describes whether RT Plan is based on patient or treatment device geometry. See C.8.8.9.1. Defined Terms: PATIENT = RT Structure Set exists TREATMENT_DEVICE = RT Structure Set does not exist
Referenced Structure Set Sequence (300C,0060) 1C The RT Structure Set on which the RT Plan is based. Only a single item shall be included in this sequence. Required if RT Plan Geometry (300A,000C) is PATIENT.
>Include ‘SOP Instance Reference Macro' Table 10-11
Referenced Dose Sequence (300C,0080) 3 Related instances of RT Dose (for grids and named/unnamed point doses). One or more items are permitted in this sequence. See Note 1.
>Include ‘SOP Instance Reference Macro' Table 10-11
Referenced RT Plan Sequence (300C,0002) 3 Related instances of RT Plan. One or more items are permitted in this sequence.
>Include ‘SOP Instance Reference Macro' Table 10-11
>RT Plan Relationship (300A,0055) 1 Relationship of referenced plan with respect to current plan. Defined Terms: PRIOR = plan delivered prior to current treatment ALTERNATIVE = alternative plan prepared for current treatment PREDECESSOR = plan used in derivation of current plan VERIFIED_PLAN = plan which is verified using the current plan. This value shall only be used if Plan Intent (300A,000A) is present and has a value of VERIFICATION CONCURRENT = plan that forms part of a set of two or more RT Plan instances representing a single conceptual ‘plan’, applied in parallel in one treatment phase

Note: An RT Dose IOD referenced within the Referenced Dose Sequence (300C,0080) can be used for storing grid-based (pixel) data, individual dose points (with optional dose point names), isodose curves, and DVH's.

C.8.8.9.1 Referenced Structure Set Sequence

An RT Plan Geometry (300A,000C) of PATIENT shall signify that an RT Structure Set has been defined upon which the plan geometry is based, and this RT Structure Set shall be specified in the Referenced Structure Set Sequence (300C,0060). An RT Plan Geometry (300A,000C) of TREATMENT_DEVICE shall indicate that no patient geometry is available, and that the RT Plan is being defined with respect to the IEC FIXED Coordinate System.

C.8.8.10 RT Prescription Module

Table C.8-46—RT PRESCRIPTION MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Prescription Description (300A,000E) 3 User-defined description of treatment prescription.
Dose Reference Sequence (300A,0010) 3 Introduces sequence of Dose References. One or more items are permitted in this sequence.
>Dose Reference Number (300A,0012) 1 Identification number of the Dose Reference. The value of Dose Reference Number (300A,0012) shall be unique within the RT Plan in which it is created.
>Dose Reference UID (300A,0013) 3 A unique identifier for a Dose Reference that can be used to link the same entity across multiple RT Plan objects.
>Dose Reference Structure Type (300A,0014) 1 Structure type of Dose Reference. Defined Terms: POINT = dose reference point specified as ROI VOLUME = dose reference volume specified as ROI COORDINATES = point specified by Dose Reference Point Coordinates (300A,0018) SITE = dose reference clinical site
>Dose Reference Description (300A,0016) 3 User-defined description of Dose Reference.
>Referenced ROI Number (3006,0084) 1C Uniquely identifies ROI representing the dose reference specified by ROI Number (3006,0022) in Structure Set ROI Sequence (3006,0020) in Structure Set Module within RT Structure Set in Referenced Structure Set Sequence (300C,0060) in RT General Plan Module. Required if Dose Reference Structure Type (300A,0014) is POINT or VOLUME.
>Dose Reference Point Coordinates (300A,0018) 1C Coordinates (x,y,z) of Reference Point in the patient based coordinate system described in C.7.6.2.1.1 (mm). Required if Dose Reference Structure Type (300A,0014) is COORDINATES.
>Nominal Prior Dose (300A,001A) 3 Dose (in Gy) from prior treatment to this Dose Reference (e.g. from a previous course of treatment).
>Dose Reference Type (300A,0020) 1 Type of Dose Reference. Defined Terms: TARGET = treatment target (corresponding to GTV, PTV, or CTV in ICRU50) ORGAN_AT_RISK = Organ at Risk (as defined in ICRU50)
>Constraint Weight (300A,0021) 3 Relative importance of satisfying constraint, where high values represent more important constraints.
>Delivery Warning Dose (300A,0022) 3 The dose (in Gy) which when reached or exceeded should cause some action to be taken.
>Delivery Maximum Dose (300A,0023) 3 The maximum dose (in Gy) which can be delivered to the dose reference.
>Target Minimum Dose (300A,0025) 3 Minimum permitted dose (in Gy) to Dose Reference if Dose Reference Type (300A,0020) is TARGET.
>Target Prescription Dose (300A,0026) 3 Prescribed dose (in Gy) to Dose Reference if Dose Reference Type (300A,0020) is TARGET.
>Target Maximum Dose (300A,0027) 3 Maximum permitted dose (in Gy) to Dose Reference if Dose Reference Type (300A,0020) is TARGET.
>Target Underdose Volume Fraction (300A,0028) 3 Maximum permitted fraction (in percent) of Target to receive less than the Target Prescription Dose if Dose Reference Type (300A,0020) is TARGET and Dose Reference Structure Type (300A,0014) is VOLUME. See C.8.8.10.1.
>Organ at Risk Full-volume Dose (300A,002A) 3 Maximum dose (in Gy) to entire Dose Reference if Dose Reference Type (300A,0020) is ORGAN_AT_RISK and Dose Reference Structure Type (300A,0014) is VOLUME.
>Organ at Risk Limit Dose (300A,002B) 3 Maximum permitted dose (in Gy) to any part of Dose Reference if Dose Reference Type (300A,0020) is ORGAN_AT_RISK and Dose Reference Structure Type (300A,0014) is VOLUME.
>Organ at Risk Maximum Dose (300A,002C) 3 Maximum dose (in Gy) to non-overdosed part of Dose Reference if Dose Reference Type (300A,0020) is ORGAN_AT_RISK and Dose Reference Structure Type (300A,0014) is VOLUME.
>Organ at Risk Overdose Volume Fraction (300A,002D) 3 Maximum permitted fraction (in percent) of the Organ at Risk to receive more than the Organ at Risk Maximum Dose if Dose Reference Type (300A,0020) is ORGAN_AT_RISK and Dose Reference Structure Type (300A,0014) is VOLUME.

C.8.8.10.1 Target Underdose Volume Fraction

If the Target Underdose Volume Fraction (300A,0028) is not present, it shall be interpreted as zero.

C.8.8.11 RT Tolerance Tables Module

Table C.8-47—RT TOLERANCE TABLES MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Tolerance Table Sequence (300A,0040) 3 Introduces sequence of tolerance tables to be used for delivery of treatment plan. One or more items are permitted in this sequence. See Note 1.
>Tolerance Table Number (300A,0042) 1 Identification number of the Tolerance Table. The value of Tolerance Table Number (300A,0042) shall be unique within the RT Plan in which it is created.
>Tolerance Table Label (300A,0043) 3 User-defined label for Tolerance Table.
>Gantry Angle Tolerance (300A,0044) 3 Maximum permitted difference (in degrees) between planned and delivered Gantry Angle.
>Gantry Pitch Angle Tolerance (300A,014E) 3 Maximum permitted difference (in degrees) between planned and delivered Gantry Pitch Angle.
>Beam Limiting Device Angle Tolerance (300A,0046) 3 Maximum permitted difference (in degrees) between planned and delivered Beam Limiting Device Angle.
>Beam Limiting Device Tolerance Sequence (300A,0048) 3 Introduces sequence of beam limiting device (collimator) tolerances. One or more items are permitted in this sequence.
>>RT Beam Limiting Device Type (300A,00B8) 1 Type of beam limiting device (collimator). Enumerated Values: X = symmetric jaw pair in IEC X direction Y = symmetric jaw pair in IEC Y direction ASYMX = asymmetric jaw pair in IEC X direction ASYMY = asymmetric pair in IEC Y direction MLCX = multileaf (multi-element) jaw pair in IEC X direction MLCY = multileaf (multi-element) jaw pair in IEC Y direction
>>Beam Limiting Device Position Tolerance (300A,004A) 1 Maximum permitted difference (in mm) between planned and delivered leaf (element) or jaw positions for current beam limiting device (collimator).
>Patient Support Angle Tolerance (300A,004C) 3 Maximum permitted difference (in degrees) between planned and delivered Patient Support Angle.
>Table Top Eccentric Angle Tolerance (300A,004E) 3 Maximum permitted difference (in degrees) between planned and delivered Table Top Eccentric Angle.
>Table Top Pitch Angle Tolerance (300A,004F) 3 Maximum permitted difference (in degrees) between the planned and delivered Table Top Pitch Angle.
>Table Top Roll Angle Tolerance (300A,0050) 3 Maximum permitted difference (in degrees) between the planned and delivered Table Top Roll Angle.
>Table Top Vertical Position Tolerance (300A,0051) 3 Maximum permitted difference (in mm) between planned and delivered Table Top Vertical Position.
>Table Top Longitudinal Position Tolerance (300A,0052) 3 Maximum permitted difference (in mm) between planned and delivered Table Top Longitudinal Position.
>Table Top Lateral Position Tolerance (300A,0053) 3 Maximum permitted difference (in mm) between planned and delivered Table Top Lateral Position.

Note: Tolerance Tables may be used to compare planned with delivered machine parameters. If the absolute difference between the planned and delivered values exceeds the Tolerance Table value, treatment may be inhibited or the operator may be warned.

C.8.8.12 RT Patient Setup Module

The RT Patient Setup Module contains information describing the positioning of the patient with respect to the treatment machine, along with any fixation devices used. It also describes the shielding devices applied to the patient. The module contains a sequence of patient setup descriptions, each of which may be referenced by one of more beams or brachy application setups.

Table C.8-48—RT PATIENT SETUP MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Patient Setup Sequence (300A,0180) 1 Introduces sequence of patient setup data for current plan. One or more items shall be included in this sequence.
>Patient Setup Number (300A,0182) 1 Identification number of the Patient Setup. The value of Patient Setup Number (300A,0182) shall be unique within the RT Plan in which it is created.
>Patient Setup Label (300A,0183) 3 The user-defined label for the patient setup.
>Patient Position (0018,5100) 1C Patient position descriptor relative to the equipment. Required if Patient Additional Position (300A,0184) is not present. See Section C.8.8.12.1.2 for Defined Terms and further explanation.
>Patient Additional Position (300A,0184) 1C User-defined additional description of patient position. Required if Patient Position (0018,5100) is not present.
>Referenced Setup Image Sequence (300A,0401) 3 Introduces sequence of setup verification images for this patient setup. One or more items are permitted in this sequence. See C.8.8.12.1.1
>>Setup Image Comment (300A,0402) 3 Comment on the Setup Image.
>>Include ‘Image SOP Instance Reference Macro' Table 10-3
>Fixation Device Sequence (300A,0190) 3 Introduces sequence of Fixation Devices used in Patient Setup. One or more items are permitted in this sequence.
>>Fixation Device Type (300A,0192) 1 Type of Fixation Device used during in Patient Setup. Defined Terms: BITEBLOCK HEADFRAME MASK MOLD CAST HEADREST BREAST_BOARD BODY_FRAME VACUUM_MOLD WHOLE_BODY_POD RECTAL_BALLOON
>>Fixation Device Label (300A,0194) 2 User-defined label identifier for Fixation Device.
>>Fixation Device Description (300A,0196) 3 User-defined description of Fixation Device.
>>Fixation Device Position (300A,0198) 3 Position/Notch number of Fixation Device.
>>Fixation Device Pitch Angle (300A,0199) 3 The Fixation Device Pitch Angle, i.e. orientation of PITCHED FIXATION DEVICE coordinate system with respect to IEC PATIENT SUPPORT coordinate system (degrees). Pitching is the rotation around IEC PATIENT SUPPORT X-axis.
>>Fixation Device Roll Angle (300A,019A) 3 The Fixation Device Roll Angle, i.e. orientation of ROLLED FIXATION DEVICE coordinate system with respect to IEC PITCHED FIXATION DEVICE coordinate system (degrees). Rolling is the rotation around IEC PATIENT SUPPORT Y-axis.
>>Accessory Code (300A,00F9) 3 An identifier for the accessory intended to be read by a device such as a bar-code reader.
>Shielding Device Sequence (300A,01A0) 3 Introduces sequence of Shielding Devices used in Patient Setup. One or more items are permitted in this sequence.
>>Shielding Device Type (300A,01A2) 1 Type of Shielding Device used in Patient Setup. Defined Terms: GUM EYE GONAD
>>Shielding Device Label (300A,01A4) 2 User-defined label for Shielding Device.
>>Shielding Device Description (300A,01A6) 3 User-defined description of Shielding Device.
>>Shielding Device Position (300A,01A8) 3 Position/Notch number of Shielding Device.
>>Accessory Code (300A,00F9) 3 An identifier for the accessory intended to be read by a device such as a bar-code reader.
>Setup Technique (300A,01B0) 3 Setup Technique used in Patient Setup. Defined Terms: ISOCENTRIC FIXED_SSD TBI BREAST_BRIDGE SKIN_APPOSITION
>Setup Technique Description (300A,01B2) 3 User-defined description of Setup Technique.
>Setup Device Sequence (300A,01B4) 3 Introduces sequence of devices used for patient alignment in Patient Setup. One or more items are permitted in this sequence.
>>Setup Device Type (300A,01B6) 1 Type of Setup Device used for Patient alignment. Defined Terms: LASER_POINTER DISTANCE_METER TABLE_HEIGHT MECHANICAL_PTR ARC
>>Setup Device Label (300A,01B8) 2 User-defined label for Setup Device used for patient alignment.
>>Setup Device Description (300A,01BA) 3 User-defined description for Setup Device used for patient alignment.
>>Setup Device Parameter (300A,01BC) 2 Setup Parameter for Setup Device in appropriate IEC 61217 coordinate system. Units shall be mm for distances and degrees for angles.
>>Setup Reference Description (300A,01D0) 3 User-defined description of Setup Reference used for patient alignment.
>>Accessory Code (300A,00F9) 3 An identifier for the accessory intended to be read by a device such as a bar-code reader.
>Table Top Vertical Setup Displacement (300A,01D2) 3 Vertical Displacement in IEC TABLE TOP coordinate system (in mm) relative to initial Setup Position, i.e. vertical offset between patient positioning performed using setup and treatment position.
>Table Top Longitudinal Setup Displacement (300A,01D4) 3 Longitudinal Displacement in IEC TABLE TOP coordinate system (in mm) relative to initial Setup Position, i.e. longitudinal offset between patient positioning performed using setup and treatment position.
>Table Top Lateral Setup Displacement (300A,01D6) 3 Lateral Displacement in IEC TABLE TOP coordinate system (in mm) relative to initial Setup Position, i.e. lateral offset between patient positioning performed using setup and treatment position.
>Motion Synchronization Sequence (300A,0410) 3 Introduces sequence of Motion Synchronization. One or more items are permitted in this sequence.
>>Respiratory Motion Compensation Technique (0018,9170) 1 Technique applied to reduce respiratory motion artifacts. Defined Terms: NONE BREATH_HOLD REALTIME = image acquisition shorter than respiratory cycle GATING = Prospective gating TRACKING = prospective through-plane or in-plane motion tracking PHASE_ORDERING = prospective phase ordering PHASE_RESCANNING = prospective techniques, such as real-time averaging, diminishing variance and motion adaptive gating RETROSPECTIVE = retrospective gating CORRECTION = retrospective image correction UNKNOWN = technique not known
>>Respiratory Signal Source (0018,9171) 1 Signal source from which respiratory motion is derived. Defined Terms: NONE BELT NASAL_PROBE CO2_SENSOR NAVIGATOR = MR navigator and organ edge detection MR_PHASE = phase (of center k-space line) ECG = baseline demodulation of the ECG SPIROMETER = Signal derived from flow sensor EXTERNAL_MARKER = Signal determined from external motion surrogate INTERNAL_MARKER = Signal determined from internal motion surrogate IMAGE = Signal derived from an image UNKNOWN = Signal source not known
>>Respiratory Motion Compensation Technique Description (0018,9185) 3 Description of respiratory motion compensation technique.
>>Respiratory Signal Source ID (0018,9186) 3 Identifies the device providing the respiratory signal.

C.8.8.12.1 RT Patient Setup Module Attributes

C.8.8.12.1.1 Referenced Setup Image Sequence

Images with modality SC or VL serve as visible light photos for visual setup control. Images with modality RTIMAGE serve as reference images on plan level. RT Images present in this sequence shall not be referenced in the Referenced Reference Image Sequence (300C,0042) of the RT Beams module.

C.8.8.12.1.2 Patient Position

Defined Terms for Patient Position shall be those specified in Section C.7.3.1.1.2, plus the following:

SITTING

In the sitting position, the patient’s face is towards the front of the chair.

C.8.8.13 RT Fraction Scheme Module

The RT Fraction Scheme module contains attributes that describe a single or multiple scheme of dose descriptions. Each sequence item contains dose specification information, fractionation patterns, and either beam or brachytherapy application setup specifications. The design of the RT Fraction Scheme module allows a beam or brachytherapy application setup to be used in multiple fraction schemes.

Table C.8-49—RT FRACTION SCHEME MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Fraction Group Sequence (300A,0070) 1 Introduces sequence of Fraction Groups in current Fraction Scheme. One or more items shall be included in this sequence.
>Fraction Group Number (300A,0071) 1 Identification number of the Fraction Group. The value of Fraction Group Number (300A,0071) shall be unique within the RT Plan in which it is created.
>Fraction Group Description (300A,0072) 3 The user defined description for the fraction group.
>Referenced Dose Sequence (300C,0080) 3 Related instances of RT Dose (for grids, isodose curves and named/unnamed point doses). One or more items are permitted in this sequence. See Note 1.
>>Include ‘SOP Instance Reference Macro' Table 10-11
>Referenced Dose Reference Sequence (300C,0050) 3 Introduces sequence of Dose References for the current Fraction Group. One or more items are permitted in this sequence.
>>Referenced Dose Reference Number (300C,0051) 1 Uniquely identifies Dose Reference specified by Dose Reference Number (300A,0012) within Dose Reference Sequence (300A,0010) in RT Prescription Module.
>>Constraint Weight (300A,0021) 3 Relative importance of satisfying constraint, where high values represent more important constraints.
>>Delivery Warning Dose (300A,0022) 3 The dose (in Gy) which when reached or exceeded should cause some action to be taken.
>>Delivery Maximum Dose (300A,0023) 3 The maximum dose (in Gy) which can be delivered to the dose reference.
>>Target Minimum Dose (300A,0025) 3 Minimum permitted dose (in Gy) to Dose Reference if Dose Reference Type (300A,0020) of referenced Dose Reference is TARGET.
>>Target Prescription Dose (300A,0026) 3 Prescribed dose (in Gy) to Dose Reference if Dose Reference Type (300A,0020) of referenced Dose Reference is TARGET.
>>Target Maximum Dose (300A,0027) 3 Maximum permitted dose (in Gy) to Dose Reference if Dose Reference Type (300A,0020) of referenced Dose Reference is TARGET.
>>Target Underdose Volume Fraction (300A,0028) 3 Maximum permitted fraction (in percent) of Target to receive less than the Target Prescription Dose (300A,0027) if Dose Reference Type (300A,0020) of referenced Dose Reference is TARGET and Dose Reference Structure Type (300A,0014) of referenced Dose Reference is VOLUME.
>>Organ at Risk Full-volume Dose (300A,002A) 3 Maximum dose (in Gy) to entire Dose Reference if Dose Reference Type (300A,0020) of referenced Dose Reference is ORGAN_AT_RISK and Dose Reference Structure Type (300A,0014) of referenced Dose Reference is VOLUME.
>>Organ at Risk Limit Dose (300A,002B) 3 Maximum permitted dose (in Gy) to any part of Dose Reference if Dose Reference Type (300A,0020) of referenced Dose Reference is ORGAN_AT_RISK and Dose Reference Structure Type (300A,0014) of referenced Dose Reference is VOLUME.
>>Organ at Risk Maximum Dose (300A,002C) 3 Maximum dose (in Gy) to non-overdosed part of Dose Reference if Dose Reference Type (300A,0020) of referenced Dose Reference is ORGAN_AT_RISK and Dose Reference Structure Type (300A,0014) of referenced Dose Reference is VOLUME.
>>Organ at Risk Overdose Volume Fraction (300A,002D) 3 Maximum permitted fraction (in percent) of Organ at Risk to receive more than the Organ at Risk Maximum Dose if Dose Reference Type (300A,0020) of referenced Dose Reference is ORGAN_AT_RISK and Dose Reference Structure Type (300A,0014) of referenced Dose Reference is VOLUME.
>Number of Fractions Planned (300A,0078) 2 Total number of treatments (Fractions) prescribed for current Fraction Group.
>Number of Fraction Pattern Digits Per Day (300A,0079) 3 Number of digits in Fraction Pattern (300A,007B) used to represent one day. See Note 2.
>Repeat Fraction Cycle Length (300A,007A) 3 Number of weeks needed to describe treatment pattern. See Note 2.
>Fraction Pattern (300A,007B) 3 String of 0's (no treatment) and 1's (treatment) describing treatment pattern. Length of string is 7 x Number of Fraction Pattern Digits Per Day x Repeat Fraction Cycle Length. Pattern shall start on a Monday. See Note 2.
>Number of Beams (300A,0080) 1 Number of Beams in current Fraction Group. If Number of Beams is greater then zero, Number of Brachy Application Setups (300A,00A0) shall equal zero.
>Referenced Beam Sequence (300C,0004) 1C Introduces sequence of treatment beams in current Fraction Group. One or more items shall be included in this sequence. Required if Number of Beams (300A,0080) is greater than zero.
>>Referenced Beam Number (300C,0006) 1 Uniquely identifies Beam specified by Beam Number (300A,00C0) within Beam Sequence (300A,00B0) in RT Beams Module.
>>Beam Dose Specification Point (300A,0082) 3 Coordinates (x,y,z) of point at which Beam Dose is specified in the patient based coordinate system described in C.7.6.2.1.1 (mm). See Note 3.
>>Beam Dose (300A,0084) 3 Dose (in Gy) at Beam Dose Specification Point (300A,0082) due to current Beam.
>>Beam Dose Point Depth (300A,0088) 3 The depth (in mm) in the patient along a ray from the source to the dose point specified by the Beam Dose Specification Point (300A,0082). See Note 6.
>>Beam Dose Point Equivalent Depth (300A,0089) 3 The radiological depth in mm (water-equivalent depth, taking tissue heterogeneity into account) in the patient along a ray from the source to the dose point specified by the Beam Dose Specification Point (300A,0082). See Note 6.
>>Beam Dose Point SSD (300A,008A) 3 Source to patient surface distance along a ray from the source to the dose point specified by the Beam Dose Specification Point (300A,0082). See Note 6.
>>Beam Meterset (300A,0086) 3 Machine setting to be delivered for current Beam, specified in Monitor Units (MU) or minutes as defined by Primary Dosimeter Unit (300A,00B3) (in RT Beams Module) for referenced Beam. See Note 4.
>Number of Brachy Application Setups (300A,00A0) 1 Number of Brachy Application Setups in current Fraction Group. If Number of Brachy Application Setups is greater then zero, Number of Beams (300A,0080) shall equal zero.
>Referenced Brachy Application Setup Sequence (300C,000A) 1C Introduces sequence of treatment Brachy Application Setups in current Fraction Group. Required if Number of Brachy Application Setups (300A,00A0) is greater than zero. One or more items shall be included in this sequence.
>>Referenced Brachy Application Setup Number (300C,000C) 1 Uniquely identifies Brachy Application Setup specified by Brachy Application Setup Number (300A,0234) within Brachy Application Setup Sequence (300A,0230) in RT Brachy Application Setups Module.
>>Brachy Application Setup Dose Specification Point (300A,00A2) 3 Coordinates (x,y,z) of point in the patient based coordinate system described in C.7.6.2.1.1 at which Brachy Application Setup Dose (300A,00A4) is specified (mm).
>>Brachy Application Setup Dose (300A,00A4) 3 Dose (in Gy) at Brachy Application Setup Dose Specification Point (300A,00A2) due to current Brachy Application Setup.

Notes: 1. An RT Dose IOD referenced within the Referenced Dose Sequence (300C,0080) can be used for storing grid-based (pixel) data, isodose curves, and/or individual dose points (with optional dose point names) for the current Fraction Group.

2. The fractionation pattern does not indicate the actual start of treatment, or the order or timing of fraction delivery. If treatment does not commence as outlined in the pattern, it is the application’s responsibility to make any necessary adjustments.

Examples of Fractionation Pattern Schemes:

a) 1 fraction group, 1 fraction per day (Monday to Friday):

Number of Fraction Pattern Digits per Day = 1, Repeat Fraction Cycle Length = 1, Fraction Pattern = 1111100

b) 2 fraction groups, 1 fraction per day, first fraction group Monday, Wednesday, and Friday, second fraction group Tuesday and Thursday:

Fraction Group 1: Number of Fraction Pattern Digits Per Day = 1, Repeat Fraction Cycle Length = 1, Fraction Pattern = 1010100

Fraction Group 2: Number of Fraction Pattern Digits Per Day = 1, Repeat Fraction Cycle Length = 1, Fraction Pattern = 0101000

c) 2 fraction groups, 1 fraction per day, alternating fraction groups every day of treatment (Monday to Friday):

Fraction Group 1: Number of Fraction Pattern Digits Per Day = 1, Repeat Fraction Cycle Length = 2, Fraction Pattern = 10101000101000

Fraction Group 2: Number of Fraction Pattern Digits Per Day = 1, Repeat Fraction Cycle Length = 2, Fraction Pattern = 01010001010100

d) 1 fraction group, 2 fractions per day (Monday to Friday):

Fraction Group 1: Number of Fraction Pattern Digits Per Day = 2, Repeat Fraction Cycle Length = 1, Fraction Pattern = 11111111110000

e) 2 fraction groups, 2 fractions per day, alternating fraction groups every treatment (Monday to Friday):

Fraction Group 1: Number of Fraction Pattern Digits Per Day = 1, Repeat Fraction Cycle Length = 1, Fraction Pattern = 1111100

Fraction Group 2: Number of Fraction Pattern Digits Per Day = 2, Repeat Fraction Cycle Length = 1, Fraction Pattern = 11111111110000

3. The Beam Dose Specification Point (300A,0082) and Brachy Application Setup Dose Specification Point (300A,00A2) contain the coordinates of the single point used for dose normalization. This point is distinct from the Referenced Dose Reference Sequence (300C,0050) in the RT Beams module and the Brachy Referenced Dose Reference Sequence (300C,0055) in the RT Brachy Application Setups module, which are used for plan evaluation and dose tracking.

4. The Meterset at a given Control Point (see RT Beams Module) is equal to the Beam Meterset (300A,0086) multiplied by the Cumulative Meterset Weight (300A,0134) for the Control Point, divided by the Final Cumulative Meterset Weight (300A,010E).

5. Attribute Referenced Patient Setup Number (300C,006A) was previously defined. Its use in this Module is now retired (see PS3.3 2004).

6. The values defined by this attribute are related to the gantry angle of the first control point referenced by Referenced Beam Number (300C,0006) of this sequence item.

C.8.8.14 RT Beams Module

The RT Beams Module contains information defining equipment parameters for delivery of external radiation beams.

Table C.8-50—RT BEAMS MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Beam Sequence (300A,00B0) 1 Introduces sequence of treatment beams for current RT Plan. One or more items shall be included in this sequence.
>Beam Number (300A,00C0) 1 Identification number of the Beam. The value of Beam Number (300A,00C0) shall be unique within the RT Plan in which it is created. See Note 1.
>Beam Name (300A,00C2) 3 User-defined name for Beam. See Note 1.
>Beam Description (300A,00C3) 3 User-defined description for Beam. See Note 1.
>Beam Type (300A,00C4) 1 Motion characteristic of Beam. See Note 5. Enumerated Values: STATIC = All Control Point Sequence (300A,0111) attributes remain unchanged between consecutive pairs of control points with changing Cumulative Meterset Weight (300A,0134). DYNAMIC = One or more Control Point Sequence (300A,0111) attributes change between one or more consecutive pairs of control points with changing Cumulative Meterset Weight (300A,0134).
>Radiation Type (300A,00C6) 2 Particle type of Beam. Defined Terms: PHOTON ELECTRON NEUTRON PROTON
>Primary Fluence Mode Sequence (3002,0050) 3 Sequence defining whether the primary fluence of the treatment beam uses a non-standard fluence-shaping. Only a single item is permitted in this sequence.
>>Fluence Mode (3002,0051) 1 Describes whether the fluence shaping is the standard mode for the beam or an alternate. Enumerated Values: STANDARD = Uses standard fluence-shaping NON_STANDARD = Uses a non-standard fluence-shaping mode
>>Fluence Mode ID (3002,0052) 1C Identifier for the specific fluence-shaping mode. Required if Fluence Mode (3002,0051) has value NON_STANDARD.
>High-Dose Technique Type (300A,00C7) 1C Type of high-dose treatment technique. Defined Terms: NORMAL = Standard treatment TBI = Total Body Irradiation HDR = High Dose Rate Required if treatment technique requires a dose that would normally require overriding of treatment machine safety controls.
>Treatment Machine Name (300A,00B2) 2 User-defined name identifying treatment machine to be used for beam delivery. See Note 2.
>Manufacturer (0008,0070) 3 Manufacturer of the equipment to be used for beam delivery.
>Institution Name (0008,0080) 3 Institution where the equipment is located that is to be used for beam delivery.
>Institution Address (0008,0081) 3 Mailing address of the institution where the equipment is located that is to be used for beam delivery.
>Institutional Department Name (0008,1040) 3 Department in the institution where the equipment is located that is to be used for beam delivery.
>Manufacturer's Model Name (0008,1090) 3 Manufacturer's model name of the equipment that is to be used for beam delivery.
>Device Serial Number (0018,1000) 3 Manufacturer's serial number of the equipment that is to be used for beam delivery.
>Primary Dosimeter Unit (300A,00B3) 3 Measurement unit of machine dosimeter. See C.8.8.14.1. Enumerated Values: MU = Monitor Unit MINUTE = minute
>Referenced Tolerance Table Number (300C,00A0) 3 Uniquely identifies Tolerance Table specified by Tolerance Table Number (300A,0042) within Tolerance Table Sequence in RT Tolerance Tables Module. These tolerances are to be used for verification of treatment machine settings.
>Source-Axis Distance (300A,00B4) 3 Radiation source to Gantry rotation axis distance of the equipment that is to be used for beam delivery (mm).
>Beam Limiting Device Sequence (300A,00B6) 1 Introduces sequence of beam limiting device (collimator) jaw or leaf (element) sets. One or more items shall be included in this sequence.
>>RT Beam Limiting Device Type (300A,00B8) 1 Type of beam limiting device (collimator). Enumerated Values: X = symmetric jaw pair in IEC X direction Y = symmetric jaw pair in IEC Y direction ASYMX = asymmetric jaw pair in IEC X direction ASYMY = asymmetric pair in IEC Y direction MLCX = multileaf (multi-element) jaw pair in IEC X direction MLCY = multileaf (multi-element) jaw pair in IEC Y direction
>>Source to Beam Limiting Device Distance (300A,00BA) 3 Radiation source to beam limiting device (collimator) distance of the equipment that is to be used for beam delivery (mm).
>>Number of Leaf/Jaw Pairs (300A,00BC) 1 Number of leaf (element) or jaw pairs (equal to 1 for standard beam limiting device jaws).
>>Leaf Position Boundaries (300A,00BE) 2C Boundaries of beam limiting device (collimator) leaves (in mm) in IEC BEAM LIMITING DEVICE coordinate axis appropriate to RT Beam Limiting Device Type (300A,00B8), i.e. X-axis for MLCY, Y-axis for MLCX. Contains N+1 values, where N is the Number of Leaf/Jaw Pairs (300A,00BC), starting from Leaf (Element) Pair 1. Required if Beam Limiting Device Sequence (300A,00B6) is sent and RT Beam Limiting Device Type (300A,00B8) is MLCX or MLCY. See Note 3.
>Referenced Patient Setup Number (300C,006A) 3 Uniquely identifies Patient Setup to be used for current beam, specified by Patient Setup Number (300A,0182) within Patient Setup Sequence of RT Patient Setup Module.
>Referenced Reference Image Sequence (300C,0042) 3 Reference images used for validation of current beam. One or more items are permitted in this sequence.
>>Include ‘SOP Instance Reference Macro' Table 10-11
>>Reference Image Number (300A,00C8) 1 Uniquely identifies Reference Image within Referenced Reference Image Sequence (300A,0042).
>>Start Cumulative Meterset Weight (300C,0008) 3 Cumulative Meterset Weight within current Beam at which image acquisition starts.
>>End Cumulative Meterset Weight (300C,0009) 3 Cumulative Meterset Weight within current Beam at which image acquisition ends.
>Planned Verification Image Sequence (300A,00CA) 3 Introduces sequence of planned verification images to be acquired during current beam. One or more items are permitted in this sequence. See C.8.8.14.2.
>>Start Cumulative Meterset Weight (300C,0008) 3 Cumulative Meterset Weight within current Beam at which image acquisition will start.
>>Meterset Exposure (3002,0032) 3 Meterset duration over which image is to be acquired, specified in Monitor units (MU) or minutes as defined by Primary Dosimeter Unit (300A,00B3).
>>End Cumulative Meterset Weight (300C,0009) 3 Cumulative Meterset Weight within current Beam at which image acquisition will end.
>>RT Image Plane (3002,000C) 3 Describes whether or not image plane is normal to beam axis. Enumerated Values: NORMAL = image plane normal to beam axis NON_NORMAL = image plane non-normal to beam axis
>>X-Ray Image Receptor Angle (3002,000E) 3 X-Ray Image Receptor Angle i.e. orientation of IEC X-RAY IMAGE RECEPTOR coordinate system with respect to IEC GANTRY coordinate system (degrees). See C.8.8.14.3.
>>RT Image Orientation (3002,0010) 3 The direction cosines of the first row and the first column with respect to the IEC X-RAY IMAGE RECEPTOR coordinate system.
>>RT Image Position (3002,0012) 3 The x and y coordinates (in mm) of the upper left hand corner of the image, in the IEC X-RAY IMAGE RECEPTOR coordinate system. This is the center of the first pixel transmitted.
>>RT Image SID (3002,0026) 3 Radiation machine source to image plane distance (mm).
>>Imaging Device-Specific Acquisition Parameters (300A,00CC) 3 User-specified device-specific parameters that describe how the imager will acquire the image.
>>Referenced Reference Image Number (300C,0007) 3 Uniquely identifies Reference Image to which planned verification image is related, specified by Reference Image Number (300A,00C8) within Referenced Reference Image Sequence (300A,0042).
>Treatment Delivery Type (300A,00CE) 3 Delivery Type of treatment. Defined Terms: TREATMENT = normal patient treatment OPEN_PORTFILM = portal image acquisition with open field TRMT_PORTFILM = portal image acquisition with treatment port CONTINUATION = continuation of interrupted treatment SETUP = no treatment beam is applied for this RT Beam. To be used for specifying the gantry, couch, and other machine positions where X-Ray set-up images or measurements are to be taken
>Referenced Dose Sequence (300C,0080) 3 Related instances of RT Dose (for grids, isodose curves, and named/unnamed point doses). One or more items are permitted in this sequence.
>>Include ‘SOP Instance Reference Macro' Table 10-11
>Number of Wedges (300A,00D0) 1 Number of wedges associated with current Beam.
>Wedge Sequence (300A,00D1) 1C Introduces sequence of treatment wedges. Required if Number of Wedges (300A,00D0) is non-zero. One or more items shall be included in this sequence.
>>Wedge Number (300A,00D2) 1 Identification number of the Wedge. The value of Wedge Number (300A,00D2) shall be unique within the Beam in which it is created.
>>Wedge Type (300A,00D3) 2 Type of wedge (if any) defined for Beam. Defined Terms: STANDARD = standard (static) wedge DYNAMIC = moving beam limiting device (collimator) jaw simulating wedge MOTORIZED = single wedge which can be removed from beam remotely
>>Wedge ID (300A,00D4) 3 User-supplied identifier for Wedge.
>>Accessory Code (300A,00F9) 3 An identifier for the accessory intended to be read by a device such as a bar-code reader.
>>Wedge Angle (300A,00D5) 2 Nominal wedge angle (degrees).
>>Wedge Factor (300A,00D6) 2 Nominal wedge factor under machine calibration conditions at the beam energy specified by the Nominal Beam Energy (300A,0114) of the first Control Point of the Control Point Sequence (300A,0111).
>>Wedge Orientation (300A,00D8) 2 Orientation of wedge, i.e. orientation of IEC WEDGE FILTER coordinate system with respect to IEC BEAM LIMITING DEVICE coordinate system (degrees).
>>Source to Wedge Tray Distance (300A,00DA) 3 Radiation source to wedge tray attachment edge distance (in mm) for current wedge.
>Number of Compensators (300A,00E0) 1 Number of compensators associated with current Beam.
>Total Compensator Tray Factor (300A,00E2) 3 Compensator Tray transmission factor (between 0 and 1), at the beam energy specified by the Nominal Beam Energy (300A,0114) of the first Control Point of the Control Point Sequence (300A,0111).
>Compensator Sequence (300A,00E3) 1C Introduces sequence of treatment compensators. One or more items shall be included in this sequence. Required if Number of Compensators (300A,00E0) is non-zero.
>>Compensator Description (300A,02EB) 3 User defined description for the compensator.
>>Compensator Number (300A,00E4) 1C Identification number of the Compensator. The value of Compensator Number (300A,00E4) shall be unique within the Beam in which it is created. Required if Number of Compensators (300A,00E0) is non-zero.
>>Compensator Type (300A,00EE) 3 Type of compensator (if any). Defined Terms: STANDARD = physical (static) compensator DYNAMIC = moving Beam Limiting Device (collimator) simulating physical compensator
>>Material ID (300A,00E1) 2C User-supplied identifier for material used to manufacture Compensator. Required if Number of Compensators (300A,00E0) is non-zero.
>>Compensator ID (300A,00E5) 3 User-supplied identifier for compensator.
>>Accessory Code (300A,00F9) 3 An identifier for the accessory intended to be read by a device such as a bar-code reader.
>>Source to Compensator Tray Distance (300A,00E6) 2 Radiation source to compensator tray attachment edge distance (in mm) for current compensator.
>>Compensator Divergence (300A,02E0) 3 Indicates presence or absence of geometrical divergence of the compensator. Enumerated Values: PRESENT = the compensator is shaped according to the beam geometrical divergence. ABSENT = the compensator is not shaped according to the beam geometrical divergence.
>>Compensator Mounting Position (300A,02E1) 3 Indicates on which side of the Compensator Tray the compensator is mounted. Enumerated Values: PATIENT_SIDE = the compensator is mounted on the side of the Compensator Tray which is towards the patient. SOURCE_SIDE = the compensator is mounted on the side of the Compensator Tray which is towards the radiation source. DOUBLE_SIDED = the compensator has a shaped (i.e. non-flat) surface on both sides of the Compensator Tray.
>>Compensator Rows (300A,00E7) 1 Number of rows in the compensator. A row is defined to be in the X direction of the IEC Beam Limiting Device Coordinate system.
>>Compensator Columns (300A,00E8) 1 Number of columns in the compensator. A column is defined to be in the Y direction of the IEC Beam Limiting Device Coordinate system.
>>Compensator Pixel Spacing (300A,00E9) 1 Physical distance (in mm) between the center of each pixel projected onto machine isocentric plane. Specified by a numeric pair - adjacent row spacing (delimiter) adjacent column spacing. See 10.7.1.3 for further explanation of the value order.
>>Compensator Position (300A,00EA) 1 The x and y coordinates of the upper left hand corner (first pixel transmitted) of the compensator, projected onto the machine isocentric plane in the IEC BEAM LIMITING DEVICE coordinate system (mm).
>>Compensator Transmission Data (300A,00EB) 1C A data stream of the pixel samples which comprise the compensator, expressed as broad-beam transmission values (between 0 and 1) along a ray line passing through the pixel, at the beam energy specified by the Nominal Beam Energy (300A,0114) of the first Control Point of the Control Point Sequence (300A,0111). The order of pixels sent is left to right, top to bottom, i.e., the upper left pixel is sent first followed by the remainder of the first row , followed by the first pixel of the 2nd row, then the remainder of the 2nd row and so on) when viewed from the radiation source. Required if Material ID (300A,00E1) is zero-length. May be present if Material ID (300A,00E1) is non-zero length. See C.8.8.14.10 and C.8.8.14.11. Note: Compensator Transmission Data may not be properly encoded if Explicit-VR transfer syntax is used and the VL of this attribute exceeds 65534 bytes.
>>Compensator Thickness Data (300A,00EC) 1C A data stream of the pixel samples which comprise the compensator, expressed as thicknesses (in mm). The order of pixels sent is left to right, top to bottom, i.e., the upper left pixel is sent first followed by the remainder of the first row , followed by the first pixel of the 2nd row, then the remainder of the 2nd row and so on) when viewed from the radiation source. Required if Material ID (300A,00E1) is non-zero length. May be present if Material ID (300A,00E1) is zero length. See C.8.8.14.9 and C.8.8.14.10 and C.8.8.14.11. Note: Compensator Thickness Data may not be properly encoded if Explicit-VR transfer syntax is used and the VL of this attribute exceeds 65534 bytes.
>>Source to Compensator Distance (300A,02E2) 1C A data stream of the pixel samples which comprise the distance from the radiation source to the compensator surface closest to the radiation source (in mm). The order of pixels sent is left to right, top to bottom (upper left pixel, followed by the remainder of row 1, followed by the remainder of the columns). Required if Material ID (300A,00E1) is non-zero length, and Compensator Mounting Position (300A,02E1) is DOUBLE_SIDED. May be present if Material ID (300A,00E1) is zero length and Compensator Mounting Position (300A,02E1) is DOUBLE_SIDED. See C.8.8.14.9 and C.8.8.14.11.
>Number of Boli (300A,00ED) 1 Number of boli associated with current Beam.
>Referenced Bolus Sequence (300C,00B0) 1C Introduces sequence of boli associated with Beam. Required if Number of Boli (300A,00ED) is non-zero. One or more items shall be included in this sequence.
>>Referenced ROI Number (3006,0084) 1 Uniquely identifies ROI representing the Bolus specified by ROI Number (3006,0022) in Structure Set ROI Sequence (3006,0020) in Structure Set Module within RT Structure Set in Referenced Structure Set Sequence (300C,0060) in RT General Plan Module.
>>Bolus ID (300A,00DC) 3 User-supplied identifier for the Bolus.
>>Bolus Description (300A,00DD) 3 User-defined description for the Bolus.
>>Accessory Code (300A,00F9) 3 An identifier for the accessory intended to be read by a device such as a bar-code reader.
>Number of Blocks (300A,00F0) 1 Number of shielding blocks associated with Beam.
>Total Block Tray Factor (300A,00F2) 3 Total block tray transmission for all block trays (between 0 and 1) at the beam energy specified by the Nominal Beam Energy (300A,0114) of the first Control Point of the Control Point Sequence (300A,0111).
>Block Sequence (300A,00F4) 1C Introduces sequence of blocks associated with Beam. One or more items shall be included in this sequence. Required if Number of Blocks (300A,00F0) is non-zero.
>>Block Tray ID (300A,00F5) 3 User-supplied identifier for block tray.
>>Accessory Code (300A,00F9) 3 An identifier for the accessory intended to be read by a device such as a bar-code reader.
>>Source to Block Tray Distance (300A,00F6) 2 Radiation Source to attachment edge of block tray assembly (mm).
>>Block Type (300A,00F8) 1 Type of block. Enumerated Values: SHIELDING = blocking material is inside contour APERTURE = blocking material is outside contour
>>Block Divergence (300A,00FA) 2 Indicates presence or otherwise of geometrical divergence. Enumerated Values: PRESENT = block edges are shaped for beam divergence ABSENT = block edges are not shaped for beam divergence
>>Block Mounting Position (300A,00FB) 3 Indicates on which side of the Block Tray the block is mounted. Enumerated Values: PATIENT_SIDE = the block is mounted on the side of the Block Tray which is towards the patient. SOURCE_SIDE = the block is mounted on the side of the Block Tray which is towards the radiation source.
>>Block Number (300A,00FC) 1 Identification number of the Block. The value of Block Number (300A,00FC) shall be unique within the Beam in which it is created.
>>Block Name (300A,00FE) 3 User-defined name for block.
>>Material ID (300A,00E1) 2 User-supplied identifier for material used to manufacture Block.
>>Block Thickness (300A,0100) 2C Physical thickness of block (in mm) parallel to radiation beam axis. Required if Material ID (300A,00E1) is non-zero length. May be present if Material ID (300A,00E1) is zero length. See C.8.8.14.4 and C.8.8.14.11.
>>Block Transmission (300A,0102) 2C Transmission through the block (between 0 and 1) at the beam energy specified by the Nominal Beam Energy (300A,0114) of the first Control Point of the Control Point Sequence (300A,0111). Required if Material ID (300A,00E1) is zero length. May be present if Material ID (300A,00E1) is non-zero length. See C.8.8.14.4 and C.8.8.14.11.
>>Block Number of Points (300A,0104) 2 Number of (x,y) pairs defining the block edge.
>>Block Data (300A,0106) 2 A data stream of (x,y) pairs which comprise the block edge. The number of pairs shall be equal to Block Number of Points (300A,0104), and the vertices shall be interpreted as a closed polygon. Coordinates are projected onto the machine isocentric plane in the IEC BEAM LIMITING DEVICE coordinate system (mm). See Note 4.
>Applicator Sequence (300A,0107) 3 Introduces sequence of Applicators associated with Beam. Only a single item is permitted in this sequence.
>>Applicator ID (300A,0108) 1 User or machine supplied identifier for Applicator.
>>Accessory Code (300A,00F9) 3 An identifier for the accessory intended to be read by a device such as a bar-code reader.
>>Applicator Type (300A,0109) 1 Type of Applicator. Defined Terms: ELECTRON_SQUARE = square electron applicator ELECTRON_RECT = rectangular electron applicator ELECTRON_CIRC = circular electron applicator ELECTRON_SHORT = short electron applicator ELECTRON_OPEN = open (dummy) electron applicator PHOTON_SQUARE = square photon applicator PHOTON _RECT = rectangular photon applicator PHOTON _CIRC = circular photon applicator INTRAOPERATIVE = intraoperative (custom) applicator STEREOTACTIC = stereotactic applicator (deprecated)
>>Applicator Geometry Sequence (300A,0431) 3 Describes the applicator aperture geometry. Only a single Item is permitted in this sequence.
>>>Applicator Aperture Shape (300A,0432) 1 Aperture shape of the applicator. Defined terms: SYM_SQUARE: A square-shaped aperture symmetrical to the central axis. SYM_RECTANGLE: A rectangular-shaped aperture symmetrical to the central axis. SYM_CIRCULAR: A circular-shaped aperture symmetrical to the central axis.
>>>Applicator Opening (300A,0433) 1C Opening (in mm) of the applicator's aperture in IEC BEAM LIMITING DEVICE coordinate system. In case of square-shaped applicator contains the length of the sides of the square. In case of circular-shaped applicators, contains the diameter of the circular aperture. Required if Applicator Aperture Shape (300A,0432) is SYM_SQUARE or SYM_CIRCULAR.
>>>Applicator Opening X (300A,0434) 1C Opening (in mm) of the applicator's aperture in IEC BEAM LIMITING DEVICE coordinate system in X-Direction. Required if Applicator Aperture Shape (300A,0432) is SYM_RECTANGLE.
>>>Applicator Opening Y (300A,0435) 1C Opening (in mm) of the applicator's aperture in IEC BEAM LIMITING DEVICE coordinate system in Y-Direction. Required if Applicator Aperture Shape (300A,0432) is SYM_RECTANGLE.
>> Source to Applicator Mounting Position Distance (300A,0436) 3 Radiation source to applicator mounting position distance (in mm) for current applicator.
>>Applicator Description (300A,010A) 3 User-defined description for Applicator.
>General Accessory Sequence (300A,0420) 3 Introduces a Sequence of General Accessories associated with this Beam. One or more items are permitted in this sequence.
>>General Accessory Number (300A,0424) 1 Identification Number of the General Accessory. The value shall be unique within the sequence.
>>General Accessory ID (300A,0421) 1 User or machine supplied identifier for General Accessory.
>>General Accessory Description (300A,0422) 3 User supplied description of General Accessory.
>>General Accessory Type (300A,0423) 3 Specifies the type of accessory. Defined Terms: GRATICULE = Accessory tray with a radio-opaque grid IMAGE_DETECTOR = Image acquisition device positioned in the beam line RETICLE = Accessory tray with radio-transparent markers or grid
>>Accessory Code (300A,00F9) 3 Machine-readable identifier for this accessory
>Final Cumulative Meterset Weight (300A,010E) 1C Value of Cumulative Meterset Weight (300A,0134) for final Control Point in Control Point Sequence (300A,0111). Required if Cumulative Meterset Weight is non-null in Control Points specified within Control Point Sequence (300A,0111). See C.8.8.14.1.
>Number of Control Points (300A,0110) 1 Number of control points in Beam.
>Control Point Sequence (300A,0111) 1 Introduces sequence of machine configurations describing treatment beam. Two or more items shall be included in this sequence. See C.8.8.14.5 and C.8.8.14.6.
>>Control Point Index (300A,0112) 1 Index of current Control Point, starting at 0 for first Control Point.
>>Cumulative Meterset Weight (300A,0134) 2 Cumulative weight to current control point. Cumulative Meterset Weight for the first item in Control Point Sequence shall always be zero. Cumulative Meterset Weight for the final item in Control Point Sequence shall always be equal to Final Cumulative Meterset Weight. See C.8.8.14.1.
>>Referenced Dose Reference Sequence (300C,0050) 3 Introduces a sequence of Dose References for current Beam. One or more items are permitted in this sequence.
>>>Referenced Dose Reference Number (300C,0051) 1 Uniquely identifies Dose Reference specified by Dose Reference Number (300A,0012) in Dose Reference Sequence (300A,0010) in RT Prescription Module.
>>>Cumulative Dose Reference Coefficient (300A,010C) 2 Coefficient used to calculate cumulative dose contribution from this Beam to the referenced Dose Reference at the current Control Point. See C.8.8.14.7.
>>>Beam Dose Point Depth (300A,0088) 3 The depth (in mm) in the patient along a ray from the source to the referenced Dose Reference at the current Control Point. This value should be provided only if the referenced Dose Reference Structure Type (300A,0014) is COORDINATES. The depth shall take into account the stated Gantry Angle (300A,011E), Beam Limiting Device Angle (300A,0120), and Patient Support Angle (300A,0122) of the current Control Point.
>>>Beam Dose Point Equivalent Depth (300A,0089) 3 The radiological depth in mm (water-equivalent depth, taking tissue heterogeneity into account) in the patient along a ray from the source to the referenced Dose Reference at the current Control Point. This value should be provided only if the referenced Dose Reference Structure Type (300A,0014) is COORDINATES. The radiological depth shall take into account the stated Gantry Angle (300A,011E), Beam Limiting Device Angle (300A,0120), and Patient Support Angle (300A,0122) of the current Control Point.
>>>Beam Dose Point SSD (300A,008A) 3 Source to patient surface distance along a ray from the source to the referenced Dose Reference at the current Control Point. This value should be provided only if the referenced Dose Reference Structure Type (300A,0014) is COORDINATES. The Source to patient surface distance shall take into account the stated Gantry Angle (300A,011E), Beam Limiting Device Angle (300A,0120), and Patient Support Angle (300A,0122) of the current Control Point.
>>Referenced Dose Sequence (300C,0080) 1C Sequence describing related instances of RT Dose (for grids, isodose curves, and named/unnamed point doses). One or more items shall be included in this sequence. Required if RT Dose is being sent, and Dose Summation Type (3004,000A) equals CONTROL_POINT.
>>>Include ‘SOP Instance Reference Macro' Table 10-11
>>Nominal Beam Energy (300A,0114) 3 Nominal Beam Energy at control point (MV/MeV).
>>Dose Rate Set (300A,0115) 3 Dose Rate to be set on treatment machine for segment beginning at current control point (e.g. MU/min).
>>Wedge Position Sequence (300A,0116) 3 A Sequence of Items describing Wedge Positions for the current control point. Required for first item of Control Point Sequence if Number of Wedges (300A,00D0) is non-zero, and in subsequent control points if Wedge Position (300A,0118) changes during Beam. See C.8.8.14.5. The number of items in this sequence shall equal the value of Number of Wedges (300A,00D0).
>>>Referenced Wedge Number (300C,00C0) 1 Uniquely references Wedge described by Wedge Number (300A,00D2) in Wedge Sequence (300A,00D1).
>>>Wedge Position (300A,0118) 1 Position of Wedge at current Control Point. Enumerated Values: IN OUT
>>Beam Limiting Device Position Sequence (300A,011A) 1C Introduces sequence of beam limiting device (collimator) jaw or leaf (element) positions. One or more items shall be included in this sequence. Required for first item of Control Point Sequence, or if Beam Limiting Device changes during Beam.
>>>RT Beam Limiting Device Type (300A,00B8) 1 Type of beam limiting device (collimator). The value of this attribute shall correspond to RT Beam Limiting Device Type (300A,00B8) defined in an item of Beam Limiting Device Sequence (300A,00B6). Enumerated Values: X = symmetric jaw pair in IEC X direction Y = symmetric jaw pair in IEC Y direction ASYMX = asymmetric jaw pair in IEC X direction ASYMY = asymmetric pair in IEC Y direction MLCX = multileaf (multi-element) jaw pair in IEC X direction MLCY = multileaf (multi-element) jaw pair in IEC Y direction
>>>Leaf/Jaw Positions (300A,011C) 1 Positions of beam limiting device (collimator) leaf (element) or jaw pairs (in mm) in IEC BEAM LIMITING DEVICE coordinate axis appropriate to RT Beam Limiting Device Type (300A,00B8), e.g. X-axis for MLCX, Y-axis for MLCY. Contains 2N values, where N is the Number of Leaf/Jaw Pairs (300A,00BC) in Beam Limiting Device Sequence (300A,00B6). Values shall be listed in IEC leaf (element) subscript order 101, 102, ... 1N, 201, 202, ... 2N. See Note 2.
>>Gantry Angle (300A,011E) 1C Gantry angle of radiation source, i.e. orientation of IEC GANTRY coordinate system with respect to IEC FIXED REFERENCE coordinate system (degrees). Required for first item of Control Point Sequence, or if Gantry Angle changes during Beam.
>>Gantry Rotation Direction (300A,011F) 1C Direction of Gantry Rotation when viewing gantry from isocenter, for segment following Control Point. Required for first item of Control Point Sequence, or if Gantry Rotation Direction changes during Beam. See C.8.8.14.8. Enumerated Values: CW = clockwise CC = counter-clockwise NONE = no rotation
>>Gantry Pitch Angle (300A,014A) 3 Gantry Pitch Angle. i.e. the rotation of the IEC GANTRY coordinate system about the X-axis of the IEC GANTRY coordinate system (degrees). If used, must be present for first item of Control Point Sequence, or if used and Gantry Pitch Rotation Angle changes during Beam, must be present. See C.8.8.25.6.5.
>>Gantry Pitch Rotation Direction (300A,014C) 3 Direction of Gantry Pitch Angle when viewing along the positive X-axis of the IEC GANTRY coordinate system, for segment following Control Point. If used, must be present for first item of Control Point Sequence, or if used and Gantry Pitch Rotation Direction changes during Beam, must be present. See C.8.8.14.8 and C.8.8.25.6.5. Enumerated Values: CW = clockwise CC = counter-clockwise NONE = no rotation
>>Beam Limiting Device Angle (300A,0120) 1C Beam Limiting Device angle, i.e. orientation of IEC BEAM LIMITING DEVICE coordinate system with respect to IEC GANTRY coordinate system (degrees). Required for first item of Control Point Sequence, or if Beam Limiting Device Angle changes during Beam.
>>Beam Limiting Device Rotation Direction (300A,0121) 1C Direction of Beam Limiting Device Rotation when viewing beam limiting device (collimator) from radiation source, for segment following Control Point. Required for first item of Control Point Sequence, or if Beam Limiting Device Rotation Direction changes during Beam. See C.8.8.14.8. Enumerated Values: CW = clockwise CC = counter-clockwise NONE = no rotation
>>Patient Support Angle (300A,0122) 1C Patient Support angle, i.e. orientation of IEC PATIENT SUPPORT (turntable) coordinate system with respect to IEC FIXED REFERENCE coordinate system (degrees). Required for first item of Control Point Sequence, or if Patient Support Angle changes during Beam.
>>Patient Support Rotation Direction (300A,0123) 1C Direction of Patient Support Rotation when viewing table from above, for segment following Control Point. Required for first item of Control Point Sequence, or if Patient Support Rotation Direction changes during Beam. See C.8.8.14.8. Enumerated Values: CW = clockwise CC = counter-clockwise NONE = no rotation
>>Table Top Eccentric Axis Distance (300A,0124) 3 Distance (positive) from the IEC PATIENT SUPPORT vertical axis to the IEC TABLE TOP ECCENTRIC vertical axis (mm).
>>Table Top Eccentric Angle (300A,0125) 1C Table Top (non-isocentric) angle, i.e. orientation of IEC TABLE TOP ECCENTRIC coordinate system with respect to IEC PATIENT SUPPORT coordinate system (degrees). Required for first item of Control Point Sequence, or if Table Top Eccentric Angle changes during Beam.
>>Table Top Eccentric Rotation Direction (300A,0126) 1C Direction of Table Top Eccentric Rotation when viewing table from above, for segment following Control Point. Required for first item of Control Point Sequence, or if Table Top Eccentric Rotation Direction changes during Beam. See C.8.8.14.8. Enumerated Values: CW = clockwise CC = counter-clockwise NONE = no rotation
>>Table Top Pitch Angle (300A,0140) 1C Table Top Pitch Angle, i.e. the rotation of the IEC TABLE TOP coordinate system about the X-axis of the IEC TABLE TOP coordinate system (degrees). If required by treatment delivery device, shall be present for first item of Control Point Sequence. If required by treatment delivery device and if Table Top Pitch Angle changes during Beam, shall be present in all subsequent items of Control Point Sequence. See C.8.8.25.6.2.
>>Table Top Pitch Rotation Direction (300A,0142) 1C Direction of Table Top Pitch Rotation when viewing the table along the positive X-axis of the IEC TABLE TOP coordinate system, for segment following Control Point. If required by treatment delivery device, shall be present for first item of Control Point Sequence. If required by treatment delivery device and if Table Top Pitch Rotation Direction changes during Beam, shall be present in all subsequent items of Control Point Sequence. See C.8.8.14.8 and C.8.8.25.6.2. Enumerated Values: CW = clockwise CC = counter-clockwise NONE = no rotation
>>Table Top Roll Angle (300A,0144) 1C Table Top Roll Angle, i.e. the rotation of the IEC TABLE TOP coordinate system about the IEC Y-axis of the IEC TABLE TOP coordinate system (degrees). If required by treatment delivery device, shall be present for first item of Control Point Sequence. If required by treatment delivery device and if Table Top Roll Angle changes during Beam, shall be present in all subsequent items of Control Point Sequence. See C.8.8.25.6.2.
>>Table Top Roll Rotation Direction (300A,0146) 1C Direction of Table Top Roll Rotation when viewing the table along the positive Y-axis of the IEC TABLE TOP coordinate system, for segment following Control Point. If required by treatment delivery device, shall be present for first item of Control Point Sequence. If required by treatment delivery device and if Table Top Roll Rotation Direction changes during Beam, shall be present in all subsequent items of Control Point Sequence. See C.8.8.14.8 and C.8.8.25.6.2. Enumerated Values: CW = clockwise CC = counter-clockwise NONE = no rotation
>>Table Top Vertical Position (300A,0128) 2C Table Top Vertical position in IEC TABLE TOP coordinate system (mm). Required for first item of Control Point Sequence, or if Table Top Vertical Position changes during Beam. See C.8.8.14.6.
>>Table Top Longitudinal Position (300A,0129) 2C Table Top Longitudinal position in IEC TABLE TOP coordinate system (mm). Required for first item of Control Point Sequence, or if Table Top Longitudinal Position changes during Beam. See C.8.8.14.6.
>>Table Top Lateral Position (300A,012A) 2C Table Top Lateral position in IEC TABLE TOP coordinate system (mm). Required for first item of Control Point Sequence, or if Table Top Lateral Position changes during Beam. See C.8.8.14.6.
>>Isocenter Position (300A,012C) 2C Isocenter coordinates (x,y,z) in the patient based coordinate system described in C.7.6.2.1.1 (mm). Required for first item of Segment Control Point Sequence, or if Segment Isocenter Position changes during Beam.
>>Surface Entry Point (300A,012E) 3 Patient surface entry point coordinates (x,y,z) in the patient based coordinate system described in C.7.6.2.1.1 (mm).
>>Source to Surface Distance (300A,0130) 3 Source to Patient Surface distance (mm).

Notes: 1. Beam Number (300A,00C0) is provided to link related information across modules, and its value should not be required to have any real-world interpretation. Beam Name (300A,00C2), a Type 3 attribute, is intended to store the primary beam identifier (often referred to as “field identifier”). Beam Description (300A,00C3), a Type 3 attribute, is intended to store additional beam identifying information (often referred to as “field name”). Equipment supporting both these attributes should state this clearly in the Conformance Statement.

2. The DICOM standard does not support the transmission of treatment unit modeling information such as depth doses and beam profiles.

3. Implementors should take note that Leaf Position Boundaries (300A,00BE) are the positions of the mechanical boundaries (projected to the isocentric plane) between beam limiting device (collimator) leaves, fixed for a given beam limiting device (collimator). Leaf/Jaw Positions (300A,011C) are values specific to a given beam control point, specifying the beam limiting device (collimator) leaf (element) openings.

4. Block coordinates may not be transmitted when such data is not available from the transmitting system. However, the receiving system may not have internal mechanisms to use or store such data. For example, a plan sent from an treatment planning system to a Record and Verify (R&V) system will contain the block data for blocked beams. Subsequent transfer of beam data from the R&V system may omit this data since the R&V system may not have stored it.

5. Refer to C.8.8.14.5 for examples of STATIC and DYNAMIC Beam Type. Note that beams having Wedge Type = DYNAMIC as the only moving parameter are not considered DYNAMIC according to the definition of Beam Type (300A,00C4).

C.8.8.14.1 Meterset calculations

The Meterset at a given Control Point is equal to the Beam Meterset (300A,0086) specified in the Referenced Beam Sequence (300C,0004) of the RT Fraction Scheme Module, multiplied by the Cumulative Meterset Weight (300A,0134) for the Control Point, divided by the Final Cumulative Meterset Weight (300A,010E). The Meterset is specified in units defined by Primary Dosimeter Unit (300A,00B3). If the calculation for Meterset results in a meterset value which is not an exact multiple of the primary meterset resolution, then the result shall be rounded to the nearest allowed meterset value (i.e. less than a half resolution unit shall be rounded down to the nearest resolution unit, and equal or greater than half a resolution unit shall be rounded up to the nearest resolution unit).

Note also that if Final Cumulative Meterset Weight (300A,010E) is equal to 100, then Cumulative Meterset Weight (300A,0134) becomes equivalent to the percentage of Beam Meterset (300A,0086) delivered at each control point. If Final Cumulative Meterset Weight (300A,010E) is equal to Beam Meterset (300A,0086), then the Cumulative Meterset Weight (300A,0134) at each control point becomes equal to the cumulative Meterset delivered at that control point.

C.8.8.14.2 Planned Verification Image Sequence

The Planned Verification Image Sequence (300A,00CA) contains attributes which describe the planned verification images to be acquired during current beam. The Start Cumulative Meterset Weight (300C,0008) specifies the Cumulative Meterset Weight at which image acquisition is to begin. If Meterset Exposure (3002,0032) is present in a sequence item and End Cumulative Meterset Weight (300C,0009) is not present then a single image shall be acquired using the meterset duration specified in Meterset Exposure (3002,0032). If End Cumulative Meterset Weight (300C,0009) is present in a sequence item and Meterset Exposure (3002,0032) is not present then a single image shall be acquired over the beam delivery from Start Cumulative Meterset Weight (300C,0008) to End Cumulative Meterset Weight (300C,0009). If both Meterset Exposure (3002,0032) and End Cumulative Meterset Weight (300C,0009) are present in a sequence item then images shall be acquired every Meterset Exposure (3002,0032) from Start Cumulative Meterset Weight (300C,0008) to End Cumulative Meterset Weight (300C,0009). No images shall extend past End Cumulative Meterset Weight (300C,0009).

C.8.8.14.3 X-Ray Image Receptor Angle

The X-Ray Image Receptor Angle (3002,000E) specifies the rotation of the image receptor device in the IEC X-RAY IMAGE RECEPTOR PLANE. A positive angle corresponds to a counter-clockwise rotation of the X-Ray Image Receptor as viewed from the radiation source in the IEC GANTRY coordinate system. The normal (non-rotated) value for this parameter is zero degrees.

C.8.8.14.4 Multiple aperture blocks

All blocks with Block Type (300A,00F8) of APERTURE for a given beam shall have equal values of Block Transmission (300A,0102) and/or Block Thickness (300A,0100) if they are specified. The composite aperture shall be evaluated as the union of the individual apertures within a single Block. Shielding block transmission(s) shall be applied multiplicatively after the (composite) aperture has been evaluated.

C.8.8.14.5 Control Point Sequence

The DICOM RT Beams Module uses a single beam model to handle static, arc, and dynamic delivery of external beam radiation by a medical accelerator or gamma beam therapy equipment (cobalt unit). All applicable parameters shall be specified at Control Point 0, with the exception of couch positions (see C.8.8.14.6). All parameters that change at any control point of a given beam shall be specified explicitly at all control points (including those preceding the change). No assumptions are made about the behavior of machine parameters between specified control points, and communicating devices shall agree on this behavior outside the current standard.

Gantry Rotation Direction (300A,011F), Beam Limiting Device Rotation Direction (300A,0121), Patient Support Rotation Direction (300A,0123), and Table Top Eccentric Rotation Direction (300A,0126) are defined as applying to the segment following the control point, and changes to these parameters during treatment may be specified without use of a “non-irradiation” segment. All other Control Point Sequence attributes are defined only at the control point. To unambiguously encode changes in discrete-valued attributes such as Wedge Position (300A,0118) and Nominal Beam Energy (300A,0114), a non-irradiation segment where Cumulative Meterset Weight (300A,0134) does not change, shall be used.

Some examples of beam specification using control points are as follows:

a) Static delivery:

Control Point 0: All applicable treatment parameters defined, Cumulative Meterset Weight = 0

Control Point 1: Cumulative Meterset Weight = 1, no other parameters defined

b) Arc delivery:

Control Point 0: All applicable treatment parameters defined, Cumulative Meterset Weight = 0, Gantry Rotation Direction = rotation direction , Gantry Angle = initial angle

Control Point 1: Cumulative Meterset Weight = 1, Gantry Rotation Direction = NONE, Gantry Angle = final angle

c) Dynamic delivery of two equally weighted segments :

Control Point 0: All applicable treatment parameters defined, Cumulative Meterset Weight = 0

Control Point 1: All changing treatment parameters defined (including those which do not change at this control point), Cumulative Meterset Weight = 0.5

Control Point 2: All changing treatment parameters defined (including those which do not change at this control point), Cumulative Meterset Weight = 1

d) Dynamic Delivery of two unequally weighted segments with a step change in table angle :

Control Point 0: All applicable treatment parameters defined, Patient Support Angle = initial angle , Patient Support Rotation Direction = NONE, Cumulative Meterset Weight = 0

Control Point 1: All changing parameters defined (including those that do not change at this control point), Cumulative Meterset Weight = 0.3, Patient Support Angle = initial angle , Patient Support Rotation Direction = rotation direction

Control Point 2: All changing parameters defined (although none should change at this control point), Cumulative Meterset Weight = 0.3, Patient Support Angle = new angle , Patient Support Rotation Direction = NONE

Control Point 3: All changing parameters defined (including those that do not change at this control point), Cumulative Meterset Weight = 1, Patient Support Angle = new angle , Patient Support Rotation Direction = NONE

C.8.8.14.6 Absolute and relative machine coordinates

All treatment machine parameters except couch translations are specified in absolute machine coordinates as defined by IEC 61217. For the Table Top Vertical Position (300A,0128), Table Top Longitudinal Position (300A,0129), and Table Top Lateral Position (300A,012A), if the first Control Point contains a value of non-zero length, all subsequent Control Point position values are absolute values in their respective coordinate system. If the first Control Point contains a zero-length value, all subsequent Control Point position values are specified relative to the (unknown) initial value.

C.8.8.14.7 Cumulative Dose Reference Coefficient

The Cumulative Dose Reference Coefficient (300A,010C) is the value by which Beam Dose (300A,0084) is multiplied to obtain the dose to the referenced dose reference site at the current control point (and after previous control points have been successfully administered). The Cumulative Dose Reference Coefficient (300A,010C) is by definition zero for the initial control point. The Cumulative Dose Reference Coefficient (300A,010C) of the final control point multiplied by Beam Dose (300A,0084) results in the final dose to the referenced dose reference site for the current beam. Dose calculation for dose reference sites other than points is not well defined.

C.8.8.14.8 Machine rotations

For the machine rotation angles Gantry Angle (300A,011E), Beam Limiting Device Angle (300A,0120), Patient Support Angle (300A,0122) , and Table Top Eccentric Angle (300A,0125), rotation direction is specified as clockwise (CW), counter-clockwise (CC), or NONE. The maximum permitted rotation between two Control Points is 360 degrees. Examples:

a) Gantry Angle moves from 5 degrees to 5 degrees, Gantry Rotation Direction = NONE:

No movement.

b) Gantry Angle moves from 5 degrees to 5 degrees, Gantry Rotation Direction = CW:

Full clockwise rotation (360 degrees).

c) Table Angle moves from 170 degrees to 160 degrees, Table Rotation Direction = CC:

Counter-clockwise rotation by 350 degrees (note direction of increasing table angle as defined by IEC 61217).

C.8.8.14.9 Compensator Thickness Data and Source to Compensator Distance

The values stored in Compensator Thickness Data (300A,00EC) and Source to Compensator Distance (300A,02E2) shall be parallel to the radiation beam axis if Compensator Divergence (300A,02E0) equals ABSENT, or divergent according to the beam geometrical divergence if Compensator Divergence (300A,02E0) equals PRESENT. If Compensator Divergence (300A,02E0) is not sent, then the parallel or divergent nature of the thicknesses is as if ABSENT was specified for Compensator Divergence (300A,02E0).

C.8.8.14.10 Compensator Transmission and Thickness Data Direction

The direction of the rows and columns in Compensator Transmission Data (300A,00EB) and Compensator Thickness Data (300A,00EC) is defined as follows: The direction of rows goes along the positive Xb direction and the direction of the columns does along the negative Yb direction of the IEC X-BEAM LIMITING DEVICE coordinate system. Other interpretations shall be documented in an implementation's conformance statement.

C.8.8.14.11 Block and Compensator Precedence for Dosimetric Calculations

If Block Thickness (300A,0100) and Block Transmission (300A,0102) are present, Block Transmission shall have precedence for dosimetric calculations. If Compensator Transmission Data (300A,00EB) and Compensator Thickness Data (300A,00EC) are present, Compensator Transmission Data shall have precedence for dosimetric calculations.

C.8.8.15 RT Brachy Application Setups Module

The RT Brachy Application Setups Module describes the application of a brachytherapy radiotherapy treatment. It contains one or more sources, each associated with one or more Channels. A Channel is a device by which a source is placed in its intended treatment position or positions. A Channel may consist of a Source Applicator plus a Transfer Tube, a Source Applicator alone, a rigid or flexible linear source, or a seed. A number of Channels (for example applicators, sources or seeds) are generally arranged in an Application Setup which may be considered a “logical” device. It is important not to confuse Application Setup with Applicator. The model used here has been primarily built around the concept of remote afterloading, but extended to support other brachytherapy applications such as manual applicators and molds, seeds, and sources. Additional devices that are not Channels are described as Brachy Accessory Devices. Examples of Accessory Devices include shields, which modify the dose distribution from all sources in the treatment. However, Channel shields modify the dose only for the source(s) in that Channel.

The data in the module are arranged as follows:

Treatment Machine Sequence ;treatment machine information (single item)
Source Sequence ;library of sources used in brachy application
Application Setup Sequence ;one or more applicators, sources, seeds etc
Brachy Accessory Device Sequence ;application level shields etc
Channel Sequence ;applicator, line source(s), seed(s) etc
Channel Shield Sequence ;channel-specific shields
Brachy Control Point Sequence ;mechanism to support individual source dwell times

Table C.8-51—RT BRACHY APPLICATION SETUPS MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Brachy Treatment Technique (300A,0200) 1 Type of brachytherapy treatment technique. Enumerated Values: INTRALUMENARY INTRACAVITARY INTERSTITIAL CONTACT INTRAVASCULAR PERMANENT See C.8.8.15.1.
Brachy Treatment Type (300A,0202) 1 Type of brachytherapy treatment. Defined Terms: MANUAL = manually positioned HDR = High dose rate MDR = Medium dose rate LDR = Low dose rate PDR = Pulsed dose rate
Treatment Machine Sequence (300A,0206) 1 Introduces single item sequence describing treatment machine to be used for treatment delivery. Only a single item shall be included in this sequence.
>Treatment Machine Name (300A,00B2) 2 User-defined name identifying treatment machine to be used for treatment delivery.
>Manufacturer (0008,0070) 3 Manufacturer of the equipment to be used for treatment delivery.
>Institution Name (0008,0080) 3 Institution where the equipment is located that is to be used for treatment delivery.
>Institution Address (0008,0081) 3 Mailing address of the institution where the equipment is located that is to be used for treatment delivery.
>Institutional Department Name (0008,1040) 3 Department in the institution where the equipment is located that is to be used for treatment delivery.
>Manufacturer's Model Name (0008,1090) 3 Manufacturer's model name of the equipment that is to be used for treatment delivery.
>Device Serial Number (0018,1000) 3 Manufacturer's serial number of the equipment that is to be used for treatment delivery.
Source Sequence (300A,0210) 1 Introduces sequence of Sources to be used within Application Setups. One or more items shall be included in this sequence.
>Source Number (300A,0212) 1 Identification number of the Source. The value of Source Number (300A,0212) shall be unique within the RT Plan in which it is created.
>Source Type (300A,0214) 1 Type of Source. Defined Terms: POINT LINE CYLINDER SPHERE
>Source Manufacturer (300A,0216) 3 Manufacturer of Source.
>Active Source Diameter (300A,0218) 3 Diameter of active Source (mm).
>Active Source Length (300A,021A) 3 Length of active Source (mm).
>Material ID (300A,00E1) 3 User-supplied identifier for encapsulation material of active Source.
>Source Encapsulation Nominal Thickness (300A,0222) 3 Nominal thickness of wall of encapsulation (mm). See C.8.8.15.12.
>Source Encapsulation Nominal Transmission (300A,0224) 3 Nominal transmission through wall of encapsulation (between 0 and 1). See C.8.8.15.12
>Source Isotope Name (300A,0226) 1 Name of Isotope.
>Source Isotope Half Life (300A,0228) 1 Half-life of Isotope (days).
>Source Strength Units (300A,0229) 1C Measurement unit of Source Strength. Required if the source is not a gamma-emitting (photon) source. May be present otherwise. Enumerated Values: AIR_KERMA_RATE = Air Kerma Rate if Source is Gamma emitting Isotope. DOSE_RATE_WATER = Dose Rate in Water if Source is Beta emitting Isotope.
>Reference Air Kerma Rate (300A,022A) 1 Air Kerma Rate in air of Isotope specified at Source Strength Reference Date (300A,022C) and Source Strength Reference Time (300A,022E) (in µGy h-1 at 1 m). Value shall be zero for non-gamma sources.
>Source Strength (300A,022B) 1C Source Strength of Isotope at Source Strength Reference Date (300A,022C) and Source Strength Reference Time (300A,022E), in units specified in Source Strength Units (300A,0229). Required if the source is not a gamma-emitting (photon) source. See C.8.8.15.13.
>Source Strength Reference Date (300A,022C) 1 Reference date for Reference Air Kerma Rate (300A,022A) or Source Strength (300A,022B) of Isotope.
>Source Strength Reference Time (300A,022E) 1 Reference time for Air Kerma Rate (300A,022A) or Source Strength (300A,022B) of Isotope.
Application Setup Sequence (300A,0230) 1 Introduces sequence of Application Setups for current RT Plan. One or more items shall be included in this sequence.
>Application Setup Type (300A,0232) 1 Type of Application Setup. Defined Terms: FLETCHER_SUIT DELCLOS BLOEDORN JOSLIN_FLYNN CHANDIGARH MANCHESTER HENSCHKE NASOPHARYNGEAL OESOPHAGEAL ENDOBRONCHIAL SYED_NEBLETT ENDORECTAL PERINEAL
>Application Setup Number (300A,0234) 1 Identification number of the Application Setup. The value of Application Setup Number (300A,0234) shall be unique within the RT Plan in which it is created.
>Application Setup Name (300A,0236) 3 User-defined name for Application Setup.
>Application Setup Manufacturer (300A,0238) 3 Manufacturer of Application Setup.
>Template Number (300A,0240) 3 Identification number of the Template. The value of Template Number (300A,0240) shall be unique within the Application Setup in which it is created.
>Template Type (300A,0242) 3 User-defined type for Template Device.
>Template Name (300A,0244) 3 User-defined name for Template Device.
>Referenced Reference Image Sequence (300C,0042) 3 Introduces sequence of reference images used for validation of current Application Setup. One or more items are permitted in this sequence.
>>Include ‘SOP Instance Reference Macro' Table 10-11
>Total Reference Air Kerma (300A,0250) 1 Total Reference Air Kerma for current Application Setup, i.e. the product of Air Kerma Rate of all Sources in all Channels with their respective Channel Times (µGy at 1 m). Value shall be zero for non-gamma sources.
>Brachy Accessory Device Sequence (300A,0260) 3 Introduces sequence of Brachy Accessory Devices associated with current Application Setup. One or more items are permitted in this sequence.
>>Brachy Accessory Device Number (300A,0262) 2 Identification number of the Brachy Accessory Device. The value of Brachy Accessory Device Number (300A,0262) shall be unique within the Application Setup in which it is created.
>>Brachy Accessory Device ID (300A,0263) 2 User or machine supplied identifier for Brachy Accessory Device.
>>Brachy Accessory Device Type (300A,0264) 1 Type of Brachy Accessory Device. Defined Terms: SHIELD DILATATION MOLD PLAQUE FLAB
>>Brachy Accessory Device Name (300A,0266) 3 User-defined name for Brachy Accessory Device.
>>Material ID (300A,00E1) 3 User-supplied identifier for material of Brachy Accessory Device. See Note.
>>Brachy Accessory Device Nominal Thickness (300A,026A) 3 Nominal thickness of Brachy Accessory Device (mm). See C.8.8.15.12.
>>Brachy Accessory Device Nominal Transmission (300A,026C) 3 Nominal Transmission through Brachy Accessory Device (between 0 and 1). See C.8.8.15.12.
>>Referenced ROI Number (3006,0084) 2 Uniquely identifies ROI representing the Brachy Accessory specified by ROI Number (3006,0022) in Structure Set ROI Sequence (3006,0020) in Structure Set Module within RT Structure Set referenced by Referenced RT Structure Set Sequence (300C,0060) in RT General Plan Module. See C.8.8.15.2.
>Channel Sequence (300A,0280) 1 Introduces sequence of Channels for current Application Setup. One or more items shall be included in this sequence.
>>Channel Number (300A,0282) 1 Identification number of the Channel. The value of Channel Number (300A,0282) shall be unique within the Application Setup in which it is created.
>>Channel Length (300A,0284) 2 Length of Channel (mm). See C.8.8.15.3.
>>Channel Total Time (300A,0286) 1 Total amount of time between first and final Control Points of the Brachy Control Point Sequence (300A,02D0) for current Channel (sec). Channel Total Time calculation is based upon the Reference Air Kerma Rate (300A,022A) of the Referenced Source Number (300C,000E).
>>Source Movement Type (300A,0288) 1 Type of Source movement. See C.8.8.15.4. Defined Terms: STEPWISE FIXED OSCILLATING UNIDIRECTIONAL
>>Number of Pulses (300A,028A) 1C Number of Pulses per fraction for current Channel. Required if Brachy Treatment Type (300A,0202) is PDR.
>>Pulse Repetition Interval (300A,028C) 1C Pulse repetition interval (sec) for current Channel. Required if Brachy Treatment Type (300A,0202) is PDR.
>>Source Applicator Number (300A,0290) 3 Identification number of the Source Applicator. The value of Source Applicator Number (300A,0290) shall be unique within the Channel in which it is created.
>>Source Applicator ID (300A,0291) 2C User or machine supplied identifier for Source Applicator. Required if Source Applicator Number (300A,0290) is sent.
>>Source Applicator Type (300A,0292) 1C Type of Source Applicator. Required if Source Applicator Number (300A,0290) is sent. Defined Terms: FLEXIBLE RIGID
>>Source Applicator Name (300A,0294) 3 User-defined name for Source Applicator.
>>Source Applicator Length (300A,0296) 1C Length of Source Applicator (mm), defined as the distance between the connector of the applicator and the distal-most position of the source. Required if Source Applicator Number (300A,0290) is sent.
>>Source Applicator Manufacturer (300A,0298) 3 Manufacturer of Source Applicator.
>>Material ID (300A,00E1) 3 User-supplied identifier for material of Source Applicator wall. See Note.
>>Source Applicator Wall Nominal Thickness (300A,029C) 3 Nominal Thickness of Source Applicator wall (mm). See C.8.8.15.12.
>>Source Applicator Wall Nominal Transmission (300A,029E) 3 Nominal Transmission through Source Applicator wall (between 0 and 1). See C.8.8.15.12.
>>Source Applicator Step Size (300A,02A0) 1C Distance of path along channel (in mm) between adjacent (potential) dwell positions. Required if Source Movement Type (300A,0288) is STEPWISE.
>>Referenced ROI Number (3006,0084) 2C Uniquely identifies ROI representing the Source Applicator specified by ROI Number (3006,0022) in Structure Set ROI Sequence (3006,0020) in Structure Set Module within RT Structure Set referenced by Referenced RT Structure Set Sequence (300C,0060) in RT General Plan Module. Required if Source Applicator Number (300A,0290) is sent. See C.8.8.15.2.
>>Transfer Tube Number (300A,02A2) 2 Identification number of the Transfer Tube. The value of Transfer Tube Number (300A,02A2) shall be unique within the Channel in which it is created.
>>Transfer Tube Length (300A,02A4) 2C Length of Transfer Tube of current afterloading Channel (mm). Required if value Transfer Tube Number (300A,02A2) is non-null.
>>Channel Shield Sequence (300A,02B0) 3 Introduces sequence of Channel Shields associated with current Channel. One or more items are permitted in this sequence. See C.8.8.15.5.
>>>Channel Shield Number (300A,02B2) 1 Identification number of the Channel Shield. The value of Channel Shield Number (300A,02B2) shall be unique within the Channel in which it is created.
>>>Channel Shield ID (300A,02B3) 2 User or machine supplied identifier for Channel Shield.
>>>Channel Shield Name (300A,02B4) 3 User-defined name for Channel Shield.
>>>Material ID (300A,00E1) 3 User-supplied identifier for material of Channel Shield. See Note.
>>>Channel Shield Nominal Thickness (300A,02B8) 3 Nominal Thickness of Channel Shield (mm). See C.8.8.15.12.
>>>Channel Shield Nominal Transmission (300A,02BA) 3 Nominal Transmission of Channel Shield (between 0 and 1). See C.8.8.15.12.
>>>Referenced ROI Number (3006,0084) 2 Uniquely identifies ROI representing the Channel Shield specified by ROI Number (3006,0022) in Structure Set ROI Sequence (3006,0020) in Structure Set Module within RT Structure Set referenced by Referenced RT Structure Set Sequence (300C,0060) in RT General Plan Module. See C.8.8.15.2.
>>Referenced Source Number (300C,000E) 1 Uniquely identifies the referenced Source within the Source Sequence (300A,0210) for current Application Setup.
>>Number of Control Points (300A,0110) 1 Number of control points in Channel. For an N-segment Channel there will be 2N (stepwise movement) or N+1 (continuous movement) control points.
>>Final Cumulative Time Weight (300A,02C8) 1C Value of Cumulative Time Weight (300A,02D6) for final Control Point in Brachy Control Point Sequence (300A,02D0). Required if Cumulative Time Weight (300A,02D6) is non-null in Control Points specified within Brachy Control Point Sequence (300A,02D0). See C.8.8.15.6.
>>Brachy Control Point Sequence (300A,02D0) 1 Introduces sequence of machine configurations describing this Channel. Two or more items shall be included in this sequence. See C.8.8.15.7.
>>>Control Point Index (300A,0112) 1 Index of current Control Point, starting at 0 for first Control Point.
>>>Cumulative Time Weight (300A,02D6) 2 Cumulative time weight to current Control Point (where the weighting is proportional to time values delivered). Cumulative Time Weight for first item in Brachy Control Point Sequence (300A,02D0) is always zero. See C.8.8.15.6 and C.8.8.15.8.
>>>Control Point Relative Position (300A,02D2) 1 Distance between current Control Point Position and the distal-most possible Source position in current Channel (mm). See C.8.8.15.9.
>>>Control Point 3D Position (300A,02D4) 3 Coordinates (x, y, z) of Control Point in the patient based coordinate system described in C.7.6.2.1.1 (mm). See C.8.8.15.10.
>>>Control Point Orientation (300A,0412) 3 (x,y,z) component of the direction vector of the brachy source or seed at the Control Point 3D Position (300A,02D4). See C.8.8.15.14.
>>>Brachy Referenced Dose Reference Sequence (300C,0055) 3 Introduces a sequence of Dose References for current Channel. One or more items are permitted in this sequence.
>>>>Referenced Dose Reference Number (300C,0051) 1 Uniquely identifies Dose Reference described in Dose Reference Sequence. (300A,0010) within RT Prescription Module of current RT Plan.
>>>>Cumulative Dose Reference Coefficient (300A,010C) 1 Coefficient used to calculate cumulative dose contribution from this Source to the referenced Dose Reference at the current Control Point. See C.8.8.15.11.

Note: Material ID (300A,00E1) may also be specified within a referenced ROI, if an ROI is used to describe the object.

C.8.8.15.1 Permanent Implants

In permanent implant techniques the value for Channel Total Time (300A,0286) shall be mean life time of the isotope. The Brachy Control Point Sequence (300A,02D0) shall consist of two items: the first having Cumulative Time Weight (300A,02D6) = 0 and the second having Cumulative Time Weight (300A,02D6) = Final Cumulative Time Weight (300A,02C8).

C.8.8.15.2 Referenced ROI Number

The Structure Set ROI shall be used in the Brachy Application Setups Module to describe the 3D coordinates of Accessory Devices, Applicators and Channel Shields, but not individual source positions (see C.8.8.15.9 and C.8.8.15.10).

C.8.8.15.3 Channel Length

If specified, the Channel Length (300A,0284) shall be the sum of the Source Applicator Length (300A,0296) and Transfer Tube Length (300A,02A4).

C.8.8.15.4 Oscillating source movement

In brachytherapy treatment techniques involving oscillating source movement (i.e. when Source Movement Type (300A,0288) is OSCILLATING), the Brachy Control Point Sequence (300A,02D0) shall consist of two items. The first Control Point shall have Cumulative Time Weight (300A,02D6) = 0, and Control Point Relative Position (300A,02D2) equal to one end point of the oscillation. The second Control Point shall have Cumulative Time Weight (300A,02D6) = Final Cumulative Time Weight (300A,02C8), and Control Point Relative Position (300A,02D2) equal to the other end point of the oscillation. Transit time shall not be modeled explicitly for oscillating techniques.

C.8.8.15.5 Channel shields

The effect of Channel Shields on dose contributions shall be specific to the Channel for which they are specified. There shall be no effect of these shields on the dose contributions from any other Channels.

C.8.8.15.6 Time calculations

The treatment time at a given Control Point is equal to the Channel Total Time (300A,0286), multiplied by the Cumulative Time Weight (300A,02D6) for the Control Point, divided by the Final Cumulative Time Weight (300A,02C8). If the calculation for treatment time results in a time value which is not an exact multiple of the timer resolution, then the result shall be rounded to the nearest allowed timer value (i.e. less than a half resolution unit shall be rounded down to the nearest resolution unit, and equal or greater than half a resolution unit shall be rounded up to the nearest resolution unit).

Note also that if Final Cumulative Time Weight (300A,02C8) is equal to 100, then Cumulative Time Weight (300A,02D6) becomes equivalent to the percentage of Channel Total Time (300A,0286) delivered at each control point. If Final Cumulative Time Weight (300A,02C8) is equal to Channel Total Time (300A,0286), then the Cumulative Time Weight (300A,02D6) at each control point becomes equal to the cumulative treatment time delivered at that control point.

If Treatment Type (300A,0202) is PDR, then the Channel Total Time (3008,0286) shall specify the duration of a single pulse.

C.8.8.15.7 Brachy Control Point Sequence

The Control Points shall be arranged such that the first Control Point for a particular Channel describes the first dwell position and the final Control Point for the Channel describes the final dwell position. If Brachy Treatment Type (300A,0202) is PDR, the Brachy Control Point Sequence (300A,02D0) shall specify the sequence of machine configurations for a single pulse. Similarly, if Source Movement Type (300A,0288) is OSCILLATING, the Brachy Control Point Sequence (300A,02D0) shall specify the sequence of machine configurations for a single period.

Some examples of Brachytherapy specification using control points are as follows:

a) Stepwise motion; Four equally weighted dwell positions; Step size = 10; Final Cumulative Time Weight = 100:

Control Point 0: Control Point Relative Position = 30, Cumulative Time Weight = 0

Control Point 1: Control Point Relative Position = 30, Cumulative Time Weight = 25

Control Point 2: Control Point Relative Position = 20, Cumulative Time Weight = 25

Control Point 3: Control Point Relative Position = 20, Cumulative Time Weight = 50

Control Point 4: Control Point Relative Position = 10, Cumulative Time Weight = 50

Control Point 5: Control Point Relative Position = 10, Cumulative Time Weight = 75

Control Point 6: Control Point Relative Position = 0, Cumulative Time Weight = 75

Control Point 7: Control Point Relative Position = 0, Cumulative Time Weight = 100

b) Fixed (manually placed) sources; Final Cumulative Time Weight = 100:

Control Point 0: Control Point Relative Position = 0, Control Point 3D Position = (x,y,z),Cumulative Time Weight = 0

Control Point 1: Control Point Relative Position = 0, Control Point 3D Position = (x,y,z),Cumulative Time Weight = 100

c) Oscillating movement; Final Cumulative Time Weight = 100 :

Control Point 0: Control Point Relative Position = 100, Cumulative Time Weight = 0

Control Point 1: Control Point Relative Position = 0, Cumulative Time Weight = 100

d) Unidirectional movement; Final Cumulative Time Weight = 100 :

Control Point 0: Control Point Relative Position = 0, Cumulative Time Weight = 0

Control Point 1: Control Point Relative Position = 100, Cumulative Time Weight = 100

e) Stepwise motion with consideration of source transit times between dwell positions; Three equally weighted dwell positions; Step size = 10; Final Cumulative Time Weight = 79:

Control Point 0: Control Point Relative Position = 30, Cumulative Time Weight = 0

Control Point 1: Control Point Relative Position = 30, Cumulative Time Weight = 25

Control Point 2: Control Point Relative Position = 20, Cumulative Time Weight = 27

Control Point 3: Control Point Relative Position = 20, Cumulative Time Weight = 52

Control Point 4: Control Point Relative Position = 10, Cumulative Time Weight = 54

Control Point 5: Control Point Relative Position = 10, Cumulative Time Weight = 79

f) Stepwise motion with consideration of source transit times between dwell positions and to first and from last dwell position; Three equally weighted dwell positions; Step size = 10; Final Cumulative Time Weight = 383:

Control Point 0: Control Point Relative Position = 1200, Cumulative Time Weight = 0

Control Point 1: Control Point Relative Position = 30, Cumulative Time Weight = 150

Control Point 2: Control Point Relative Position = 30, Cumulative Time Weight = 175

Control Point 3: Control Point Relative Position = 20, Cumulative Time Weight = 177

Control Point 4: Control Point Relative Position = 20, Cumulative Time Weight = 202

Control Point 5: Control Point Relative Position = 10, Cumulative Time Weight = 204

Control Point 6: Control Point Relative Position = 10, Cumulative Time Weight = 229

Control Point 7: Control Point Relative Position = 1200, Cumulative Time Weight = 383

C.8.8.15.8 Source transit time

The Source transit times between dwell positions of a remote afterloader may be considered by specifying a non-zero increment in the Cumulative Time Weight (300A,02D6) when the Source moves between Control Points. In this case the Channel Total Time (300A,0286) shall include the overall Source transit time for the Channel.

C.8.8.15.9 Control Point Relative Position

Control Point Relative Position (300A,02D2) shall describe where a given source in a channel is located with respect to the end of the channel. This position shall correspond to the end of the afterloader applicator, not the “safe position”.

C.8.8.15.10 Control Point 3D Position

Control Point 3D Position (300A,02D4) shall describe the absolute 3D coordinates of a source. This position shall correspond to the center of a source in an applicator during a remote or manually controlled afterloading treatment.

C.8.8.15.11 Cumulative Dose Reference Coefficient

The Cumulative Dose Reference Coefficient (300A,010C) is the value by which Brachy Application Setup Dose (300A,00A4) is multiplied to obtain the dose to the referenced dose reference site at the current control point (and after previous control points have been successfully administered). The Cumulative Dose Reference Coefficient (300A,010C) is by definition zero for the initial control point. The Cumulative Dose Reference Coefficient (300A,010C) of the final control point multiplied by Brachy Application Setup Dose (300A,00A4) results in the final dose to the referenced dose reference site for the current channel. Dose calculation for dose reference sites other than points is not well defined.

If Treatment Type (300A,0202) is PDR, then the Cumulative Dose Reference Coefficient (3008,010C) shall specify the dose delivered to the dose reference during a single pulse. The total dose delivered to the dose reference shall then be expressed by Cumulative Dose Reference Coefficient (3008,010C) multiplied by Number of Pulses (300A,028A) multiplied by Brachy Application Setup Dose (300A,00A4).

C.8.8.15.12 Nominal Thickness and Nominal Transmission

If provided, Source Encapsulation Nominal Thickness (300A,0222), Brachy Accessory Device Nominal Thickness (300A,026A), Source Applicator Wall Nominal Thickness (300A,029C), and Channel Shield Nominal Thickness (300A,02B8) shall indicate that the related objects are of uniform thickness with the specified value. If this is not the case, these attributes shall not be provided.

If provided, Source Encapsulation Nominal Transmission (300A,0224), Brachy Accessory Device Nominal Transmission (300A,026C), Source Applicator Wall Nominal Transmission (300A,029E), and Channel Shield Nominal Transmission (300A,02BA) shall indicate that the related objects are of uniform transmission with the specified value. If this is not the case, these attributes shall not be provided.

No assumptions are made about the source characteristics beyond the parameters specified here.

C.8.8.15.13 Reference Point for calibration of beta emitting isotopes

For beta emitting isotopes, the Source Strength (300A,022B) shall be defined at reference point (r0,θ0), where r0 is the radial distance of 2 mm from the source longitudinal axis, and θ0 is the angle of 90 degrees between the source longitudinal axis and the line defined by the center of the source and the reference point. Refer to:

• IEC 60601-2-17 (Medical electrical equipment - Particular requirements for the safety of automatically-controlled brachytherapy afterloading equipment), where the beta source strength is defined as: ABSORBED DOSE RATE [Gy s-1] in water at 2 mm along the perpendicular bisector from a RADIOACTIVE SOURCE emitting beta RADIATION.

• Nath et. al.: Intravascular brachytherapy physics: Report of the AAPM Radiation Therapy Committee Task Group No. 60, Med. Phys 26 (2) Feb 1999, pp 119-152.

C.8.8.15.14 Orientation of Brachy Sources

The Control Point Orientation (300A,0412) shall be used to define the orientation of an anisotropic brachytherapy source or seed for the purpose of calculating the effect of the anisotropy on the dose calculation. The Control Point Orientation (300A,0412) shall be given by the direction vector of the long axis of the Brachy source or seed in the insertion direction, in the DICOM Patient Coordinate System. The direction vector shall be oriented from the source center as defined by the Control Point 3D Position (300A,02D4) along the long axis of the source and in the insertion direction.

C.8.8.16 Approval Module

Table C.8-52—APPROVAL MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Approval Status (300E,0002) 1 Approval status at the time the SOP Instance was created. Enumerated Values: APPROVED = Reviewer recorded that object met an implied criterion UNAPPROVED = No review of object has been recorded REJECTED = Reviewer recorded that object failed to meet an implied criterion
Review Date (300E,0004) 2C Date on which object was reviewed. Required if Approval Status (300E,0002) is APPROVED or REJECTED.
Review Time (300E,0005) 2C Time at which object was reviewed. Required if Approval Status (300E,0002) is APPROVED or REJECTED.
Reviewer Name (300E,0008) 2C Name of person who reviewed object. Required if Approval Status (300E,0002) is APPROVED or REJECTED.

C.8.8.17 RT General Treatment Record Module

Table C.8-53—RT GENERAL TREATMENT RECORD MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Instance Number (0020,0013) 1 Instance number identifying this particular instance of the object.
Treatment Date (3008,0250) 2 Date when current fraction was delivered, or Date last fraction was delivered in case of RT Treatment Summary Record IOD. See Note.
Treatment Time (3008,0251) 2 Time when current fraction was delivered (begun), or Time last fraction was delivered (begun) in case of RT Treatment Summary Record IOD. See Note.
Referenced RT Plan Sequence (300C,0002) 2 Reference to a RT Plan. Zero or one Item shall be included in this Sequence.
>Include ‘SOP Instance Reference Macro' Table 10-11
Referenced Treatment Record Sequence (3008,0030) 3 Reference to RT Treatment Records to which the current RT Treatment Record is significantly related. One or more Items are permitted in this sequence.
>Include ‘SOP Instance Reference Macro' Table 10-11

Note: Treatment Date (3008,0250) and Treatment Time (3008,0251) can be used to chronologically order a sequence of treatments, where each treatment is represented by an instance of a RT Beams Treatment Record or RT Brachy Treatment Record. In the case of a RT Treatment Summary Record, it can be used to identify the period for which the treatment summary is valid. Therefore, implementers are strongly advised to include values for these attributes whenever possible.

C.8.8.18 RT Treatment Machine Record Module

Table C.8-54—RT TREATMENT MACHINE RECORD MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Treatment Machine Sequence (300A,0206) 1 Introduces sequence describing treatment machine used for treatment delivery. Only a single Item shall be included in this Sequence.
>Treatment Machine Name (300A,00B2) 2 User-defined name identifying treatment machine used for treatment delivery.
>Manufacturer (0008,0070) 2 Manufacturer of the equipment used for treatment delivery.
>Institution Name (0008,0080) 2 Institution where the equipment is located that was used for treatment delivery.
>Institution Address (0008,0081) 3 Mailing address of the institution where the equipment is located that was used for treatment delivery.
>Institutional Department Name (0008,1040) 3 Department in the institution where the equipment is located that was used for treatment delivery.
>Manufacturer's Model Name (0008,1090) 2 Manufacturer's model name of the equipment used for treatment delivery.
>Device Serial Number (0018,1000) 2 Manufacturer's serial number of the equipment used for treatment delivery.

C.8.8.19 Measured Dose Reference Record Module

Table C.8-55—MEASURED DOSE REFERENCE RECORD MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Measured Dose Reference Sequence (3008,0010) 1 Introduces sequence of doses measured during treatment delivery, summed over entire session. One or more Items shall be included in this sequence.
>Referenced Dose Reference Number (300C,0051) 1C Uniquely identifies Dose Reference specified by Dose Reference Number (300A,0012) in Dose Reference Sequence (300A,0010) in RT Prescription Module of referenced RT Plan. Required only if Measured Dose Reference Number (3008,0064) is not sent. It shall not be present otherwise.
>Measured Dose Reference Number (3008,0064) 1C Unique identifier of measured dose point. Required only if Referenced Dose Reference Number (300C,0051) is not sent. It shall not be present otherwise.
>Dose Units (3004,0002) 1 Units used to describe measured dose. Enumerated Values: GY = Gray RELATIVE = Dose relative to implicit reference value
>Measured Dose Value (3008,0016) 2 Measured Dose in units specified by Dose Units (3004,0002).
>Measured Dose Type (3008,0014) 2 Type of dose measurement. Defined Terms: DIODE = semiconductor diode TLD = thermoluminescent dosimeter ION_CHAMBER = ion chamber GEL = dose sensitive gel EPID = electronic portal imaging device FILM = dose sensitive film
>Measured Dose Description (3008,0012) 3 User-defined description of Dose Reference (e.g. “Exit dose”, “Point A”).

C.8.8.20 Calculated Dose Reference Record Module

Table C.8-56—CALCULATED DOSE REFERENCE RECORD MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Calculated Dose Reference Sequence (3008,0070) 1 Introduces sequence of doses estimated for each treatment delivery. One or more Items shall be included in this sequence.
>Referenced Dose Reference Number (300C,0051) 1C Uniquely identifies Dose Reference specified by Dose Reference Number (300A,0012) in Dose Reference Sequence (300A,0010) in RT Prescription Module of referenced RT Plan. Required only if Calculated Dose Reference Number (3008,0072) is not sent. It shall not be present otherwise.
>Calculated Dose Reference Number (3008,0072) 1C Unique identifier of dose reference point within RT Treatment Record IOD. Required only if Referenced Dose Reference Number (300C,0051) is not sent. It shall not be present otherwise.
>Calculated Dose Reference Dose Value (3008,0076) 2 Calculated Dose (Gy).
>Calculated Dose Reference Description (3008,0074) 3 User-defined description of Calculated Dose Reference.

C.8.8.21 RT Beams Session Record Module

Table C.8-57—RT BEAMS SESSION RECORD MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Referenced Fraction Group Number (300C,0022) 3 Identifier of Fraction Group within referenced RT Plan.
Number of Fractions Planned (300A,0078) 2 Total number of treatments (Fractions) planned for current Fraction Group.
Primary Dosimeter Unit (300A,00B3) 1 Measurement unit of machine dosimeter. Enumerated Values: MU = Monitor Unit MINUTE = minute
Treatment Session Beam Sequence (3008,0020) 1 Introduces sequence of Beams administered during treatment session. One or more Items shall be included in this sequence.
>Referenced Beam Number (300C,0006) 3 References Beam specified by Beam Number (300A,00C0) in Beam Sequence (300A,00B0) in RT Beams Module within referenced RT Plan.
>Beam Name (300A,00C2) 3 User-defined name for delivered Beam.
>Beam Description (300A,00C3) 3 User-defined description for delivered Beam.
>Beam Type (300A,00C4) 1 Motion characteristic of delivered Beam. Enumerated Values: STATIC = all beam parameters remain unchanged during delivery DYNAMIC = one or more beam parameters changes during delivery
>Radiation Type (300A,00C6) 1 Particle type of delivered Beam. Defined Terms: PHOTON, ELECTRON, NEUTRON, PROTON.
>Primary Fluence Mode Sequence (3002,0050) 3 Sequence defining whether the primary fluence of the treatment beam used a non-standard fluence-shaping when the beam was delivered. Only a single item is permitted in this sequence.
>>Fluence Mode (3002,0051) 1 Describes whether the fluence shaping is the standard mode for the beam or an alternate. Enumerated Values: STANDARD = Uses standard fluence-shaping NON_STANDARD = Uses a non-standard fluence-shaping mode
>>Fluence Mode ID (3002,0052) 1C Identifier for the specific fluence-shaping mode. Required if Fluence Mode (3002,0051) has value NON_STANDARD.
>High-Dose Technique Type (300A,00C7) 1C Type of high-dose treatment technique. Defined Terms: NORMAL = Standard treatment TBI = Total Body Irradiation HDR = High Dose Rate Required if treatment technique requires a dose that would normally require overriding of treatment machine safety controls.
>Referenced Verification Image Sequence (300C,0040) 3 Introduces sequence of verification images obtained during delivery of current beam. One or more Items are permitted in this sequence.
>>Include ‘SOP Instance Reference Macro' Table 10-11
>>Start Meterset (3008,0078) 3 Cumulative Meterset Weight within Beam referenced by Referenced Beam Number at which image acquisition starts.
>>End Meterset (3008,007A) 3 Cumulative Meterset Weight within Beam referenced by Referenced Beam Number at which image acquisition ends.
>Referenced Measured Dose Reference Sequence (3008,0080) 3 Introduces sequence of doses measured during treatment delivery for current Beam. One or more Items are permitted in this sequence.
>>Referenced Dose Reference Number (300C,0051) 1C Uniquely references Dose Reference specified by Dose Reference Number (300A,0012) in Dose Reference Sequence (300A,0010) in RT Prescription Module of referenced RT Plan. Required if Referenced Measured Dose Reference Number (3008,0082) is not sent. It shall not be present otherwise.
>>Referenced Measured Dose Reference Number (3008,0082) 1C Uniquely references Measured Dose Reference specified by Measured Dose Reference Number (3008,0064) in Measured Dose Reference Sequence (3008,0010). Required if Referenced Dose Reference Number (300C,0051) is not sent. It shall not be present otherwise.
>>Measured Dose Value (3008,0016) 1 Measured Dose in units specified by Dose Units (3004,0002) in sequence referenced by Measured Dose Reference Sequence (3008,0010) or Dose Reference Sequence (300A,0010) in RT Prescription Module of referenced RT Plan as defined above.
>Referenced Calculated Dose Reference Sequence (3008,0090) 3 Introduces sequence of doses estimated for each treatment delivery. One or more Items are permitted in this sequence.
>>Referenced Dose Reference Number (300C,0051) 1C Uniquely identifies Dose Reference specified by Dose Reference Number (300A,0012) in Dose Reference Sequence (300A,0010) in RT Prescription Module of referenced RT Plan. Required if Referenced Calculated Dose Reference Number (3008,0092) is not sent.
>>Referenced Calculated Dose Reference Number (3008,0092) 1C Uniquely identifies Calculated Dose Reference specified by Calculated Dose Reference Number (3008,0072) within Calculated Dose Reference Sequence (3008,0070). Required if Referenced Dose Reference Number (300C,0051) is not sent.
>>Calculated Dose Reference Dose Value (3008,0076) 1 Calculated Dose (Gy).
>Source-Axis Distance (300A,00B4) 3 Radiation source to gantry rotation axis distance of the equipment that was used for beam delivery (mm).
>Beam Limiting Device Leaf Pairs Sequence (3008,00A0) 1 Introduces sequence of beam limiting device (collimator) jaw or leaf (element) leaf pair values. One or more Items shall be included in this sequence.
>>RT Beam Limiting Device Type (300A,00B8) 1 Type of beam limiting device (collimator). Enumerated Values: X = symmetric jaw pair in IEC X direction Y = symmetric jaw pair in IEC Y direction ASYMX = asymmetric jaw pair in IEC X direction ASYMY = asymmetric pair in IEC Y direction MLCX = multileaf (multi-element) jaw pair in IEC X direction MLCY = multileaf (multi-element) jaw pair in IEC Y direction
>>Number of Leaf/Jaw Pairs (300A,00BC) 1 Number of leaf (element) or jaw pairs (equal to 1 for standard beam limiting device jaws).
>Referenced Patient Setup Number (300C,006A) 3 Uniquely identifies Patient Setup used within current beam, specified by Patient Setup Number (300A,0182) within Patient Setup Sequence (300A,0180) of RT Treatment Record.
>Number of Wedges (300A,00D0) 1 Number of wedges associated with current delivered Beam.
>Recorded Wedge Sequence (3008,00B0) 1C Introduces sequence of treatment wedges present during delivered Beam. Required if Number of Wedges (300A,00D0) is non-zero. One or more Items shall be included in this sequence.
>>Wedge Number (300A,00D2) 3 Identification number of the Wedge. The value of Wedge Number (300A,00D2) shall be unique within the wedge sequence.
>>Wedge Type (300A,00D3) 2 Type of wedge defined for delivered Beam. Defined Terms: STANDARD = standard (static) wedge DYNAMIC = moving Beam Limiting Device (collimator) jaw simulating wedge MOTORIZED = single wedge which can be removed from beam remotely
>>Wedge ID (300A,00D4) 3 User-supplied identifier for wedge.
>>Accessory Code (300A,00F9) 3 An identifier for the accessory intended to be read by a device such as a bar-code reader.
>>Wedge Angle (300A,00D5) 3 Nominal wedge angle delivered (degrees).
>>Wedge Orientation (300A,00D8) 3 Orientation of wedge, i.e. orientation of IEC WEDGE FILTER coordinate system with respect to IEC BEAM LIMITING DEVICE coordinate system (degrees).
>Number of Compensators (300A,00E0) 2 Number of compensators associated with current delivered Beam.
>Recorded Compensator Sequence (3008,00C0) 3 Introduces sequence of treatment compensators associated with current Beam. One or more Items are permitted in this sequence.
>>Referenced Compensator Number (300C,00D0) 1 Uniquely identifies compensator specified by Compensator Number (300A,00E4) within Beam referenced by Referenced Beam Number (300C,0006).
>>Compensator Type (300A,00EE) 2 Type of compensator (if any). Defined Terms: STANDARD = physical (static) compensator DYNAMIC = moving Beam Limiting Device (collimator) simulating compensator
>>Compensator ID (300A,00E5) 3 User-supplied identifier for compensator.
>>Accessory Code (300A,00F9) 3 An identifier for the accessory intended to be read by a device such as a bar-code reader.
>Number of Boli (300A,00ED) 2 Number of boli used with current Beam.
>Referenced Bolus Sequence (300C,00B0) 3 Introduces sequence of boli associated with Beam. One or more Items are permitted in this sequence.
>>Referenced ROI Number (3006,0084) 1 Uniquely identifies ROI representing the bolus specified by ROI Number (3006,0022) in Structure Set ROI Sequence (3006,0020) in Structure Set Module within RT Structure Set IOD referenced by referenced RT Plan in Referenced RT Plan Sequence (300C,0002) in RT General Treatment Record Module.
>>Bolus ID (300A,00DC) 3 User-supplied identifier for the Bolus.
>>Accessory Code (300A,00F9) 3 An identifier for the accessory intended to be read by a device such as a bar-code reader.
>Number of Blocks (300A,00F0) 2 Number of shielding blocks or Electron Inserts associated with Beam.
>Recorded Block Sequence (3008,00D0) 3 Introduces sequence of blocks associated with current Beam. One or more Items are permitted in this sequence.
>>Block Tray ID (300A,00F5) 3 User-supplied identifier for block tray or Electron Insert.
>>Accessory Code (300A,00F9) 3 An identifier for the accessory intended to be read by a device such as a bar-code reader.
>>Referenced Block Number (300C,00E0) 3 Uniquely identifies block specified by Block Number (300A,00FC) within Beam referenced by Referenced Beam Number (300C,0006).
>>Block Name (300A,00FE) 2 User-defined name for block.
>Applicator Sequence (300A,0107) 3 Introduces sequence of Applicators associated with Beam. Only a single item is permitted in this sequence.
>>Applicator ID (300A,0108) 1 User or machine supplied identifier for Applicator.
>>Accessory Code (300A,00F9) 3 An identifier for the accessory intended to be read by a device such as a bar-code reader.
>>Applicator Type (300A,0109) 1 Type of Applicator. Defined Terms: ELECTRON_SQUARE = square electron applicator ELECTRON_RECT = rectangular electron applicator ELECTRON_CIRC = circular electron applicator ELECTRON_SHORT = short electron applicator ELECTRON_OPEN = open (dummy) electron applicator PHOTON_SQUARE = square photon applicator PHOTON _RECT = rectangular photon applicator PHOTON _CIRC = circular photon applicator INTRAOPERATIVE = intraoperative (custom) applicator STEREOTACTIC = stereotactic applicator (deprecated)
>>Applicator Geometry Sequence (300A,0431) 3 Describes the applicator aperture geometry. Only a single Item is permitted in this sequence.
>>>Applicator Aperture Shape (300A,0432) 1 Aperture shape of the applicator. Defined terms: SYM_SQUARE: A square-shaped aperture symmetrical to the central axis. SYM_RECTANGLE: A rectangular-shaped aperture symmetrical to the central axis. SYM_CIRCULAR: A circular-shaped aperture symmetrical to the central axis.
>>>Applicator Opening (300A,0433) 1C Opening (in mm) of the applicator's aperture in IEC BEAM LIMITING DEVICE coordinate system. In case of square-shaped applicator contains the length of the sides of the square. In case of circular-shaped applicators, contains the diameter of the circular aperture. Required if Applicator Aperture Shape (300A,0432) is SYM_SQUARE or SYM_CIRCULAR.
>>>Applicator Opening X (300A,0434) 1C Opening (in mm) of the applicator's aperture in IEC BEAM LIMITING DEVICE coordinate system in X-Direction. Required if Applicator Aperture Shape (300A,0432) is SYM_RECTANGLE.
>>>Applicator Opening Y (300A,0435) 1C Opening (in mm) of the applicator's aperture in IEC BEAM LIMITING DEVICE coordinate system in Y-Direction. Required if Applicator Aperture Shape (300A,0432) is SYM_RECTANGLE.
>> Source to Applicator Mounting Position Distance (300A,0436) 3 Radiation source to applicator mounting position distance (in mm) for current applicator.
>>Applicator Description (300A,010A) 3 User-defined description for Applicator.
>General Accessory Sequence (300A,0420) 3 Introduces a Sequence of General Accessories associated with this Beam. One or more items are permitted in this sequence.
>>General Accessory Number (300A,0424) 1 Identification Number of the General Accessory. The value shall be unique within the sequence.
>>General Accessory ID (300A,0421) 1 User or machine supplied identifier for General Accessory.
>>General Accessory Description (300A,0422) 3 User supplied description of General Accessory.
>>General Accessory Type (300A,0423) 3 Specifies the type of accessory. Defined Terms: GRATICULE = Accessory tray with a radio-opaque grid IMAGE_DETECTOR = Image acquisition device positioned in the beam line RETICLE = Accessory tray with radio-transparent markers or grid
>>Accessory Code (300A,00F9) 3 Machine-readable identifier for this accessory
>Current Fraction Number (3008,0022) 2 Fraction number for this beam administration.
>Treatment Delivery Type (300A,00CE) 2 Delivery Type of treatment. Defined Terms: TREATMENT = normal patient treatment OPEN_PORTFILM = portal image acquisition with open field TRMT_PORTFILM = portal image acquisition with treatment port CONTINUATION = continuation of interrupted treatment SETUP = no treatment beam is applied for this RT Beam. To be used for specifying the gantry, couch, and other machine positions where X-Ray set-up images or measurements are to be taken VERIFICATION = Treatment used for Quality Assurance rather than patient treatment
>Treatment Termination Status (3008,002A) 1 Conditions under which treatment was terminated. Enumerated Values: NORMAL = treatment terminated normally OPERATOR = operator terminated treatment MACHINE = machine terminated treatment UNKNOWN = status at termination unknown
>Treatment Termination Code (3008,002B) 3 Treatment machine termination code. This code is dependent upon the particular application and equipment.
>Treatment Verification Status (3008,002C) 2 Conditions under which treatment was verified by a verification system. Enumerated Values: VERIFIED = treatment verified VERIFIED_OVR = treatment verified with at least one out-of-range value overridden NOT_VERIFIED = treatment verified manually
>Specified Primary Meterset (3008,0032) 3 Desired machine setting of primary meterset.
>Specified Secondary Meterset (3008,0033) 3 Desired machine setting of secondary meterset.
>Delivered Primary Meterset (3008,0036) 3 Machine setting actually delivered as recorded by primary meterset.
>Delivered Secondary Meterset (3008,0037) 3 Machine setting actually delivered as recorded by secondary meterset.
>Specified Treatment Time (3008,003A) 3 Treatment Time set (sec).
>Delivered Treatment Time (3008,003B) 3 Treatment Time actually delivered (sec).
>Number of Control Points (300A,0110) 1 Number of control points delivered.
>Control Point Delivery Sequence (3008,0040) 1 Introduces sequence of beam control points for current treatment beam. One or more Items shall be included in this sequence. See C.8.8.21.1.
>>Referenced Control Point Index (300C,00F0) 3 Uniquely identifies Control Point specified by Control Point Index (300A,0112) within Beam referenced by Referenced Beam Number (300C,0006).
>>Treatment Control Point Date (3008,0024) 1 Date when the delivery of radiation at this control point began. For the final control point this shall be the Date when the previous control point ended.
>>Treatment Control Point Time (3008,0025) 1 Time when the delivery of radiation at this control point began. For the final control point this shall be the Time when the previous control point ended.
>>Specified Meterset (3008,0042) 2 Desired machine setting for current control point. See C.8.8.21.2.
>>Delivered Meterset (3008,0044) 1 Machine setting actually delivered at current control point. See C.8.8.21.2.
>>Dose Rate Set (300A,0115) 2 Dose Rate set on treatment machine for segment beginning at current control point (meterset/min).
>>Dose Rate Delivered (3008,0048) 2 Dose Rate actually delivered for segment beginning at current control point (meterset/min).
>>Nominal Beam Energy (300A,0114) 3 Nominal Beam Energy at control point.
>>Nominal Beam Energy Unit (300A,0015) 1C Units used for Nominal Beam Energy (300A,0114). Required if Nominal Beam Energy (300A,0114) is sent. Defined Terms: MV = Megavolt MEV = Mega electron-Volt If Radiation Type (300A,00C6) is PHOTON, Nominal Beam Energy Unit (300A,0015) shall be MV. If Radiation Type (300A,00C6) is ELECTRON, Nominal Beam Energy Unit (300A,0015) shall be MEV.
>>Wedge Position Sequence (300A,0116) 3 Introduces sequence of Wedge positions for current control point. One or more Items are permitted in this sequence.
>>>Referenced Wedge Number (300C,00C0) 1 Uniquely identifies wedge specified by Wedge Number (300A,00D2) within Beam referenced by Referenced Beam Number (300C,0006).
>>>Wedge Position (300A,0118) 1 Position of Wedge at current control point. Enumerated Values: IN, OUT.
>>Beam Limiting Device Position Sequence (300A,011A) 1C Introduces sequence of beam limiting device (collimator) jaw or leaf (element) positions. One or more Items shall be included in this sequence. Required for Control Point 0 of Control Point Delivery Sequence (3008,0040) or if beam limiting device (collimator) changes during beam administration.
>>>RT Beam Limiting Device Type (300A,00B8) 1 Type of beam limiting device. The value of this attribute shall correspond to RT Beam Limiting Device Type (300A,00B8) defined in an element of Beam Limiting Device Leaf Pairs Sequence (3008,00A0). Enumerated Values: X = symmetric jaw pair in IEC X direction Y = symmetric jaw pair in IEC Y direction ASYMX = asymmetric jaw pair in IEC X direction ASYMY = asymmetric pair in IEC Y direction MLCX = multileaf (multi-element) jaw pair in IEC X direction MLCY = multileaf (multi-element) jaw pair in IEC Y direction
>>>Leaf/Jaw Positions (300A,011C) 1 Positions of beam limiting device (collimator) leaf (element) or jaw pairs (mm) in IEC BEAM LIMITING DEVICE coordinate axis appropriate to RT Beam Limiting Device Type (300A,00B8), e.g. X-axis for MLCX, Y-axis for MLCY. Contains 2N values, where N is the Number of Leaf/Jaw Pairs (300A,00BC) defined in element of Beam Limiting Device Leaf Pairs Sequence (3008,00A0). Values shall be in IEC leaf subscript order 101, 102, … 1N, 201, 202 … 2N.
>>Gantry Angle (300A,011E) 1C Treatment machine gantry angle, i.e. orientation of IEC GANTRY coordinate system with respect to IEC FIXED REFERENCE coordinate system (degrees). Required for Control Point 0 of Control Point Delivery Sequence (3008,0040) or if Gantry Angle changes during beam administration.
>>Gantry Rotation Direction (300A,011F) 1C Direction of Gantry Rotation when viewing gantry from isocenter, for segment beginning at current Control Point. Required for Control Point 0 of Control Point Delivery Sequence (3008,0040), or if Gantry Rotation Direction changes during beam administration. Enumerated Values: CW = clockwise CC = counter-clockwise NONE = no rotation
>>Gantry Pitch Angle (300A,014A) 3 Gantry Pitch Angle. i.e. the rotation of the IEC GANTRY coordinate system about the X-axis of the IEC GANTRY coordinate system (degrees). If used, must be present for first item of Control Point Sequence, or if used and Gantry Pitch Rotation Angle changes during Beam, must be present. See C.8.8.25.6.5.
>>Gantry Pitch Rotation Direction (300A,014C) 3 Direction of Gantry Pitch Angle when viewing along the positive X-axis of the IEC GANTRY coordinate system, for segment following Control Point. If used, must be present for first item of Control Point Sequence, or if used and Gantry Pitch Rotation Direction changes during Beam, must be present. See C.8.8.14.8 and C.8.8.25.6.5. Enumerated Values: CW = clockwise CC = counter-clockwise NONE = no rotation
>>Beam Stopper Position (3008,0230) 3 Position of Beam Stopper during beam administration. Enumerated Values: EXTENDED = Beam Stopper extended RETRACTED = Beam Stopper retracted UNKNOWN = Position unknown
>>Beam Limiting Device Angle (300A,0120) 1C Beam Limiting Device (collimator) angle, i.e. orientation of IEC BEAM LIMITING DEVICE coordinate system with respect to IEC GANTRY coordinate system (degrees). Required for Control Point 0 of Control Point Delivery Sequence (3008,0040) or if beam limiting device (collimator) angle changes during beam delivery.
>>Beam Limiting Device Rotation Direction (300A,0121) 1C Direction of Beam Limiting Device Rotation when viewing beam limiting device (collimator) from radiation source, for segment beginning at current Control Point. Required for Control Point 0 of Control Point Delivery Sequence (3008,0040) or if Beam Limiting Device Rotation Direction changes during beam administration. Enumerated Values: CW = clockwise CC = counter-clockwise NONE = no rotation
>>Patient Support Angle (300A,0122) 1C Patient Support angle, i.e. orientation of IEC PATIENT SUPPORT (turntable) coordinate system with respect to IEC FIXED REFERENCE coordinate system (degrees). Required for Control Point 0 of Control Point Delivery Sequence (3008,0040) or if Patient Support Angle changes during beam administration.
>>Patient Support Rotation Direction (300A,0123) 1C Direction of Patient Support Rotation when viewing table from above, for segment beginning at current Control Point. Required for Control Point 0 of Control Point Delivery Sequence (3008,0040), or if Patient Support Rotation Direction changes during beam administration. Enumerated Values: CW = clockwise CC = counter-clockwise NONE = no rotation
>>Table Top Eccentric Axis Distance (300A,0124) 3 Distance (positive) from the IEC PATIENT SUPPORT vertical axis to the IEC TABLE TOP ECCENTRIC vertical axis (mm).
>>Table Top Eccentric Angle (300A,0125) 1C Table Top (non-isocentric) angle, i.e. orientation of IEC TABLE TOP ECCENTRIC coordinate system with respect to IEC PATIENT SUPPORT coordinate system (degrees). Required for Control Point 0 of Control Point Delivery Sequence (3008,0040) or if Table Top Eccentric Angle changes during beam administration.
>>Table Top Eccentric Rotation Direction (300A,0126) 1C Direction of Table Top Eccentric Rotation when viewing table from above, for segment beginning at current Control Point. Required for Control Point 0 of Control Point Delivery Sequence (3008,0040) or if Table Top Eccentric Rotation Direction changes during beam administration. Enumerated Values: CW = clockwise CC = counter-clockwise NONE = no rotation
>>Table Top Pitch Angle (300A,0140) 1C Table Top Pitch Angle, i.e. the rotation of the IEC TABLE TOP coordinate system about the X-axis of the IEC TABLE TOP coordinate system (degrees). If required by treatment delivery device, shall be present for first item of Control Point Sequence. If required by treatment delivery device and if Table Top Pitch Angle changes during Beam, shall be present in all subsequent items of Control Point Sequence. See C.8.8.25.6.2.
>>Table Top Pitch Rotation Direction (300A,0142) 1C Direction of Table Top Pitch Rotation when viewing the table along the positive X-axis of the IEC TABLE TOP coordinate system, for segment following Control Point. If required by treatment delivery device, shall be present for first item of Control Point Sequence. If required by treatment delivery device and if Table Top Pitch Rotation Direction changes during Beam, shall be present in all subsequent items of Control Point Sequence. See C.8.8.14.8 and C.8.8.25.6.2. Enumerated Values: CW = clockwise CC = counter-clockwise NONE = no rotation
>>Table Top Roll Angle (300A,0144) 1C Table Top Roll Angle, i.e. the rotation of the IEC TABLE TOP coordinate system about the IEC Y-axis of the IEC TABLE TOP coordinate system (degrees). If required by treatment delivery device, shall be present for first item of Control Point Sequence. If required by treatment delivery device and if Table Top Roll Angle changes during Beam, shall be present in all subsequent items of Control Point Sequence. See C.8.8.25.6.2.
>>Table Top Roll Rotation Direction (300A,0146) 1C Direction of Table Top Roll Rotation when viewing the table along the positive Y-axis of the IEC TABLE TOP coordinate system, for segment following Control Point. If required by treatment delivery device, shall be present for first item of Control Point Sequence. If required by treatment delivery device and if Table Top Roll Rotation Direction changes during Beam, shall be present in all subsequent items of Control Point Sequence. See C.8.8.14.8 and C.8.8.25.6.2. Enumerated Values: CW = clockwise CC = counter-clockwise NONE = no rotation
>>Table Top Vertical Position (300A,0128) 2C Table Top Vertical position in IEC TABLE TOP coordinate system (mm). This value is interpreted as an absolute, rather than relative, Table setting. Required for Control Point 0 of Control Point Delivery Sequence (3008,0040) or if Table Top Vertical Position changes during beam administration.
>>Table Top Longitudinal Position (300A,0129) 2C Table Top Longitudinal position in IEC TABLE TOP coordinate system (mm). This value is interpreted as an absolute, rather than relative, Table setting. Required for Control Point 0 of Control Point Delivery Sequence (3008,0040) or if Table Top Longitudinal Position changes during beam administration.
>>Table Top Lateral Position (300A,012A) 2C Table Top Lateral position in IEC TABLE TOP coordinate system (mm). This value is interpreted as an absolute, rather than relative, Table setting. Required for Control Point 0 of Control Point Delivery Sequence (3008,0040) or if Table Top Lateral Position changes during beam administration.
>>Corrected Parameter Sequence (3008,0068) 3 Introduces a sequence of items describing any corrections made to any attributes prior to delivery of the next control point. One or more Items are permitted in this sequence.
>>>Parameter Sequence Pointer (3008,0061) 1 Contains the Data Element Tag of the parent sequence containing the attribute that was corrected. The value is limited in scope to the Treatment Session Beam Sequence (3008,0020) and all nested sequences therein.
>>>Parameter Item Index (3008,0063) 1 Contains the sequence item index (starting at 1) of the corrected attribute within its parent sequence.
>>>Parameter Pointer (3008,0065) 1 Contains the Data Element Tag of the attribute that was corrected.
>>>Correction Value (3008,006A) 1 The value applied to the attribute that was referenced by the Parameter Sequence Pointer (3008,0061), Parameter Item Index (3008,0063) and Parameter Pointer (3008,0065).
>>Override Sequence (3008,0060) 3 Introduces sequence of parameters that were overridden during the administration of the beam segment immediately prior to the current control point. One or more Items are permitted in this sequence.
>>>Override Parameter Pointer (3008,0062) 2 Contains the Data Element Tag of the attribute that was overridden.
>>>Parameter Sequence Pointer (3008,0061) 3 Contains the Data Element Tag of the parent sequence containing the attribute that was overridden. The value is limited in scope to the Treatment Session Beam Sequence (3008,0020) and all nested sequences therein.
>>>Parameter Item Index (3008,0063) 3 Contains the sequence item index (monotonically increasing from 1) of the overridden attributes within its parent sequence. The value is limited in scope to the Treatment Session Beam Sequence (3008,0020) and all nested sequences therein.
>>>Operators’ Name (0008,1070) 2 Name of operator who authorized override.
>>>Override Reason (3008,0066) 3 User-defined description of reason for override of parameter specified by Override Parameter Pointer (3008,0062).

C.8.8.21.1 Control point machine delivery parameters

All treatment machine delivery parameters (including table angles and positions) in the RT Treatment Session Record Module shall be specified as absolute, not relative, values at the Control Point.

C.8.8.21.2 Specified and Delivered Meterset Values

C.8.8.21.2.1 Beam Level

The value of Specified Primary Meterset (3008,0032) shall be the value specified by the Beam Meterset (300A,0086) in the corresponding Fraction Group of the referenced RT Plan. The referenced RT Plan is found in the Referenced RT Plan Sequence (300C,0002), and within this plan the Fraction Group is found using the Referenced Fraction Group Number (300C,0022) in this module. The Beam is found in the referenced RT Plan using the Referenced Beam Number (300C,0006) in the same item of the Treatment Session Beam Sequence (3008,0020) as the Specified Primary Meterset (3008,0032).

The value of Delivered Primary Meterset (3008,0036) shall be the accumulated value of the delivered meterset across all Control Points, which is recorded in this item of the Treatment Session Beam Sequence (3008,0020).

Note that, for example, when a partial treatment has occurred and resumption(s) have been delivered which complete delivery of all control points remaining, the sum of the Delivered Primary Meterset (3008,0036) values in all RT Beams Session Records for the beam in question and the fraction being treated will match the specified meterset for the whole fraction.

C.8.8.21.2.2 Control Point Level

Specified Meterset (3008,0042) contains the MU as specified in the corresponding RT Plan at a given control point.

Delivered Meterset (3008,0044) shall contain one of the following three values:

Control points which already have been treated in an earlier session shall contain the Meterset value at which the delivery of the current beam started. Control points which have been completely treated during the current session shall contain the Specified Meterset value for this Control Point. Control Points which have not yet been treated or not completely shall contain the total delivered MU up to the point where the interruption has occurred (i.e. the last control point treated).

This can be expressed by the following equation:

DelMS[CP n ] = MAX ( StartMS, MIN ( SpecMS[CP n ], EndMS ))

with

DelMS[CP n ]: Delivered Meterset value at control point n

SpecMS[CP n ]: Specified Meterset value at control point n

StartMS: Meterset value where delivery of current beam started

EndMS: Meterset value where delivery of current beam ended

By this definition it is unambigously recorded, which ‘segments’ of control points have been delivered in case of partial treatments.

Example 1: 2 Control Points, 2 complete Partial Treatments

Total Meterset: 50

Interruption at: 18 MU

RT Plan:

[pic]

RT Treatment Record 1 of 2

[pic]

RT Treatment Record 2 of 2

[pic]

Example 2: 4 Control Points, 3 complete Partial Treatments

Total Meterset: 50

Interruption at: 25, 30 MU

RT Plan:

[pic]

RT Treatment Record 1 of 3

[pic]

RT Treatment Record 2 of 3

[pic]

RT Treatment Record 3 of 3

[pic]

Example 3: 7 Control Points, 2 Partial Treatments with small gap

Total Meterset: 50

Interuption at: 25 MU, Resumption at 30 MU

RT Plan:

[pic]

RT Treatment Record 1 of 2

[pic]

RT Treatment Record 2 of 2

[pic]

C.8.8.22 RT Brachy Session Record Module

Table C.8-58—RT BRACHY SESSION RECORD MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Referenced Fraction Group Number (300C,0022) 3 Identifier of Fraction Group within referenced RT Plan.
Number of Fractions Planned (300A,0078) 2 Total number of treatments (Fractions) planned for current Fraction Group.
Brachy Treatment Technique (300A,0200) 1 Type of brachytherapy treatment technique. Enumerated Values: INTRALUMENARY, INTRACAVITARY, INTERSTITIAL, CONTACT, INTRAVASCULAR, PERMANENT. See RT Plan IOD.
Brachy Treatment Type (300A,0202) 1 Type of brachytherapy treatment. Defined Terms: MANUAL = manually positioned HDR = High dose rate MDR = Medium dose rate LDR = Low dose rate PDR = Pulsed dose rate
Recorded Source Sequence (3008,0100) 1 Introduces sequence of Sources to be used within Application Setups. One or more Items shall be included in this sequence.
>Source Number (300A,0212) 1 Identification number of the Source. The value of Source Number (300A,0212) shall be unique within the Recorded Source Sequence (3008,0100) in which it is created.
>Source Type (300A,0214) 1 Type of Source. Defined Terms: POINT, LINE, CYLINDER, SPHERE.
>Source Manufacturer (300A,0216) 2 Manufacturer of source.
>Source Serial Number (3008,0105) 2 Serial Number of source.
>Source Isotope Name (300A,0226) 1 User-defined name of Isotope.
>Source Isotope Half Life (300A,0228) 1 Half-life of Isotope (days).
>Source Strength Units (300A,0229) 1C Measurement unit of Source Strength. Required if the source is not a gamma-emitting (photon) source. May be present otherwise. Enumerated Values: AIR_KERMA_RATE = Air Kerma Rate if Source is Gamma emitting Isotope. DOSE_RATE_WATER = Dose Rate in Water if Source is Beta emitting Isotope.
>Reference Air Kerma Rate (300A,022A) 1 Air Kerma Rate in air of Isotope specified at Source Strength Reference Date (300A,022C) and Source Strength Reference Time (300A,022E) (in µGy h-1 at 1 m). Value shall be zero for non-gamma sources.
>Source Strength (300A,022B) 1C Source Strength of Isotope at Source Strength Reference Date (300A,022C) and Source Strength Reference Time (300A,022E), in units specified in Source Strength Units (300A,0229). Required if the source is not a gamma-emitting (photon) source. See C.8.8.15.13.
>Source Strength Reference Date (300A,022C) 1 Reference date for Reference Air Kerma Rate (300A,022A) or Source Strength (300A,022B) of Isotope.
>Source Strength Reference Time (300A,022E) 1 Reference time for Air Kerma Rate (300A,022A) or Source Strength (300A,022B) of Isotope.
Treatment Session Application Setup Sequence (3008,0110) 1 Introduces sequence of Application Setups for RT Treatment Record for current RT Plan. One or more Items shall be included in this sequence.
>Application Setup Type (300A,0232) 1 Type of Application Setup. Defined Terms: FLETCHER_SUIT, DELCLOS, BLOEDORN, JOSLIN_FLYNN, CHANDIGARH, MANCHESTER, HENSCHKE, NASOPHARYNGEAL, OESOPHAGEAL, ENDOBRONCHIAL, SYED_NEBLETT, ENDORECTAL, PERINEAL.
>Referenced Brachy Application Setup Number (300C,000C) 3 References application setup specified by Application Setup Number (300A,0234) in Application Setup Sequence (300A,0230) in RT Brachy Applications Module within referenced RT Plan.
>Application Setup Name (300A,0236) 3 User-defined name for Application Setup.
>Application Setup Manufacturer (300A,0238) 3 Manufacturer of Application Setup.
>Template Number (300A,0240) 3 Identification number of the Template.
>Template Type (300A,0242) 3 User-defined type for Template Device.
>Template Name (300A,0244) 3 User-defined name for Template Device.
>Application Setup Check (3008,0116) 3 Results of check-wire travel through all channels of current Application Setup. Enumerated Values: PASSED = Passed check FAILED = Failed check UNKNOWN = Unknown status
>Referenced Verification Image Sequence (300C,0040) 3 Introduces sequence of verification images obtained during delivery of current beam. One or more Items are permitted in this sequence. See Note.
>>Include ‘SOP Instance Reference Macro' Table 10-11
>Total Reference Air Kerma (300A,0250) 1 Total Reference Air Kerma for current Application Setup, i.e. the sum of the products of the Air Kerma Rates of each Source in each Channel with its respective Channel Time (µGy at 1 m). Value shall be zero for non-gamma sources.
>Referenced Measured Dose Reference Sequence (3008,0080) 3 Introduces sequence of doses measured during treatment delivery, summed over entire session. One or more Items are permitted in this sequence.
>>Referenced Dose Reference Number (300C,0051) 1C Uniquely references Dose Reference specified by Dose Reference Number (300A,0012) in Dose Reference Sequence (300A,0010) in RT Prescription Module of referenced RT Plan. Required if Referenced Measured Dose Reference Number (3008,0082) is not sent. It shall not be present otherwise.
>>Referenced Measured Dose Reference Number (3008,0082) 1C Uniquely references Measured Dose Reference specified by Measured Dose Reference Number (3008,0064) in Measured Dose Reference Sequence (3008,0010). Required if Referenced Dose Reference Number (300C,0051) is not sent. It shall not be present otherwise.
>>Measured Dose Value (3008,0016) 1 Measured Dose in units specified by Dose Units (3004,0002) in sequence referenced by Measured Dose Reference Sequence (3008,0010) or Dose Reference Sequence (300A,0010) in RT Prescription Module of referenced RT Plan as defined above.
>Referenced Calculated Dose Reference Sequence (3008,0090) 3 Introduces sequence of doses estimated for each treatment delivery. One or more Items are permitted in this sequence.
>>Referenced Dose Reference Number (300C,0051) 1 Uniquely identifies Dose Reference specified by Dose Reference Number (300A,0012) in Dose Reference Sequence (300A,0010) in RT Prescription Module of referenced RT Plan. Required if Referenced Calculated Dose Reference Number (3008,0092) is not sent. It shall not be present otherwise.
>>Referenced Calculated Dose Reference Number (3008,0092) 1C Uniquely identifies Calculated Dose Reference specified by Calculated Dose Reference Number (3008,0072) within Calculated Dose Reference Sequence (3008,0070). Required if Referenced Dose Reference Number (300C,0051) is not sent. It shall not be present otherwise.
>>Calculated Dose Reference Dose Value (3008,0076) 1 Calculated Dose (Gy).
>Current Fraction Number (3008,0022) 2 Fraction number for this application setup.
>Treatment Delivery Type (300A,00CE) 2 Delivery Type of treatment. Defined Terms: TREATMENT = normal patient treatment CONTINUATION = continuation of interrupted treatment
>Treatment Termination Status (3008,002A) 1 Conditions under which treatment was terminated. Enumerated Values: NORMAL = treatment terminated normally OPERATOR = operator terminated treatment MACHINE = machine terminated treatment for other than NORMAL condition UNKNOWN = status at termination unknown
>Treatment Termination Code (3008,002B) 3 Treatment machine termination code. This code is dependent upon the particular application and equipment.
>Treatment Verification Status (3008,002C) 2 Conditions under which treatment was verified by a verification system. Enumerated Values: VERIFIED = treatment verified VERIFIED_OVR = treatment verified with at least one out-of-range value overridden NOT_VERIFIED = treatment verified manually
>Recorded Brachy Accessory Device Sequence (3008,0120) 3 Introduces sequence of Brachy Accessory Devices associated with current Application Setup. One or more Items are permitted in this sequence.
>>Referenced Brachy Accessory Device Number (3008,0122) 2 Identification number of the Brachy Accessory Device. The value of Brachy Accessory Device Number (300A,0262) shall be unique within the Application Setup in which it is created.
>>Brachy Accessory Device ID (300A,0263) 2 User or machine supplied identifier for Brachy Accessory Device.
>>Brachy Accessory Device Type (300A,0264) 1 Type of Brachy Accessory Device. Defined Terms: SHIELD, DILATATION, MOLD, PLAQUE, FLAB.
>>Brachy Accessory Device Name (300A,0266) 3 User-defined name for Brachy Accessory Device.
>Recorded Channel Sequence (3008,0130) 1 Introduces sequence of Channels for current Application Setup. One or more Items shall be included in this sequence.
>>Channel Number (300A,0282) 1 Identification number of the Channel. The value of Channel Number (300A,0282) shall be unique within the Application Setup in which it is created.
>>Channel Length (300A,0284) 2 Length of Channel (mm). See RT Plan IOD.
>>Specified Channel Total Time (3008,0132) 1 Total amount of time specified between Control Point 0 and final Control Point of the Brachy Control Point Sequence (300A,02D0) for current Channel (sec).
>>Delivered Channel Total Time (3008,0134) 1 Total amount of time actually delivered between Control Point 0 and final Control Point of the Brachy Control Point Sequence (300A,02D0) for current Channel (sec).
>>Source Movement Type (300A,0288) 1 Type of Source movement. Defined Terms: STEPWISE, FIXED, OSCILLATING, UNIDIRECTIONAL.
>>Specified Number of Pulses (3008,0136) 1C Number of Pulses specified per fraction for current Channel. Required if Brachy Treatment Type (300A,0202) is PDR. See C.8.8.22.1.
>>Delivered Number of Pulses (3008,0138) 1C Number of Pulses actually delivered per fraction for current Channel. Required if Brachy Treatment Type (300A,0202) is PDR. See C.8.8.22.1.
>>Specified Pulse Repetition Interval (3008,013A) 1C Pulse repetition interval (sec) specified for current Channel. Required if Brachy Treatment Type (300A,0202) is PDR. See C.8.8.22.1
>>Delivered Pulse Repetition Interval (3008,013C) 1C Pulse repetition interval (sec) actually delivered for current Channel. Required if Brachy Treatment Type (300A,0202) is PDR. See C.8.8.22.1.
>>Referenced Measured Dose Reference Sequence (3008,0080) 3 Introduces sequence of doses measured during treatment delivery, summed over entire session. One or more Items are permitted in this sequence.
>>>Referenced Dose Reference Number (300C,0051) 1C Uniquely references Dose Reference specified by Dose Reference Number (300A,0012) in Dose Reference Sequence (300A,0010) in RT Prescription Module of referenced RT Plan. Required if Referenced Measured Dose Reference Number (3008,0082) is not sent. It shall not be present otherwise.
>>>Referenced Measured Dose Reference Number (3008,0082) 1C References Measured Dose Reference specified by Measured Dose Reference Number (3008,0064) in Measured Dose Reference Sequence (3008,0010). Required if Referenced Dose Reference Number (300C,0051) is not sent. It shall not be present otherwise.
>>>Measured Dose Value (3008,0016) 1 Measured Dose.
>>Referenced Calculated Dose Reference Sequence (3008,0090) 3 Introduces sequence of doses estimated for each treatment delivery. One or more Items are permitted in this sequence.
>>>Referenced Dose Reference Number (300C,0051) 1C Uniquely identifies Dose Reference specified by Dose Reference Number (300A,0012) in Dose Reference Sequence (300A,0010) in RT Prescription Module of referenced RT Plan. Required if Referenced Calculated Dose Reference Number (3008,0092) is not sent. It shall not be present otherwise.
>>>Referenced Calculated Dose Reference Number (3008,0092) 1C Uniquely identifies Calculated Dose Reference specified by Calculated Dose Reference Number (3008,0072) within Calculated Dose Reference Sequence (3008,0070). Required if Referenced Dose Reference Number (300C,0051) is not sent. It shall not be present otherwise.
>>>Calculated Dose Reference Dose Value (3008,0076) 1 Calculated Dose (Gy).
>>Recorded Source Applicator Sequence (3008,0140) 3 Introduces sequence of recorded Source Applicators. One or more Items are permitted in this sequence.
>>>Referenced Source Applicator Number (3008,0142) 2 Identification number of the Source Applicator. The value of Source Applicator Number (300A,0290) shall be unique within the Channel in which it is created.
>>>Source Applicator ID (300A,0291) 2 User or machine supplied identifier for Source Applicator.
>>>Source Applicator Type (300A,0292) 1 Type of Source Applicator. Enumerated Values: FLEXIBLE, RIGID.
>>>Source Applicator Name (300A,0294) 3 User-defined name for Source Applicator.
>>>Source Applicator Length (300A,0296) 1 Length of Source Applicator (mm), defined as the distance between the connector of the applicator and the distal-most position of the source.
>>>Source Applicator Manufacturer (300A,0298) 3 Manufacturer of Source Applicator.
>>>Source Applicator Step Size (300A,02A0) 1C Distance of path along channel (mm) between adjacent (potential) dwell positions. Required if Source Movement Type (300A,0288) is STEPWISE.
>>Transfer Tube Number (300A,02A2) 2 Identification number of the Transfer Tube. The value of Transfer Tube Number (300A,02A2) shall be unique within the Channel in which it is created.
>>Transfer Tube Length (300A,02A4) 2C Length of Transfer Tube of current afterloading Channel (mm). Required if value Transfer Tube Number (300A,02A2) is not zero length.
>>Recorded Channel Shield Sequence (3008,0150) 3 Introduces sequence of Channel Shields associated with current Channel. One or more Items are permitted in this sequence. See RT Plan IOD for description of Channel Shields.
>>>Referenced Channel Shield Number (3008,0152) 2 Identification number of the Channel Shield. The value of Channel Shield Number (300A,02B2) shall be unique within the Channel in which it is created.
>>>Channel Shield ID (300A,02B3) 2 User or machine supplied identifier for Channel Shield.
>>>Channel Shield Name (300A,02B4) 3 User-defined name for Channel Shield.
>>Referenced Source Number (300C,000E) 1 Uniquely identifies the referenced Source within the Recorded Source Sequence (3008,0100) for current Application Setup.
>>Safe Position Exit Date (3008,0162) 1C Date on which the source(s) exited the safe. Required if Recorded Channel Sequence (3008,0130) is sent and Brachy Treatment Type (300A,0202) is not MANUAL.
>>Safe Position Exit Time (3008,0164) 1C Time on which the source(s) exited the safe. Required if Recorded Channel Sequence (3008,0130) is sent and Brachy Treatment Type (300A,0202) is not MANUAL.
>>Safe Position Return Date (3008,0166) 1C Date on which the source(s) returned to the safe. Required if Recorded Channel Sequence (3008,0130) is sent and Brachy Treatment Type (300A,0202) is not MANUAL.
>>Safe Position Return Time (3008,0168) 1C Time on which the source(s) returned to the safe. Required if Recorded Channel Sequence (3008,0130) is sent and Brachy Treatment Type (300A,0202) is not MANUAL.
>>Number of Control Points (300A,0110) 1 Number of control points in Channel. For an N-segment Channel there will be 2N (stepwise movement) or N+1 (continuous movement) control points.
>>Brachy Control Point Delivered Sequence (3008,0160) 1 Introduces sequence of machine configurations describing this Channel. Two or more items shall be included in this sequence. See RT Plan IOD and C.8.8.22.1 for description of Brachy Control Point Delivered Sequence.
>>>Referenced Control Point Index (300C,00F0) 3 Index of current Control Point, starting at 0 for first Control Point.
>>>Treatment Control Point Date (3008,0024) 1 Date when the delivery of radiation at this control point began. For the final control point this shall be the Date when the previous control point ended.
>>>Treatment Control Point Time (3008,0025) 1 Time when the delivery of radiation at this control point began. For the final control point this shall be the Time when the previous control point ended.
>>>Control Point Relative Position (300A,02D2) 1 Distance between current Control Point Position and the distal-most possible Source position in current Channel (mm). See RT Plan IOD.
>>>Override Sequence (3008,0060) 3 Introduces sequence of parameters which were overridden during the administration of the treatment immediately prior to the current control point. One or more Items are permitted in this sequence.
>>>>Override Parameter Pointer (3008,0062) 2 Contains the Data Element Tag of the attribute which was overridden.
>>>>Operators’ Name (0008,1070) 2 Name of operator who authorized override.
>>>>Override Reason (3008,0066) 3 User-defined description of reason for override of parameter specified by Override Parameter Pointer (3008,0062).

Note: The Referenced Verification Image Sequence (300C,0040) may contain either images taken specifically for verification of the brachy application setup or reference images used in place of verification images, as might be done in HDR treatment planning.

C.8.8.22.1 PDR (Pulsed Dose Rate) Treatment

In Brachytherapy treatment techniques where Brachy Treatment Type (300A,0202) is PDR, the Brachy Control Point Sequence (300A,02D0) shall consist of 2N items, where N = Delivered Number of Pulses (3008,0138). Each control point pair shall specify the start and end of a single pulse.

C.8.8.23 RT Treatment Summary Record Module

Table C.8-59—RT TREATMENT SUMMARY RECORD MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Current Treatment Status (3008,0200) 1 Status of the Treatment at the time the Treatment Summary was created. Enumerated Values: NOT_STARTED, ON_TREATMENT, ON_BREAK, SUSPENDED, STOPPED, COMPLETED. See C.8.8.23.1.
Treatment Status Comment (3008,0202) 3 Comment on current treatment status.
First Treatment Date (3008,0054) 2 Date of delivery of the first treatment.
Most Recent Treatment Date (3008,0056) 2 Date of delivery of the most recent administration.
Fraction Group Summary Sequence (3008,0220) 3 Introduces sequence describing current state of planned vs. delivered fraction groups. One or more Items are permitted in this sequence.
>Referenced Fraction Group Number (300C,0022) 3 References Fraction Group Number (300A,0071) in Fraction Group Sequence (300A,0070) in the referenced RT Plan.
>Fraction Group Type (3008,0224) 2 Indicates type of fraction group. Enumerated Values: EXTERNAL_BEAM, BRACHY.
>Number of Fractions Planned (300A,0078) 2 Number of fractions planned for this fraction group.
>Number of Fractions Delivered (3008,005A) 2 Number of fractions delivered as of Treatment Summary Report.
>Fraction Status Summary Sequence (3008,0240) 3 Introduces sequence describing status of fractions in Fraction Group. One or more Items are permitted in this sequence.
>>Referenced Fraction Number (3008,0223) 1 Identifies fraction.
>>Treatment Date (3008,0250) 2 Date when fraction was delivered.
>>Treatment Time (3008,0251) 2 Time when fraction was delivered.
>>Treatment Termination Status (3008,002A) 2 Conditions under which treatment was terminated. Enumerated Values: NORMAL = treatment terminated normally OPERATOR = operator terminated treatment MACHINE = machine terminated treatment for other than NORMAL condition UNKNOWN = status at termination unknown
Treatment Summary Measured Dose Reference Sequence (3008,00E0) 3 Introduces sequence of references to Measured Dose References. One or more Items are permitted in this sequence.
>Referenced Dose Reference Number (300C,0051) 3 Uniquely identifies Dose Reference specified by Dose Reference Number (300A,0012) in Dose Reference Sequence (300A,0010) in RT Prescription Module of referenced RT Plan referenced in Referenced RT Plan Sequence (300C,0002) of RT General Treatment Record Module.
>Dose Reference Description (300A,0016) 3 User-defined description of Dose Reference.
>Cumulative Dose to Dose Reference (3008,0052) 1 Cumulative Dose delivered to Dose Reference (Gy).
Treatment Summary Calculated Dose Reference Sequence (3008,0050) 3 Introduces sequence of references to Calculated Dose References. One or more Items are permitted in this sequence.
>Referenced Dose Reference Number (300C,0051) 3 Uniquely identifies Dose Reference specified by Dose Reference Number (300A,0012) in Dose Reference Sequence (300A,0010) in RT Prescription Module of referenced RT Plan referenced in Referenced RT Plan Sequence (300C,0002) of RT General Treatment Record Module.
>Dose Reference Description (300A,0016) 3 User-defined description of Dose Reference.
>Cumulative Dose to Dose Reference (3008,0052) 1 Cumulative Dose delivered to Dose Reference (Gy).

Note: The RT Treatment Summary Record IOD may contain references to related RT Treatment Session Record IODs. These references are contained within the Referenced Treatment Record Sequence (3008,0030) of the RT General Treatment Record Module.

C.8.8.23.1 Current Treatment Status

The definition of the enumerated values for Current Treatment Status (3008,0200) are defined as follows:

NOT_STARTED Patient has not yet begun treatment.

ON_TREATMENT Patient is currently undergoing treatment.

ON_BREAK Patient is currently not undergoing treatment, but a resumption date is known.

SUSPENDED Patient is currently not undergoing treatment, but resumption of treatment is planned at an unknown date.

STOPPED Patient has stopped treatment without completing the planned course.

COMPLETED Patient completed the planned course of treatment.

A change in the Current Treatment Status (or any other field) in a RT Treatment Summary Record Object shall define a new instance of the RT Treatment Summary Record IOD.

C.8.8.24 RT Ion Tolerance Tables Module

The RT Ion Tolerance Tables Module contains information describing the maximum allowed differences between the planned and measured attributes for Ion therapy.

Table C.8.8.24-1RT ION TOLERANCE TABLES MODULE ATTRIBUTES

Attribute Name Tag Type Description
Ion Tolerance Table Sequence (300A,03A0) 1 Introduces sequence of ion tolerance tables to be used for delivery of treatment plan. One or more items shall be included in this sequence. See Note 1.
>Tolerance Table Number (300A,0042) 1 Identification number of the Tolerance Table. The value of Tolerance Table Number (300A,0042) shall be unique within the RT Ion Plan in which it is created.
>Tolerance Table Label (300A,0043) 3 User-defined label for Tolerance Table.
>Gantry Angle Tolerance (300A,0044) 3 Maximum permitted difference (in degrees) between planned and delivered Gantry Angle.
>Beam Limiting Device Angle Tolerance (300A,0046) 3 Maximum permitted difference (in degrees) between planned and delivered Beam Limiting Device Angle.
>Beam Limiting Device Tolerance Sequence (300A,0048) 3 Introduces sequence of beam limiting device (collimator) tolerances. One or more items are permitted in this sequence.
>>RT Beam Limiting Device Type (300A,00B8) 1 Type of beam limiting device (collimator). Enumerated Values: X = symmetric jaw pair in IEC X direction Y = symmetric jaw pair in IEC Y direction ASYMX = asymmetric jaw pair in IEC X direction ASYMY = asymmetric pair in IEC Y direction MLCX = multileaf (multi-element) jaw pair in IEC X direction MLCY = multileaf (multi-element) jaw pair in IEC Y direction
>>Beam Limiting Device Position Tolerance (300A,004A) 1 Maximum permitted difference (in mm) between planned and delivered leaf (element) or jaw positions for current beam limiting device (collimator).
>Patient Support Angle Tolerance (300A,004C) 3 Maximum permitted difference (in degrees) between planned and delivered Patient Support Angle.
>Table Top Vertical Position Tolerance (300A,0051) 3 Maximum permitted difference (in mm) between planned and delivered Table Top Vertical Position.
>Table Top Longitudinal Position Tolerance (300A,0052) 3 Maximum permitted difference (in mm) between planned and delivered Table Top Longitudinal Position.
>Table Top Lateral Position Tolerance (300A,0053) 3 Maximum permitted difference (in mm) between planned and delivered Table Top Lateral Position.
>Table Top Pitch Angle Tolerance (300A,004F) 3 Maximum permitted difference (in degrees) between planned and delivered Table Top Pitch Angle.
>Table Top Roll Angle Tolerance (300A,0050) 3 Maximum permitted difference (in degrees) between planned and delivered Table Top Roll Angle.
>Snout Position Tolerance (300A,004B) 3 Maximum permitted difference (in mm) between planned and delivered Snout Position.

Note 1: Tolerance Tables may be used to compare planned values to actual machine values. If the absolute difference between the planned and actual values exceeds the Tolerance Table value, treatment may be inhibited or the operator may be warned.

C.8.8.25 RT Ion Beams Module

The RT Ion Beams Module contains information defining equipment parameters for delivery of external Ion radiation beams.

Table C.8.8.25-1RT ION BEAMS MODULE ATTRIBUTES

Attribute Name Tag Type Description
Ion Beam Sequence (300A,03A2) 1 Introduces sequence of setup and/or treatment beams for current RT Ion Plan. One or more items shall be included in this sequence.
>Beam Number (300A,00C0) 1 Identification number of the Beam. The value of Beam Number (300A,00C0) shall be unique within the RT Ion Plan in which it is created. See section C.8.8.25.1.
>Beam Name (300A,00C2) 1 User-defined name for Beam. See section C.8.8.25.1.
>Beam Description (300A,00C3) 3 User-defined description for Beam. See section C.8.8.25.1.
>Beam Type (300A,00C4) 1 Motion characteristic of Beam. Enumerated Values: STATIC = all beam parameters remain unchanged during delivery DYNAMIC = one or more beam parameters changes during delivery
>Radiation Type (300A,00C6) 1 Particle type of Beam. Defined Terms: PHOTON PROTON ION
>Radiation Mass Number (300A,0302) 1C Mass number of radiation. Required if Radiation Type (300A,00C6) is ION
>Radiation Atomic Number (300A,0304) 1C Atomic number of radiation. Required if Radiation Type (300A,00C6) is ION
>Radiation Charge State (300A,0306) 1C Charge state of radiation. Required if Radiation Type (300A,00C6) is ION
>Scan Mode (300A,0308) 1 The method of beam scanning to be used during treatment. Defined Terms: NONE = No beam scanning is performed. UNIFORM = The beam is scanned between control points to create a uniform lateral fluence distribution across the field. MODULATED = The beam is scanned between control points to create a modulated lateral fluence distribution across the field.
>Treatment Machine Name (300A,00B2) 2 User-defined name identifying treatment machine to be used for beam delivery. See section C.8.8.25.2.
>Manufacturer (0008,0070) 3 Manufacturer of the equipment to be used for beam delivery.
>Institution Name (0008,0080) 3 Institution where the equipment is located that is to be used for beam delivery.
>Institution Address (0008,0081) 3 Mailing address of the institution where the equipment is located that is to be used for beam delivery.
>Institutional Department Name (0008,1040) 3 Department in the institution where the equipment is located that is to be used for beam delivery.
>Manufacturer's Model Name (0008,1090) 3 Manufacturer's model name of the equipment that is to be used for beam delivery.
>Device Serial Number (0018,1000) 3 Manufacturer's serial number of the equipment that is to be used for beam delivery.
>Primary Dosimeter Unit (300A,00B3) 1 Measurement unit of machine dosimeter. Enumerated Values: MU = Monitor Unit NP = number of particles
>Referenced Tolerance Table Number (300C,00A0) 3 Uniquely identifies Tolerance Table specified by Tolerance Table Number (300A,0042) within Tolerance Table Sequence in RT Ion Tolerance Tables Module. These tolerances are to be used for verification of treatment machine settings.
>Virtual Source-Axis Distances (300A,030A) 1 Distance (in mm) from virtual source position to gantry rotation axis or nominal isocenter position (fixed beam-lines) of the equipment to be used for beam delivery. Specified by a numeric pair - the VSAD in the IEC Gantry X direction followed by the VSAD in the IEC Gantry Y direction. The VSAD is commonly used for designing apertures in contrast to the effective source-axis-distance (ESAD) that is commonly used with the inverse square law for calculating the dose decrease with distance. See section C.8.8.25.4.
>Ion Beam Limiting Device Sequence (300A,03A4) 3 Introduces sequence of beam limiting device (collimator) jaw or leaf (element) sets. One or more items are permitted in this sequence.
>>RT Beam Limiting Device Type (300A,00B8) 1 Type of beam limiting device (collimator). Enumerated Values: X = symmetric jaw pair in IEC X direction Y = symmetric jaw pair in IEC Y direction ASYMX = asymmetric jaw pair in IEC X direction ASYMY = asymmetric pair in IEC Y direction MLCX = multileaf (multi-element) jaw pair in IEC X direction MLCY = multileaf (multi-element) jaw pair in IEC Y direction
>>Isocenter to Beam Limiting Device Distance (300A,00BB) 2 Isocenter to beam limiting device (collimator) distance (in mm) of the equipment that is to be used for beam delivery. See section C.8.8.25.4.
>>Number of Leaf/Jaw Pairs (300A,00BC) 1 Number of leaf (element) or jaw pairs (equal to 1 for standard beam limiting device jaws).
>>Leaf Position Boundaries (300A,00BE) 1C Boundaries of beam limiting device (collimator) leaves (in mm) in IEC BEAM LIMITING DEVICE coordinate axis appropriate to RT Beam Limiting Device Type (300A,00B8), i.e. X-axis for MLCY, Y-axis for MLCX. Contains N+1 values, where N is the Number of Leaf/Jaw Pairs (300A,00BC), starting from Leaf (Element) Pair 1. Required if RT Beam Limiting Device Type (300A,00B8) is MLCX or MLCY. See section C.8.8.25.3.
>Referenced Patient Setup Number (300C,006A) 3 Uniquely identifies Patient Setup to be used for current beam, specified by Patient Setup Number (300A,0182) within Patient Setup Sequence of RT Patient Setup Module.
>Referenced Reference Image Sequence (300C,0042) 3 Reference images used for validation of current beam. One or more items are permitted in this sequence.
>>Include SOP Instance Reference Macro Table 10-11
>>Reference Image Number (300A,00C8) 1 Uniquely identifies Reference Image within Referenced Reference Image Sequence (300C,0042).
>Treatment Delivery Type (300A,00CE) 1 Delivery Type of treatment. Defined Terms: TREATMENT = normal patient treatment OPEN_PORTFILM = portal image acquisition with open field (the source of radiation is specified by Radiation Type (300A,00C6)) TRMT_PORTFILM = portal image acquisition with treatment port (the source of radiation is specified by Radiation Type (300A,00C6)) CONTINUATION = continuation of interrupted treatment SETUP = no treatment beam is applied for this RT Beam. To be used for specifying the gantry, couch, and other machine positions where X-Ray set-up images or measurements shall be taken.
>Referenced Dose Sequence (300C,0080) 3 Related instances of RT Dose (for grids, isodose curves, and named/unnamed point doses). One or more items are permitted in this sequence.
>>Include SOP Instance Reference Macro Table 10-11 The Referenced Class SOP UID shall be that of the RT Dose SOP Class (1.2.840.10008.5.1.4.1.1.481.2)
>Number of Wedges (300A,00D0) 1 Number of wedges associated with current beam.
>Total Wedge Tray Water-Equivalent Thickness (300A,00D7) 3 Shift of the wedge tray induced on the range of the ion beam as measured in water (in mm).
>Ion Wedge Sequence (300A,03AA) 1C Introduces sequence of treatment wedges. Required if Number of Wedges (300A,00D0) is non-zero. The number of items shall be identical to the value of Number of Wedges (300A,00D0).
>>Wedge Number (300A,00D2) 1 Identification number of the Wedges. The value of Wedge Number (300A,00D2) shall be unique within the Beam in which it was created.
>>Wedge Type (300A,00D3) 2 Typer of wedge (if any) defined for Beam. Defined Terms: STANDARD = standard (static) wedge MOTORIZED = single wedge that can be removed from beam remotely. PARTIAL_STANDARD = wedge does not extend across the whole field and is operated manually. PARTIAL_MOTORIZ = wedge does not extend across the whole field and can be removed from beam remotely.
>>Wedge ID (300A,00D4) 3 User-supplied identifier for Wedge.
>>Accessory Code (300A,00F9) 3 An accessory identifier to be read by a device such as a bar code reader.
>>Wedge Angle (300A,00D5) 2 Nominal wedge angle (degrees).
>>Wedge Orientation (300A,00D8) 2 Orientation of wedge, i.e. orientation of IEC WEDGE FILTER coordinate system with respect to the IEC BEAM LIMITING DEVICE coordinate systems (degrees).
>>Isocenter to Wedge Tray Distance (300A,00D9) 1 Isocenter to downstream edge of wedge tray (mm). See section C.8.8.25.4
>Number of Compensators (300A,00E0) 1 Number of compensators associated with current Beam.
>Total Compensator Tray Water-Equivalent Thickness (300A,02E3) 3 Water-Equivalent thickness of the compensator tray (in mm) parallel to radiation beam axis.
>Ion Range Compensator Sequence (300A,02EA) 1C Introduces sequence of compensators. Required if Number of Compensators (300A,00E0) is non-zero. The number of items shall be identical to the value of Number of Compensators (300A,00E0).
>>Compensator Description (300A,02EB) 3 User defined description for the compensator.
>>Compensator Number (300A,00E4) 1 Identification number of the Compensator. The value of Compensator Number (300A,00E4) shall be unique within the Beam in which it is created.
>>Material ID (300A,00E1) 2 User-supplied identifier for material used to manufacture Compensator.
>>Compensator ID (300A,00E5) 3 User-supplied identifier for the compensator.
>>Accessory Code (300A,00F9) 3 An accessory identifier to be read by a device such as a bar code reader.
>>Isocenter to Compensator Tray Distance (300A,02E4) 1C Isocenter to compensator tray attachment edge distance (in mm) for current range compensator. Required if Compensator Mounting Position (300A,02E1) is not DOUBLE_SIDED. See section C.8.8.25.4
>>Compensator Divergence (300A,02E0) 1 Indicates presence or absence of geometrical divergence of the range compensator. Enumerated Values: PRESENT = the range compensator is shaped according to the beam geometrical divergence. ABSENT = the range compensator is not shaped according to the beam geometrical divergence.
>>Compensator Mounting Position (300A,02E1) 1 Indicates on which side of the Compensator Tray the compensator is mounted. Enumerated Values: PATIENT_SIDE = the Compensator is mounted on the side of the Compensator Tray that is towards the patient. SOURCE_SIDE = the Compensator is mounted on the side of the Compensator Tray that is towards the radiation source. DOUBLE_SIDED = the Compensator has a shaped (i.e. non-flat) surface on both sides of the Compensator Tray.
>>Compensator Rows (300A,00E7) 1 Number of rows in the range compensator. A row is defined to be in the X direction of the IEC Beam Limiting Device Coordinate system.
>>Compensator Columns (300A,00E8) 1 Number of columns in the range compensator. A column is defined to be in the Y direction of the IEC Beam Limiting Device Coordinate system.
>>Compensator Pixel Spacing (300A,00E9) 1 Physical distance (in mm) between the center of each pixel projected onto machine isocentric plane. Specified by a numeric pair - adjacent row spacing followed by adjacent column spacing. See 10.7.1.3 for further explanation of the value order.
>>Compensator Position (300A,00EA) 1 The x and y coordinates of the upper left hand corner (first pixel transmitted) of the range compensator, projected onto the machine isocentric plane in the IEC BEAM LIMITING DEVICE coordinate system (mm).
>>Compensator Column Offset (300A,02E5) 1C The offset distance (in mm) applied to the x coordinate of the Compensator Position (300A,00EA) for even numbered rows. Required if the compensator pattern is hexogonal.
>>Compensator Thickness Data (300A,00EC) 1 A data stream of the pixel samples that comprise the range compensator, expressed as physical thickness (in mm), either parallel to radiation beam axis if Compensator Divergence (300A,02E0) equals ABSENT, or divergent according to the beam geometrical divergence if Compensator Divergence (300A,02E0) equals PRESENT. The order of pixels sent is left to right, top to bottom (upper left pixel, followed by the remainder of row 1, followed by the remainder of the rows).
>>Isocenter to Compensator Distances (300A,02E6) 1C A data stream of the pixel samples that comprise the distance from the isocenter to the compensator surface closest to the radiation source (in mm). The order of pixels sent is left to right, top to bottom (upper left pixel, followed by the remainder of row 1, followed by the remainder of the rows). Required if Material ID (300A,00E1) is non-zero length, and Compensator Mounting Position (300A,02E1) is DOUBLE_SIDED. See sections C.8.8.14.9 and C.8.8.25.4
>>Compensator Relative Stopping Power Ratio (300A,02E7) 3 Compensator Linear Stopping Power Ratio, relative to water, at the beam energy specified by the Nominal Beam Energy (300A,0114) of the first Control Point of the Ion Control Point Sequence (300A,03A8).
>>Compensator Milling Tool Diameter (300A,02E8) 3 The diameter (in mm) of the milling tool to be used to create the compensator. The diameter is expressed as the actual physcial size and not a projected size at isocenter.
>Number of Boli (300A,00ED) 1 Number of boli associated with current Beam.
>Referenced Bolus Sequence (300C,00B0) 1C Introduces sequence of boli associated with Beam. Required if Number of Boli (300A,00ED) is non-zero. The number of items shall be identical to the value of Number of Boli (300A,00ED).
>>Referenced ROI Number (3006,0084) 1 Uniquely identifies ROI representing the Bolus specified by ROI Number (3006,0022) in Structure Set ROI Sequence (3006,0020) in Structure Set Module within RT Structure Set in Referenced Structure Set Sequence (300C,0060) in RT General Plan Module.
>>Accessory Code (300A,00F9) 3 An accessory identifier to be read by a device such as a bar code reader.
>Number of Blocks (300A,00F0) 1 Number of shielding blocks associated with Beam.
>Total Block Tray Water-Equivalent Thickness (300A,00F3) 3 Water-Equivalent thickness of the block tray (in mm) parallel to radiation beam axis.
>Ion Block Sequence (300A,03A6) 1C Introduces sequence of blocks associated with Beam. Required if Number of Blocks (300A,00F0) is non-zero. The number of items shall be identical to the value of Number of Blocks (300A,00F0).
>>Block Tray ID (300A,00F5) 3 User-supplied identifier for block tray.
>>Accessory Code (300A,00F9) 3 An accessory identifier to be read by a device such as a bar code reader.
>>Isocenter to Block Tray Distance (300A,00F7) 1 Isocenter to downstream edge of block tray (mm). See section C.8.8.25.4
>>Block Type (300A,00F8) 1 Type of block. See section C.8.8.14.4. Enumerated Values: SHIELDING = blocking material is inside contour APERTURE = blocking material is outside contour
>>Block Divergence (300A,00FA) 1 Indicates presence or otherwise of geometrical divergence. Enumerated Values: PRESENT = block edges are shaped for beam divergence ABSENT = block edges are not shaped for beam divergence
>>Block Mounting Position (300A,00FB) 1 Indicates on which side of the Block Tray the block is mounted. Enumerated Values; PATIENT_SIDE = the block is mounted on the side of the Block Tray that is towards the patient. SOURCE_SIDE = the block is mounted on the side of the Block Tray that is towards the radiation source.
>>Block Number (300A,00FC) 1 Identification number of the Block. The value of Block Number (300A,00FC) shall be unique within the Beam in which it is created.
>>Block Name (300A,00FE) 3 User-defined name for block.
>>Material ID (300A,00E1) 2 User-supplied identifier for material used to manufacture Block.
>>Block Thickness (300A,0100) 1 Physical thickness of block (in mm) parallel to radiation beam axis. See section C.8.8.14.4.
>>Block Number of Points (300A,0104) 1 Number of (x,y) pairs defining the block edge.
>>Block Data (300A,0106) 1 A data stream of (x,y) pairs that comprise the block edge. The number of pairs shall be equal to Block Number of Points (300A,0104), and the vertices shall be interpreted as a closed polygon. Coordinates are projected onto the machine isocentric plane in the IEC BEAM LIMITING DEVICE coordinate system (mm).
>Snout Sequence (300A,030C) 3 Introduces sequence of Snouts associated with Beam. Only a single item is permitted in this sequence.
>>Snout ID (300A,030F) 1 User or machine supplied identifier for Snout.
>>Accessory Code (300A,00F9) 3 An accessory identifier to be read by a device such as a bar code reader.
>Applicator Sequence (300A,0107) 3 Introduces sequence of Applicators associated with Beam. Only a single item is permitted in this sequence.
>>Applicator ID (300A,0108) 1 User or machine supplied identifier for Applicator.
>>Accessory Code (300A,00F9) 3 An accessory identifier to be read by a device such as a bar code reader.
>>Applicator Type (300A,0109) 1 Type of applicator. Defined Terms: ION_SQUARE = square ion applicator ION_RECT = rectangluar ion applicator ION_CIRC = circular ion applicator ION_SHORT = short ion applicator ION_OPEN = open (dummy) ion applicator INTEROPERATIVE = interoperative (custom) applicator STEREOTACTIC = stereotactic applicator
>>Applicator Description (300A,010A) 3 User-defined description for Applicator.
>General Accessory Sequence (300A,0420) 3 Introduces a Sequence of General Accessories associated with this Beam. One or more items are permitted in this sequence.
>>General Accessory Number (300A,0424) 1 Identification Number of the General Accessory. The value shall be unique within the sequence.
>>General Accessory ID (300A,0421) 1 User or machine supplied identifier for General Accessory.
>>General Accessory Description (300A,0422) 3 User supplied description of General Accessory.
>>General Accessory Type (300A,0423) 3 Specifies the type of accessory. Defined Terms: GRATICULE = Accessory tray with a radio-opaque grid IMAGE_DETECTOR = Image acquisition device positioned in the beam line RETICLE = Accessory tray with radio-transparent markers or grid
>>Accessory Code (300A,00F9) 3 Machine-readable identifier for this accessory
>Number of Range Shifters (300A,0312) 1 Number of range shifters associated with current beam.
>Range Shifter Sequence (300A,0314) 1C Introduces sequence of range shifters associated with Beam. Required if Number of Range Shifters (300A,0312) is non-zero. The number of items shall be identical to the value of Number of Range Shifters (300A,0312).
>>Range Shifter Number (300A,0316) 1 Identification number of the Range Shifter. The value of Range Shifter Number (300A,0316) shall be unique within the Beam in which it is created.
>>Range Shifter ID (300A,0318) 1 User or machine supplied identifier for Range Shifter.
>>Accessory Code (300A,00F9) 3 An accessory identifier to be read by a device such as a bar code reader.
>>Range Shifter Type (300A,0320) 1 Type of Range Shifter. Defined Terms: ANALOG = Device is variable thickness and is composed of opposing sliding wedges, water column or similar mechanism. BINARY = Device is composed of different thickness materials that can be moved in or out of the beam in various stepped combinations.
>>Range Shifter Description (300A,0322) 3 User defined description of Range Shifter.
>Number of Lateral Spreading Devices (300A,0330) 1 Number of lateral spreading devices associated with current beam.
>Lateral Spreading Device Sequence (300A,0332) 1C Introduces sequence of lateral spreading devices associated with Beam. Required if Number of Lateral Spreading Devices (300A,0330) is non-zero. The number of items shall be identical to the value of Number of Lateral Spreading Devices (300A,0330).
>>Lateral Spreading Device Number (300A,0334) 1 Identification number of the Lateral Spreading Device. The value of Lateral Spreading Device Number (300A,0334) shall be unique within the Beam in which it is created.
>>Lateral Spreading Device ID (300A,0336) 1 User or machine supplied identifier for Lateral Spreading Device.
>>Accessory Code (300A,00F9) 3 An accessory identifier to be read by a device such as a bar code reader.
>>Lateral Spreading Device Type (300A,0338) 1 Type of Lateral Spreading Device. Defined Terms: SCATTERER = metal placed into the beam path to scatter charged particles laterally. MAGNET = nozzle configuration of magnet devices to expand beam laterally.
>>Lateral Spreading Device Description (300A,033A) 3 User-defined description for lateral spreading device.
>Number of Range Modulators (300A,0340) 1 Number of range modulators associated with current beam.
>Range Modulator Sequence (300A,0342) 1C Introduces sequence of range modulators associated with Beam. Required if Number of Range Modulators (300A,0340) is non-zero. The number of items shall be identical to the value of Number of Range Modulators (300A,0340).
>>Range Modulator Number (300A,0344) 1 Identification number of the Range Modulator. The value of Range Modulator Number (300A,0344) shall be unique within the Beam in which it is created.
>>Range Modulator ID (300A,0346) 1 User or machine supplied identifier for Range Modulator.
>>Accessory Code (300A,00F9) 3 An accessory identifier to be read by a device such as a bar code reader.
>>Range Modulator Type (300A,0348) 1 Type of Range Modulator. Defined Terms: FIXED = fixed modulation width and weights using ridge filter or constant speed wheel with constant beam current WHL_FIXEDWEIGHTS = selected wheel/track (Range Modulator ID) is spinning at constant speed. Modulation width is adjusted by switching constant beam current on and off at wheel steps indicated by Range Modulator Gating Values. WHL_MODWEIGHTS = selected wheel/track (Range Modulator ID) is spinning at constant speed. Weight per wheel step is adjusted by modulating beam current according to selected Beam Current Modulation ID (300A,034C). Only one item in the Range Modulator Sequence (300A,0342) can have a Range Modulator Type (300A,0348) of WHL_MODWEIGHTS.
>>Range Modulator Description (300A,034A) 3 User-defined description of Range Modulator.
>>Beam Current Modulation ID (300A,034C) 1C User-supplied identifier for the beam current modulation pattern. Required if Range Modulator Type (300A,0348) is WHL_MODWEIGHTS
>Include Patient Support Identification Macro Table C.8.8.28-1
>Fixation Light Azimuthal Angle (300A,0356) 3 Azimuthal angle (degrees) of the fixation light coordinate around IEC BEAM LIMITING DEVICE Y-axis. Used for eye treatments. See section C.8.8.25.6.4.
>Fixation Light Polar Angle (300A,0358) 3 Polar angle (degrees) of the fixation light coordinate. Used for eye treatments. See section C.8.8.25.6.4.
>Final Cumulative Meterset Weight (300A,010E) 1C Value of Cumulative Meterset Weight (300A,0134) for final Control Point in Ion Control Point Sequence (300A,03A8). Required if Cumulative Meterset Weight is non-null in Control Points specified within Ion Control Point Sequence. See section C.8.8.14.1.
>Number of Control Points (300A,0110) 1 Number of control points in Beam. Value shall be greater than or equal to 2.
>Ion Control Point Sequence (300A,03A8) 1 Introduces sequence of machine configurations describing Ion treatment beam. The number of items shall be identical to the value of Number of Control Points (300A,0110). See C.8.8.25.7.
>>Control Point Index (300A,0112) 1 Index of current Control Point, starting at 0 for first Control Point.
>>Cumulative Meterset Weight (300A,0134) 2 Cumulative weight to current control point. Cumulative Meterset Weight for the first item in Control Point Sequence shall always be zero. Cumulative Meterset Weight for the final item in Ion Control Point Sequence shall always be equal to Final Cumulative Meterset Weight.
>>Referenced Dose Reference Sequence (300C,0050) 3 Introduces a sequence of Dose References for current Beam. One or more items are permitted in this sequence.
>>>Referenced Dose Reference Number (300C,0051) 1 Uniquely identifies Dose Reference specified by Dose Reference Number (300A,0012) in Dose Reference Sequence (300A,0010) in RT Prescription Module.
>>>Cumulative Dose Reference Coefficient (300A,010C) 2 Coefficient used to calculate cumulative dose contribution from this Beam to the referenced Dose Reference at the current Control Point.
>>Nominal Beam Energy (300A,0114) 1C Nominal Beam Energy at control point in MeV per nucleon. Defined at nozzle entrance before all Beam Modifiers. Required for first item of Control Point Sequence, or if Nominal Beam Energy changes during Beam, and KVp (0018,0060) is not present.
>>KVp (0018,0060) 1C Peak kilo voltage output of the setup X-Ray generator to be used. Required for first item of Control Point Sequence, or if KVp changes during setup, and Nominal Beam Energy (300A,0114) is not present.
>>Meterset Rate (300A,035A) 3 Specifies the speed of delivery of the specified dose in units specified by Primary Dosimeter Unit (300A,00B3) per minute.
>>Ion Wedge Position Sequence (300A,03AC) 1C Introduces sequence of Wedge positions for current control point. Required for first item of Ion Control Point Sequence if Number of Wedges (300A,00D0) is non-zero, and in subsequent control points if Wedge Position (300A,0118) or Wedge Thin Edge Position (300A,00DB) changes during beam. The number of items shall be identical to the value of Number of Wedges (300A,00D0).
>>>Referenced Wedge Number (300C,00C0) 1 Uniquely references Wedge described by Wedge Number (300A,00D2) in Wedge Sequence (300A,00D1).
>>>Wedge Position (300A,0118) 1 Position of Wedge at current Control Point. Enumerated Values: IN OUT
>>>Wedge Thin Edge Position (300A,00DB) 1C Closest distance from the central axis of the beam along a wedge axis to the thin edge as projected to the machine isocentric plane (mm). Value is positive is the wedge does not cover the central axis, negative if it does. Required if Wedge Type (300A,00D3) of the wedge referenced by Referenced Wedge Number (300C,00C0) is PARTIAL_STANDARD or PARTIAL_MOTORIZ. See section C.8.8.25.6.4.
>>Range Shifter Settings Sequence (300A,0360) 1C Introduces sequence of Range Shifter settings for the current control point. One or more items shall be included in this sequence. Required for first item of Control Point Sequence if Number of Range Shifters (300A,0312) is non-zero, or if Range Shifter Setting (300A,0362) changes during Beam.
>>>Referenced Range Shifter Number (300C,0100) 1 Uniquely references Range Shifter described by Range Shifter Number (300A,0316) in Range Shifter Sequence (300A,0314).
>>>Range Shifter Setting (300A,0362) 1 Machine specific setting attribute for the range shifter. The specific encoding of this value should be documented in a Conformance Statement. See section C.8.8.25.5.
>>>Isocenter to Range Shiffter Distance (300A,0364) 3 Isocenter to downstream edge of range shifter (mm) at current control point. See section C.8.8.25.4
>>>Range Shifter Water Equivalent Thickness (300A,0366) 3 Water equivalent thickness (in mm) of the range shifter at the central axis for the beam energy incident upon the device.
>>Lateral Spreading Device Settings Sequence (300A,0370) 1C Introduces sequence of Lateral Spreading Device settings for the current control point. One or more items shall be included in this sequence. Required for first item of Control Point Sequence if Number of Lateral Spreading Devices (300A,0330) is non-zero, or if Lateral Spreading Device Setting (300A,0372) changes during Beam.
>>>Referenced Lateral Spreading Device Number (300C,0102) 1 Uniquely references Lateral Spreading Device described by Lateral Spreading Device Number (300A,0334) in Lateral Spreading Device Sequence (300A,0332).
>>>Lateral Spreading Device Setting (300A,0372) 1 Machine specific setting attribute for the lateral spreading device. The specific encoding of this value should be documented in a Conformance Statement. See section C.8.8.25.5.
>>>Isocenter to Lateral Spreading Device Distance (300A,0374) 3 Isocenter to downstream edge of Lateral Spreading Device (mm) at current control point. See section C.8.8.25.4
>>>Lateral Spreading Device Water Equivalent Thickness (300A,033C) 3 Water equivalent thickness (in mm) of the lateral spreading device at the central axis for the beam energy incident upon the device.
>>Range Modulator Settings Sequence (300A,0380) 1C Introduces sequence of Range Modulator Settings for current control point. One or more items shall be included in this sequence. Required for first item of Control Point Sequence if Number of Range Modulators (300A,0340) is non-zero, or if Range Modulator Setting changes during Beam.
>>>Referenced Range Modulator Number (300C,0104) 1 Uniquely references Range Modulator described by Range Modulator Number (300A,0344) in Range Modulator Sequence (300A,0342).
>>>Range Modulator Gating Start Value (300A,0382) 1C Start position defines the range modulator position at which the beam is switched on. Required if Range Modulator Type (300A,0348) of the range modulator referenced by Referenced Range Modulator Number (300C,0104) is WHL_MODWEIGHTS or WHL_FIXEDWEIGHTS
>>>Range Modulator Gating Stop Value (300A,0384) 1C Stop position defines the range modulator position at which the beam is switched off. Required if Range Modulator Type (300A,0348) of the range modulator referenced by Referenced Range Modulator Number (300C,0104) is WHL_MODWEIGHTS or WHL_FIXEDWEIGHTS
>>>Range Modulator Gating Start Water Equivalent Thickness (300A,0386) 3 If Range Modulator Type (300A,0348) is WHL_MODWEIGHTS or WHL_FIXEDWEIGHTS: Water equivalent thickness (in mm) of the range modulator at the position specified by Range Modulator Gating Start Value (300A,0382). If Range Modulator Type (300A,0348) is FIXED: Minimum water equivalent thickness (in mm) of the range modulator.
>>>Range Modulator Gating Stop Water Equivalent Thickness (300A,0388) 3 If Range Modulator Type (300A,0348) is WHL_MODWEIGHTS or WHL_FIXEDWEIGHTS: Water equivalent thickness (in mm) of the range modulator at the position specified by Range Modulator Gating Stop Value (300A,0384). If Range Modulator Type (300A,0348) is FIXED: Maximum water equivalent thickness (in mm) of the range modulator.
>>>Isocenter to Range Modulator Distance (300A,038A) 3 Isocenter to downstream edge of range modulator (mm) at current control point. See section C.8.8.25.4
>>Include Beam Limiting Device Position Macro Table C.8.8.27-1
>>Gantry Angle (300A,011E) 1C Gantry angle of radiation source, i.e. orientation of IEC GANTRY coordinate system with respect to IEC FIXED REFERENCE coordinate system (degrees). Required for first item of Control Point Sequence, or if Gantry Angle changes during Beam.
>>Gantry Rotation Direction (300A,011F) 1C Direction of Gantry Rotation when viewing gantry from isocenter, for segment following Control Point. Required for first item of Control Point Sequence, or if Gantry Rotation Direction changes during Beam. See section C.8.8.14.8. Enumerated Values: CW = clockwise CC = counter-clockwise NONE = no rotation
>>Gantry Pitch Angle (300A,014A) 2C Gantry Pitch Angle of the radiation source, i.e. the rotation of the IEC GANTRY coordinate system about the X-axis of the IEC GANTRY coordinate system (degrees). Required for first item of Control Point Sequence, or if Gantry Pitch Rotation Angle changes during Beam. See C.8.8.25.6.5.
>>Gantry Pitch Rotation Direction (300A,014C) 2C Direction of Gantry Pitch Angle when viewing along the positive X-axis of the IEC GANTRY coordinate system, for segment following Control Point. Required for first item of Control Point Sequence, or if Gantry Pitch Rotation Direction changes during Beam. See C.8.8.14.8 and C.8.8.25.6.5. Enumerated Values: CW = clockwise CC = counter-clockwise NONE = no rotation
>>Beam Limiting Device Angle (300A,0120) 1C Beam Limiting Device angle, i.e. orientation of IEC BEAM LIMITING DEVICE coordinate system with respect to IEC GANTRY coordinate system (degrees). Required for first item of Control Point Sequence, or if Beam Limiting Device Angle changes during Beam.
>>Beam Limiting Device Rotation Direction (300A,0121) 1C Direction of Beam Limiting Device Rotation when viewing beam limiting device (collimator) from radiation source, for segment following Control Point. Required for first item of Control Point Sequence, or if Beam Limiting Device Rotation Direction changes during Beam. See section C.8.8.14.8. Enumerated Values: CW = clockwise CC = counter-clockwise NONE = no rotation
>>Scan Spot Tune ID (300A,0390) 1C User-supplied or machine code identifier for machine configuration to produce beam spot. This may be the nominal spot size or some other machine specific value. Required if Scan Mode (300A,0308) is MODULATED.
>>Number of Scan Spot Positions (300A,0392) 1C Number of spot positions used to specify scanning pattern for current segment beginning at control point. Required if Scan Mode (300A,0308) is MODULATED.
>>Scan Spot Position Map (300A,0394) 1C The x and y coordinates of the scan spots are defined as projected onto the machine isocentric plane in the IEC GANTRY coordinate system (mm). Required if Scan Mode (300A,0308) is MODULATED. Contains 2N values where N is the Number of Scan Spot Positions (300A,0392).
>>Scan Spot Meterset Weights (300A,0396) 1C A data set of meterset weights corresponding to scan spot positions. The order of weights matches the positions in Scan Spot Positions (300A,0394). The sum contained in all meterset weights shall match the difference of the cumulative meterset weight of the current control point to the following control point. Required if Scan Mode (300A,0308) is MODULATED.
>>Scanning Spot Size (300A,0398) 3 The Scanning Spot Size as calculated using the Full Width Half Maximum (FWHM). Specified by a numeric pair - the size measured in air at isocenter in IEC GANTRY X direction followed by the size in the IEC GANTRY Y direction (mm).
>>Number of Paintings (300A,039A) 1C The number of times the scan pattern given by Scan Spot Position Map (300A,0394) and Scan Spot Meterset Weights (300A,0396) shall be applied at the current control point. To obtain the meterset weight per painting, the values in the Scan Spot Meterset Weights (300A,0396) should be divided by the value of this attribute. Required if Scan Mode (300A,0308) is MODULATED.
>>Patient Support Angle (300A,0122) 1C Patient Support angle, i.e. orientation of IEC PATIENT SUPPORT (turntable) coordinate system with respect to IEC FIXED REFERENCE coordinate system (degrees). Required for first item of Control Point Sequence, or if Patient Support Angle changes during Beam.
>>Patient Support Rotation Direction (300A,0123) 1C Direction of Patient Support Rotation when viewing table from above, for segment following Control Point. Required for first item of Control Point Sequence, or if Patient Support Rotation Direction changes during Beam. See section C.8.8.14.8. Enumerated Values: CW = clockwise CC = counter-clockwise NONE = no rotation
>>Table Top Pitch Angle (300A,0140) 2C Table Top Pitch Angle, i.e. the rotation of the IEC TABLE TOP coordinate system about the X-axis of the IEC TABLE TOP coordinate system (degrees). Required for first item of Control Point Sequence, or if Table Top Pitch Angle changes during Beam. See section C.8.8.25.6.2.
>>Table Top Pitch Rotation Direction (300A,0142) 2C Direction of Table Top Pitch Rotation when viewing the table along the positive X-axis of the IEC TABLE TOP coordinate system, for segment following Control Point. Required for first item of Control Point Sequence, or if Table Top Pitch Rotation Direction changes during Beam. See C.8.8.14.8 and C.8.8.25.6.2. Enumerated Values: CW = clockwise CC = counter-clockwise NONE = no rotation
>>Table Top Roll Angle (300A,0144) 2C Table Top Roll Angle, i.e. the rotation of the IEC TABLE TOP coordinate system about the Y-axis of the IEC TABLE TOP coordinate system (degrees). Required for first item of Control Point Sequence, or if Table Top Roll Angle changes during Beam. See section C.8.8.25.6.2.
>>Table Top Roll Rotation Direction (300A,0146) 2C Direction of Table Top Roll Rotation when viewing the table along the positive Y-axis of the IEC TABLE TOP coordinate system, for segment following Control Point. Required for first item of Control Point Sequence, or if Table Top Roll Rotation Direction changes during Beam. See C.8.8.14.8 and C.8.8.25.6.2. Enumerated Values: CW = clockwise CC = counter-clockwise NONE = no rotation.
>>Head Fixation Angle (300A,0148) 3 Angle (in degrees) of the head fixation for eye treatments with respect to the Table Top Pitch Angle (300A,0140) coordinate system. Positive head fixation angle is the same direction as positive Table Top pitch. See section C.8.8.25.6.4.
>>Table Top Vertical Position (300A,0128) 2C Table Top Vertical position in IEC TABLE TOP coordinate system (mm). Required for first item of Control Point Sequence, or if Table Top Vertical Position changes during Beam. See section C.8.8.14.6.
>>Table Top Longitudinal Position (300A,0129) 2C Table Top Longitudinal position in IEC TABLE TOP coordinate system (mm). Required for first item of Control Point Sequence, or if Table Top Longitudinal Position changes during Beam. See section C.8.8.14.6.
>>Table Top Lateral Position (300A,012A) 2C Table Top Lateral position in IEC TABLE TOP coordinate system (mm). Required for first item of Control Point Sequence, or if Table Top Lateral Position changes during Beam. See section C.8.8.14.6.
>>Snout Position (300A,030D) 2C Axial position of the snout (in mm) measured from isocenter to the downstream side of the snout (without consideration of variable length elements such as blocks, MLC and/or compensators). Required for first item in Control Point Sequence, or if Snout Position changes during Beam.
>>Isocenter Position (300A,012C) 2C Isocenter coordinates (x,y,z) in the patient based coordinate system described in C.7.6.2.1.1 (mm). Required for first item of Segment Control Point Sequence, or if Segment Isocenter Position changes during Beam.
>>Surface Entry Point (300A,012E) 3 Patient surface entry point coordinates (x,y,z), along the central axis of the beam, in the patient based coordinate system described in C.7.6.2.1.1 (mm).

C.8.8.25.1 Beam Identifying Information

Beam Number (300A,00C0) is provided to link related information across modules, and its value has no real-world interpretation. Beam Name (300A,00C2), a Type 1 attribute, is intended to store the primary beam identifier (often referred to as “Field ID”). Beam Description (300A,00C3), a Type 3 attribute, is intended to store additional beam identifying information (often referred to as “Field Name”).

C.8.8.25.2 Treatment Machine Name

The DICOM standard does not support the transmission of treatment unit modeling information such as depth doses and beam profiles. In the case of Ion therapy, the Treatment Machine Name attribute is used to uniquely identify a treatment port (or beam line), since there is in effect only one treatment machine (i.e. synchrotron).

C.8.8.25.3 Leaf Position Boundaries

The Leaf Position Boundaries (300A,00BE) shall be the positions of the mechanical boundaries (projected to the isocentric plane) between beam limiting device (collimator) leaves, fixed for a given beam limiting device (collimator). Leaf/Jaw positions (300A,011C) are values specific to a given control point, specifying the beam limiting device (collimator) leaf (element) openings.

In an RT Ion Plan, the Virtual SAD can have different values along the X/Y axes (see C.8.8.25.4). Thus the effects of possibly different X/Y SADs shall be taken into account when leaf position boundaries and leaf/jaw positions are projected from the virtual source to the plane of isocenter.

Leaf Position Boundaries (300A,00BE), are outside the control point sequence, which may define a collimator rotation. Therefore their values shall be defined for a collimator angle of 0 Deg IEC nominal position). For rotated collimators, the leaf position calculation is as follows: Define M x and M y as the magnification factors for the scaling of the leaf positions from their real space position to the isocenter plane. M x and M y are calculated from the virtual SADs VSAD x or VSAD y , respectively, and the Isocenter to Beam Limiting Device Distance (300A,00BB).

[pic]

The magnification factor M α for an arbitrary beam limiting device angle ( then becomes:

[pic]

The Snout Position (300A,030D) may be changed between beams, and possibly between control points as well. This results in different effective isocenter to beam limiting device distances and thus leaf position boundaries for the same physical beam limiting device for each beam and possibly control points.

The values for Beam Limiting Device Distances (300A,00BB) and Leaf Position Boundaries (300A,00BE) are defined outside the control point sequence. Therefore the Isocenter to Beam Limiting Device Distance (300A,00BB) and the Leaf Position Boundaries (300A,00BE) shall be defined to apply to the first control point of the respective beam. If the snout position changes for subsequent control points, this must be taken into account for the projection of the leaf/jaw positions (i.e. replace IsocenterToBeamLimitingDeviceDistance in the above formula by the effective distance as calculated from the shift in snout position).

C.8.8.25.4 Virtual Source-Axis Distances and the use of trays in ion therapy

The apparent source position in ion therapy is not constant or can be different in x or y direction. The apparent source position (as measured from field size projections) shall be called Virtual Source, the distance from the virtual source to isocenter the Virtual SAD.

Most of the cases, no trays are used for blocks, compensators and wedges. However, the concept of trays together with the mounting position is useful for specifying exactly at which point the position of these devices shall be measured. Therefore, trays shall always be sent, even though they are only virtual trays.

Figure C.8.8.25-1 shows an example.

[pic]

Figure C.8.8.25-1 Virtual Source-Axis Distances

Examples: The use of the above attributes for snout positioning and block/compensator manufacturing:

a.) Snout positioning:

The mounting positions as depicted in the drawing are only examples. As the block tray does not really exist in most of the cases, it is only used as a reference position. As some machines use the downstream face of the block as a reference position for their snout positioning, it could make sense to define for example that the block mounting position must be SOURCE_SIDE. In this case, one uses the downstream face of the block as the reference position, which is the same side as used by the machine. This definition is always independent of the actual thickness of the block. The Isocenter-Block Distance is defined and the machine can deduce the position of the snout from this value.

b.) Scaling of block/compensator data for manufacturing

The Isocenter position is always used as the reference position for all distances measured ‘from isocenter’. Real size block and compensator manufacturing should be based on the distance from the Virtual Source (X/Y) to the device, i.e. VirtualSourceToDeviceDistance = VirtualSAD - IsocenterToDeviceDistance.

C.8.8.25.5 Range Shifter and Lateral Spreading Device Settings

The Range Shifter and Lateral Spreading Device Settings attributes are used to capture machine specific values related to these devices. For example, some machines may specify the Range Shifter setting as the desired Water-Equivalent Thickness (in mm). Others contain a series of interchangeable plates, whose position in or out of the beam is specified by a series of ones and zeros (i.e. 100010 would specify that plates #1 and #5 are in the beam. If the device does not a specific setting, but rather is defined by the ID, then the enumerated values IN/OUT shall be used for the setting.

C.8.8.25.6 Coordinate Systems

Where explicitly specified, the coordinate systems defined by IEC 61217 shall be applied, with the exception of the IEC Patient Coordinate System.

In addition, the following sections define the coordinate systems to be used in situations where IEC 61217 coordinate systems are not applicable. No other coordinate systems shall be used.

C.8.8.25.6.1 Fixed Beam Line

The direction of fixed beam-line can be described as a gantry system, provided that the position of the (virtual) gantry bearing is defined. The relation between their patient support coordinate system axes and the choice of the ‘gantry’ angle, e.g. 90 or 270 deg, shall be consistent with a standard gantry coordinate system. All coordinate systems derived from the IEC GANTRY coordinate system (BEAM LIMITING DEVICE, WEDGE, X-RAY IMAGE RECEPTOR) automatically follow in the same way as defined in a ‘real’ gantry system.

The IEC PATIENT SUPPORT system is linked to the IEC GANTRY coordinate system through its common parent system, the IEC FIXED coordinate system. The Y-axis of IEC GANTRY points towards the (virtual) gantry bearing. The Y-axis of the IEC FIXED coordinate system has to point in the same direction. Z-axis in IEC FIXED coordinate system is always pointing upwards. With Y and Z-axes defined, the X-axis of IEC FIXED is also given.

Figure C.8.8.25-2 shows IEC FIXED (F), GANTRY (G) and PATIENT SUPPORT (S) coordinate systems for a horizontal fixed beam-line.

[pic]

Figure C.8.8.25-2 Fixed Beam Line

C.8.8.25.6.2 Table Top Pitch and Table Top Roll

Pitch and Roll Coordinate Systems of the Table Top are not defined in IEC 61217. These angles are defined in the DICOM standard in a way compatible with the current notion of IEC by introducing them as rotations of the IEC Table Top System as indicated below.

The Table Top Pitch Angle is defined as the rotation of the coordinate axes Yt, Zt about axis Xt by an angle (t; see Figure C.8.8.25-3. An increase in the value of angle (t corresponds to the clockwise rotation of the Table Top as viewed from the Table Top coordinate system origin along the positive Xt axis.

The Table Top Roll Angle is defined as the rotation of the coordinate axes Xt, Zt about axis Yt by an angle (t; see Figure C.8.8.25-4. An increase in the value of angle (t corresponds to the clockwise rotation of the Table Top as viewed from the Table Top coordinate system origin along the positive Yt axis.

[pic]

Figure C.8.8.25-3 Table Top Pitch Angle

[pic]

Figure C.8.8.25-4 Table Top Roll Angle

C.8.8.25.6.3 Seated Treatments

RT Ion Plan contains an attribute Patient Support Type (300A,0350), which can be CHAIR or TABLE. The patient support type CHAIR does not change the coordinate axes of the patient support coordinate systems relative to their parent systems. It is more an attribute of the type like the patient position in imaging (i.e. HFS, HFP, …).

The orientation of the treatment chair shall be defined with the chair positioned in such way, that the patient looks towards the gantry bearing (or along the Y axis of the IEC FIXED system) if all angles, especially IEC PATIENT SUPPORT angle are 0(. All other parameters follow straight forward, once this definition is accepted. I.e. chair rotation is a rotation of IEC PATIENT SUPPORT coordinate system; a backward tilt of the chair is a positive rotation of the PITCHED TABLE TOP coordinate system. A translation of the chair is a translation of the IEC TABLE TOP system.

The roll angle is typically 0º.

For a seated treatment on a horizontal beam-line, the following angles are therefore defined:If IEC GANTRY angle is 90º (270º), IEC PATIENT SUPPORT angle is 270º (90º) for the position where the patient looks into the beam port.

C.8.8.25.6.4 Ocular Treatments

C.8.8.25.6.4.1 Gantry Beam Line

Eye treatments on the gantry shall use all existing IEC coordinate systems with their standard definition. This applies especially to IEC BEAM LIMITING DEVICE, IEC WEDGE FILTER, IEC X-RAY IMAGE RECEPTOR.

IEC PATIENT SUPPORT, and IEC TABLE TOP coordinate systems are defined as above. Additionally, a rotation of the head fixation device is possible. The Head Fixation Angle (300A,0148) shall be defined as the angle of the head fixation device with respect to the TABLE TOP coordinate system. Positive head fixation angle is in the same direction as positive PATIENT SUPPORT pitch, i.e. backwards.

Proton eye treatments require an additional coordinate system for the placement of the fixation light. Since it is usually mounted onto the beam port the ‘natural’ coordinate system for devices mounted there is the IEC BEAM LIMITING DEVICE coordinate system. The angles for the fixation light positions shall therefore be defined as follows:

Rotation of the fixation light about the IEC BEAM LIMITING DEVICE Z-axis (Zb) is defined as Azimuthal Angle. The Azimuthal Angle is equal to 0( when the fixation light is positioned on the axis Xb of the IEC BEAM LIMITING DEVICE coordinate system. An increase in the value of the Azimuthal Angle corresponds to clockwise rotation of the fixation light as view along the axis Zb towards the virtual source.

The polar angle is always positive and defined as the angle between IEC BEAM LIMITING DEVICE Z-axis and the line connecting isocenter with the fixation light position.

Proton eye treatments require the wedge thin edge position as one additional. The wedge thin edge position allows the specification of a wedge, which does not cover the full open field. The wedge thin edge position is positive, if the wedge does not cover the isocenter position and negative, if it does cover.

Figures C.8.8.25-5 and C.8.8.25-6 show the angles and attributes as described above.

[pic]

Figure C.8.8.25-5 Patient’s eye view

[pic]

Figure C.8.8.25-6 Lateral view along the positive axis Xb

C.8.8.25.6.4.2 Fixed Beam Line

The coordinate systems for the treatment chair are defined above and shall also be applied to seated eye treatments.

In this case, it is recommended that a beam limiting device angle of 90º be formally applied (provided the gantry angle is defined to be 90º (and not 270º). This results in the same coordinates of the fixation light and wedge relative to the patient as in the treatment situation with the patient lying on the table.

C.8.8.25.6.5 Gantry Pitch Angle

The Gantry Pitch angle is not defined in IEC 61217. This angle is defined in the DICOM standard in a way compatible with the current notion of IEC by introducing it as rotation of the IEC GANTRY System as indicated below.

The Gantry Pitch Angle is defined as the rotation of the coordinate axes Yg, Zg about axis Xg by an angle (g; see Figure C.8.8.25-7. An increase in the value of angle (g corresponds to the clockwise rotation as viewed from the isocenter along the positive Xg axis

[pic]

Figure C.8.8.25-7 Gantry Pitch Angle

C.8.8.25.7 Ion Control Point Sequence

The control point sequence for RT Ion Beams is defined using the same rule set as in the RT Beams module (see Section C.8.8.14.5 Control Point Sequence). Specifically, the following rules apply:

This definition allows unambigous and explicit determination of those parameters changing while irradation is occuring, as opposed to those parameters that change between irradiation segments. No assumptions are made about the behavior of machine parameters between specified control points, and communicating devices shall agree on this behavior outside the standard.

The following example illustrates this rule (not all parameters are shown), in the case of a scanning beam with 2 segments and Total Cumulative Meterset of 70.

Control Point 0: All applicable treatment parameters defined, Cumulative Meterset Weight = 0Nominal Energy: 200Scan Spot Position Map: -40, -35, -40, -30 (Positions for 1 st segment)Scan Spot Meterset Weight: 0.5, 0.3, 1.2, (Values add up to meterset difference between Control Points 0 and 1)

Control Point 1: All applicable treatment parameters defined, Cumulative Meterset Weight = 30.0Nominal Energy: 200Scan Spot Position Map: -40, -35, -40, -30 (Positions for 1 st segment)Scan Spot Meterset Weight: 0.0, 0.0, 0.0, … (All values are 0.0, because Meterset Weight difference betweeen Control Point 1 and 2 is 0.0)

Control Point 2: All applicable treatment parameters defined, Cumulative Meterset Weight = 30.0Nominal Energy: 180Scan Spot Position Map: -55, -40, -55, -35, (Positions for 2 nd segment)Spot Meterset Weight: 0.7, 0.8, 1.5 (Values add up to meterset difference between Control Points 2 and 3)

Control Point 3: All applicable treatment parameters defined, Cumulative Meterset Weight = 70.0Nominal Energy: 180Scan Spot Position Map: -55, -40, -55, -35, (Positions for 2 nd segment) Spot Meterset Weight: 0.0, 0.0, 0.0, (All values are 0.0, because there is no following control point (end of sequence).

C.8.8.26 RT Ion Beams Session Record Module

Table C.8.8.26-1 specifies the Attributes that describe the measured and recorded settings aquired during Ion Radiation Treatments.

Table C.8.8.26-1RT ION BEAMS SESSION RECORD MODULE ATTRIBUTES

Attribute Name Tag Type Description
Referenced Fraction Group Number (300C,0022) 3 Identifier of fraction group within referenced RT Ion Plan.
Number of Fractions Planned (300A,0078) 2 Total number of treatments (fractions) planned for current fraction group.
Primary Dosimeter Unit (300A,00B3) 1 Measurement unit of the machine dosimeter. Enumerated Values: MU = Monitor Units NP = Number of Particles
Treatment Session Ion Beam Sequence (3008,0021) 1 Introduces sequence of setup and/or treatment beams administered during treatment session. One or more items shall be included in this sequence.
>Referenced Beam Number (300C,0006) 1 References Beam specified by Beam Number (300A,00C0) in Ion Beam Sequence (300A,03A2) in RT Ion Beams Module within the referenced RT Ion Plan.
>Beam Name (300A,00C2) 1 User-defined name for Beam. See section C.8.8.25.1.
>Beam Description (300A,00C3) 3 User-defined description for Beam. See section C.8.8.25.1.
>Beam Type (300A,00C4) 1 Motion characteristic of Beam. Enumerated Values: STATIC = all beam parameters remain unchanged during delivery DYNAMIC = one or more beam parameters changes during delivery
>Radiation Type (300A,00C6) 1 Particle type of Beam. Defined Terms: PHOTON PROTON ION
>Radiation Mass Number (300A,0302) 1C Mass number of radiation. Required if Radiation Type (300A,00C6) is ION
>Radiation Atomic Number (300A,0304) 1C Atomic number of radiation. Required if Radiation Type (300A,00C6) is ION
>Radiation Charge State (300A,0306) 1C Charge state of radiation. Required if Radiation Type (300A,00C6) is ION
>Scan Mode (300A,0308) 1 The method of beam scanning used during treatment. Defined Terms: NONE = No beam scanning is performed. UNIFORM = The beam is scanned between control points to create a uniform lateral fluence distribution across the field. MODULATED = The beam is scanned between control points to create a modulated lateral fluence distribution across the field.
>Referenced Tolerance Table Number (300C,00A0) 3 Uniquely identifies Ion Tolerance Table specified by Tolerance Table Number (300A,0042) within Ion Tolerance Table Sequence in RT Ion Tolerance Tables Module. These tolerances are to be used for verification of treatment machine settings.
>Beam Limiting Device Leaf Pairs Sequence (3008,00A0) 3 Introduces sequence of beam limiting device (collimator) jaw or leaf (element) sets. One or more items are permitted in this sequence.
>>RT Beam Limiting Device Type (300A,00B8) 1 Type of beam limiting device (collimator). Enumerated Values: X = symmetric jaw pair in IEC X direction Y = symmetric jaw pair in IEC Y direction ASYMX = asymmetric jaw pair in IEC X direction ASYMY = asymmetric pair in IEC Y direction MLCX = multileaf (multi-element) jaw pair in IEC X direction MLCY = multileaf (multi-element) jaw pair in IEC Y direction
>>Number of Leaf/Jaw Pairs (300A,00BC) 1 Number of leaf (element) or jaw pairs (equal to 1 for standard beam limiting device jaws).
>Referenced Patient Setup Number (300C,006A) 3 Uniquely identifies Ion Patient Setup to be used for current beam, specified by Patient Setup Number (300A,0182) within Patient Setup Sequence of RT Patient Setup Module.
>Referenced Verification Image Sequence (300C,0040) 3 Introduces sequence of verification images obtained during delivery of current beam. One or more items are permitted in this sequence. See C.8.8.14.2.
>>Include SOP Instance Reference Macro Table 10-11
>Referenced Measured Dose Reference Sequence (3008,0080) 3 Introduces sequence of doses measured during treatment delivery for current Beam. One or more Items are permitted in this sequence.
>>Referenced Dose Reference Number (300C,0051) 1C Uniquely references Dose Reference specified by Dose Reference Number (300A,0012) in Dose Reference Sequence (300A,0010) in RT Prescription Module of referenced RT Ion Plan. Required if Referenced Measured Dose Reference Number (3008,0082) is not sent.
>>Referenced Measured Dose Reference Number (3008,0082) 1C Uniquely references Measured Dose Reference specified by Measured Dose Reference Number (3008,0064) in Measured Dose Reference Sequence (3008,0010). Required if Referenced Dose Reference Number (300C,0051) is not sent.
>>Measured Dose Value (3008,0016) 1 Measured Dose in units specified by Dose Units (3004,0002) in sequence referenced by Measured Dose Reference Sequence (3008,0010) or Dose Reference Sequence (300A,0010) in RT Prescription Module of Referenced RT Ion Plan as defined above.
>Referenced Calculated Dose Reference Sequence (3008,0090) 3 Introduces sequence of doses estimated for each treatment delivery. One or more Items are permitted in this sequence.
>>Referenced Dose Reference Number (300C,0051) 1C Uniquely identifies Dose Reference specified by Dose Reference Number (300A,0012) in Dose Reference Sequence (300A,0010) in RT Prescription Module of referenced RT Ion Plan. Required if Referenced Calculated Dose Reference Number (3008,0092) is not sent.
>>Referenced Calculated Dose Reference Number (3008,0092) 1C Uniquely identifies Calculated Dose Reference specified by Calculated Dose Reference Number (3008,0072) within Calculated Dose Reference Sequence (3008,0070). Required if Referenced Dose Reference Number (300C,0051) is not sent.
>>Calculated Dose Reference Dose Value (3008,0076) 1 Calculated Dose (Gy).
>Number of Wedges (300A,00D0) 1 Number of wedges associated with current beam.
>Recorded Wedge Sequence (3008,00B0) 1C Introduces sequence of treatment wedges. Required if Number of Wedges (300A,00D0) is non-zero. One or more items shall be included in this sequence. The number of items shall be identical to the value of Number of Wedges (300A,00D0).
>>Wedge Number (300A,00D2) 1 Identification number of the Wedges. The value of Wedge Number (300A,00D2) shall be unique within the Beam in which it was created.
>>Wedge Type (300A,00D3) 2 Type of wedge (if any) defined for Beam. Defined Terms: STANDARD = standard (static) wedge MOTORIZED = single wedge that can be removed from beam remotely. PARTIAL_STANDARD = wedge does not extend across the whole field and is operated manually. PARTIAL_MOTORIZ = wedge does not extend across the whole field and can be removed from beam remotely.
>>Wedge ID (300A,00D4) 3 User-supplied identifier for Wedge.
>>Accessory Code (300A,00F9) 3 An accessory identifier to be read by a device such as a bar code reader.
>>Wedge Angle (300A,00D5) 2 Nominal wedge angle (degrees).
>>Wedge Orientation (300A,00D8) 2 Orientation of wedge, i.e. orientation of IEC WEDGE FILTER coordinate system with respect to the IEC BEAM LIMITING DEVICE coordinate systems (degrees).
>Number of Compensators (300A,00E0) 1 Number of range compensators associated with current Beam.
>Recorded Compensator Sequence (3008,00C0) 1C Introduces sequence of treatment compensators. Required if Number of Compensators (300A,00E0) is non-zero. One or more items shall be included in this sequence. The number of items shall be identical to the value of Number of Compensators (300A,00E0).
>>Referenced Compensator Number (300C,00D0) 1 Uniquely identifies compensator specified by Compensator Number (300A,00E4) within Beam referenced by Referenced Beam Number (300C,0006).
>>Compensator ID (300A,00E5) 3 User-supplied identifier for compensator.
>>Accessory Code (300A,00F9) 3 An accessory identifier to be read by a device such as a bar code reader.
>Number of Boli (300A,00ED) 1 Number of boli associated with current Beam.
>Referenced Bolus Sequence (300C,00B0) 1C Introduces sequence of boli associated with Beam. Required if Number of Boli (300A,00ED) is non-zero. One or more items shall be included in this sequence. The number of items shall be identical to the value of Number of Boli (300A,00ED).
>>Referenced ROI Number (3006,0084) 1 Uniquely identifies ROI representing the Bolus specified by ROI Number (3006,0022) in Structure Set ROI Sequence (3006,0020) in Structure Set Module within RT Structure Set in Referenced Structure Set Sequence (300C,0060) in RT General Plan Module.
>>Accessory Code (300A,00F9) 3 An accessory identifier to be read by a device such as a bar code reader.
>Number of Blocks (300A,00F0) 1 Number of shielding blocks associated with Beam.
>Recorded Block Sequence (3008,00D0) 1C Introduces sequence of blocks associated with Beam. Required if Number of Blocks (300A,00F0) is non-zero. One or more items shall be included in this sequence. The number of items shall be identical to the value of Number of Blocks (300A,00F0).
>>Block Tray ID (300A,00F5) 3 User-supplied identifier for block tray.
>>Accessory Code (300A,00F9) 3 An accessory identifier to be read by a device such as a bar code reader.
>>Referenced Block Number (300C,00E0) 1 Uniquely identifies block specified by Block Number (300A,00FC) within Beam referenced by Referenced Beam Number (300C,0006).
>>Block Name (300A,00FE) 3 User-defined name for block.
>Recorded Snout Sequence (3008,00F0) 1C Introduces sequence of Snouts associated with Beam. Required if Snout Sequence (300A,030C) is included in the RT Ion Plan referenced within the Referenced RT Plan Sequence (300C,0002). Only a single item shall be included in this sequence.
>>Snout ID (300A,030F) 1 User or machine supplied identifier for Snout.
>>Accessory Code (300A,00F9) 3 An accessory identifier to be read by a device such as a bar code reader.
>Applicator Sequence (300A,0107) 1C Introduces sequence of Applicators associated with Beam. Required if Applicator Sequence (300A,0107) is included in the RT Ion Plan referenced within the Referenced RT Plan Sequence (300C,0002). Only a single item shall be included in this sequence.
>>Applicator ID (300A,0108) 1 User or machine supplied identifier for Applicator.
>>Accessory Code (300A,00F9) 3 An accessory identifier to be read by a device such as a bar code reader.
>>Applicator Type (300A,0109) 1 Type of applicator. Defined Terms: ION_SQUARE = square ion applicator ION_RECT = rectangluar ion applicator ION_CIRC = circular ion applicator ION_SHORT = short ion applicator ION_OPEN = open (dummy) ion applicator INTEROPERATIVE = interoperative (custom) applicator STEREOTACTIC = stereotactic applicator
>>Applicator Description (300A,010A) 3 User-defined description for Applicator.
>General Accessory Sequence (300A,0420) 3 Introduces a Sequence of General Accessories associated with this Beam. One or more items are permitted in this sequence.
>>General Accessory Number (300A,0424) 1 Identification Number of the General Accessory. The value shall be unique within the sequence.
>>General Accessory ID (300A,0421) 1 User or machine supplied identifier for General Accessory.
>>General Accessory Description (300A,0422) 3 User supplied description of General Accessory.
>>General Accessory Type (300A,0423) 3 Specifies the type of accessory. Defined Terms: GRATICULE = Accessory tray with a radio-opaque grid IMAGE_DETECTOR = Image acquisition device positioned in the beam line RETICLE = Accessory tray with radio-transparent markers or grid
>>Accessory Code (300A,00F9) 3 Machine-readable identifier for this accessory
>Number of Range Shifters (300A,0312) 1 Number of range shifters associated with current beam.
>Recorded Range Shifter Sequence (3008,00F2) 1C Introduces sequence of range shifters recorded with Beam. Required if Number of Range Shifters (300A,0312) is non-zero. One or more items shall be included in this sequence. The number of items shall be identical to the value of Number of Range Shifters (300A,0312).
>>Referenced Range Shifter Number (300C,0100) 1 Uniquely identifies range shifter specified by Range Shifter Number (300A,0316) within Beam referenced by Referenced Beam Number (300C,0006).
>>Range Shifter ID (300A,0318) 1 User or machine supplied identifier for Range Modulator.
>>Accessory Code (300A,00F9) 3 An accessory identifier to be read by a device such as a bar code reader.
>Number of Lateral Spreading Devices (300A,0330) 1 Number of lateral spreading devices associated with current beam.
>Recorded Lateral Spreading Device Sequence (3008,00F4) 1C Introduces sequence of lateral spreading devices associated with Beam. Required if Number of Lateral Spreading Devices (300A,0330) is non-zero. One or more items shall be included in this sequence. The number of items shall be identical to the value of Number of Lateral Spreading Devices (300A,0330).
>>Referenced Lateral Spreading Device Number (300C,0102) 1 Uniquely identifies lateral spreading device specified by Lateral Spreading Device Number (300A,0334) within Beam referenced by Referenced Beam Number (300C,0006).
>>Lateral Spreading Device ID (300A,0336) 1 User or machine supplied identifier for Lateral Spreading Device.
>>Accessory Code (300A,00F9) 3 An accessory identifier to be read by a device such as a bar code reader.
>Number of Range Modulators (300A,0340) 1 Number of range modulators associated with current beam.
>Recorded Range Modulator Sequence (3008,00F6) 1C Introduces sequence of range modulators associated with Beam. Required if Number of Range Modulators (300A,0340) is non-zero. One or more items shall be included in this sequence. The number of items shall be identical to the value of Number of Range Modulators (300A,0340).
>>Referenced Range Modulator Number (300C,0104) 1 Uniquely identifies range modulator specified by Range Modulator Number (300A,0344) within Beam referenced by Referenced Beam Number (300C,0006).
>>Range Modulator ID (300A,0346) 1 User or machine supplied identifier for Range Modulator.
>>Accessory Code (300A,00F9) 3 An accessory identifier to be read by a device such as a bar code reader.
>>Range Modulator Type (300A,0348) 1 Type of Range Modulator. Defined Terms: FIXED = fixed modulation width and weights using ridge filter or constant speed wheel with constant beam current WHL_FIXEDWEIGHTS = selected wheel/track (Range Modulator ID) is spinning at constant speed. Modulation width is adjusted by switching constant beam current on and off at wheel steps indicated by Range Modulator Interrupt Values WHL_MODWEIGHTS = selected wheel/track (Range Modulator ID) is spinning at constant speed. Weight per wheel step is adjusted by modulating beam current according to selected Beam Current Modulation ID (300A,034C) Only one item in the Recorded Range Modulator Sequence (3008,00F6) can have a Range Modulator Type (300A,0348) of WHL_MODWEIGHTS.
>>Beam Current Modulation ID (300A,034C) 1C User-supplied identifier for the beam current modulation pattern. Required if Range Modulator Type (300A,0348) is WHL_MODWEIGHTS
>Include Patient Support Identification Macro Table C.8.8.28-1
>Fixation Light Azimuthal Angle (300A,0356) 3 Azimuthal angle (degrees) of the fixation light coordinate around IEC PATIENT SUPPORT Y-axis. Used for eye treatments. See section C.8.8.25.6.4.
>Fixation Light Polar Angle (300A,0358) 3 Polar angle (degrees) of the fixation light coordinate. Used for eye treatments. See section C.8.8.25.6.4.
>Current Fraction Number (3008,0022) 2 Fraction number for this beam administration.
>Treatment Delivery Type (300A,00CE) 2 Delivery Type of treatment. Defined Terms: TREATMENT = normal patient treatment OPEN_PORTFILM = portal image acquisition with open field (the source of radiation is specified by Radiation Type (300A,00C6)) TRMT_PORTFILM = portal image acquisition with treatment port (the source of radiation is specified by Radiation Type (300A,00C6)) CONTINUATION = continuation of interrupted treatment SETUP = no treatment beam was applied for this RT Beam. To be used for specifying the gantry, couch, and other machine positions where X-Ray set-up images or measurements were taken VERIFICATION = Treatment used for Quality Assurance rather than patient treatment
>Treatment Termination Status (3008,002A) 1 Conditions under which treatment was terminated. Enumerated Values: NORMAL = treatment terminated normally OPERATOR = operator terminated treatment MACHINE = machine terminated treatment UNKNOWN = status at termination unknown
>Treatment Termination Code (3008,002B) 3 Treatment machine termination code. This code is dependent upon the particular application and equipment.
>Treatment Verification Status (3008,002C) 2 Conditions under which treatment was verified by a verification system. Enumerated Values: VERIFIED = treatment verified VERIFIED_OVR = treatment verified with at least one out-of-range value overridden NOT_VERIFIED = treatment verified manually
>Specified Primary Meterset (3008,0032) 3 Desired machine setting of primary meterset in units specified by Primary Dosimeter Unit (300A,00B3). See C.8.8.26.1.
>Specified Secondary Meterset (3008,0033) 3 Desired machine setting of secondary meterset. See C.8.8.26.1.
>Delivered Primary Meterset (3008,0036) 3 Machine setting actually delivered as recorded by primary meterset in units specified by Primary Dosimeter Unit (300A,00B3). See C.8.8.26.1.
>Delivered Secondary Meterset (3008,0037) 3 Machine setting actually delivered as recorded by secondary meterset. See C.8.8.26.1.
>Specified Treatment Time (3008,003A) 3 Treatment Time set (sec).
>Delivered Treatment Time (3008,003B) 3 Treatment Time actually delivered (sec).
>Number of Control Points (300A,0110) 1 Number of control points in Beam.
>Ion Control Point Delivery Sequence (3008,0041) 1 Introduces sequence of beam control points for current ion treatment beam. One or more items shall be included in this sequence. The number of items shall be identical to the value of Number of Control Points (300A,0110). See section C.8.8.21.1.
>>Referenced Control Point Index (300C,00F0) 1 Uniquely identifies Control Point specified by Control Point Index (300A,0112) within the Beam referenced by Referenced Beam Number (300C,0006).
>>Treatment Control Point Date (3008,0024) 1 Date when the delivery of radiation at this control point began. For the final control point this shall be the Date when the previous control point ended.
>>Treatment Control Point Time (3008,0025) 1 Time when the delivery of radiation at this control point began. For the final control point this shall be the Time when the previous control point ended.
>>Specified Meterset (3008,0042) 2 Desired machine setting for current control point in units specified by Primary Dosimeter Unit (300A,00B3).
>>Delivered Meterset (3008,0044) 1 Machine setting actually delivered at current control point in units specified by Primary Dosimeter Unit (300A,00B3).
>>Meterset Rate Set (3008,0045) 3 The specified speed of delivery of the specified dose in units specified by Primary Dosimeter Unit (300A,00B3) per minute.
>>Meterset Rate Delivered (3008,0046) 3 The delivered speed of delivery of the specified dose in units specified by Primary Dosimeter Unit (300A,00B3) per minute.
>>Nominal Beam Energy (300A,0114) 1C Nominal Beam Energy at control point in MeV per nucleon. Defined at nozzle entrance before all Beam Modifiers. Required for Control Point 0 of Ion Control Point Delivery Sequence (3008,0041) or if Nominal Beam Energy (300A,0114) changes during beam administration, and KVp (0018,0060) is not present.
>>KVp (0018,0060) 1C Peak kilo voltage output of the setup X-Ray generator used. Required for Control Point 0 of Ion Control Point Delivery Sequence (3008,0041), or if KVp changes during setup, and Nominal Beam Energy (300A,0114) is not present.
>>Ion Wedge Position Sequence (300A,03AC) 1C Introduces sequence of Wedge positions for current control point. Required for first item of Ion Control Point Sequence if Number of Wedges (300A,00D0) is non-zero, and in subsequent control points if Wedge Position (300A,0118) or Wedge Thin Edge Position (300A,00DB) changes during beam. One or more items shall be included in this sequence. The number of items shall be identical to the value of Number of Wedges (300A,00D0).
>>>Referenced Wedge Number (300C,00C0) 1 Uniquely references Wedge described by Wedge Number (300A,00D2) in Wedge Sequence (300A,00D1).
>>>Wedge Position (300A,0118) 1 Position of Wedge at current control point. Enumerated Values: IN, OUT.
>>>Wedge Thin Edge Position (300A,00DB) 1C Closest distance from the central axis of the beam along a wedge axis to the thin edge as projected to the machine isocentric plane (mm). Value is positive is the wedge does not cover the central axis, negative if it does. Required if Wedge Type (300A,00D3) of the wedge referenced by Referenced Wedge Number (300C,00C0) is PARTIAL_STANDARD or PARTIAL_MOTORIZ. See section C.8.8.25.6.4.
>>Include Beam Limiting Device Position Macro Table C.8.8.27-1
>>Range Shifter Settings Sequence (300A,0360) 1C Introduces sequence of Range Shifter settings for the current control point. One or more items shall be included in this sequence. Required for Control Point 0 of Ion Control Point Delivery Sequence (3008,0041) or if Range Shifter Setting (300A,0362) changes during beam administration, and Number of Range Shifters (300A,0312) is non-zero.
>>>Referenced Range Shifter Number (300C,0100) 1 Uniquely references Range Shifter described by Range Shifter Number (300A,0316) in Range Shifter Sequence (300A,0314).
>>>Range Shifter Setting (300A,0362) 1 Machine specific setting attribute for the range shifter. The specific encoding of this value should be documented in a Conformance Statement. See section C.8.8.25.5.
>>Lateral Spreading Device Settings Sequence (300A,0370) 1C Introduces sequence of Lateral Spreading Device settings for the current control point. One or more items shall be included in this sequence. Required for Control Point 0 of Ion Control Point Delivery Sequence (3008,0041) or if Lateral Spreading Device Setting (300A,0372) changes during beam administration, and Number of Lateral Spreading Devices (300A,0330) is non-zero.
>>>Referenced Lateral Spreading Device Number (300C,0102) 1 Uniquely references Lateral Spreading Device described by Lateral Spreading Device Number (300A,0334) in Lateral Spreading Device Sequence (300A,0332).
>>>Lateral Spreading Device Setting (300A,0372) 1 Machine specific setting attribute for the lateral spreading device. The specific encoding of this value should be documented in a Conformance Statement. See section C.8.8.25.5.
>>Range Modulator Settings Sequence (300A,0380) 1C Introduces sequence of Range Modulator Settings for current control point. One or more items shall be included in this sequence. Required for Control Point 0 of Ion Control Point Delivery Sequence (3008,0041), or if Range Modulator Settings change during beam administration, and Number of Range Modulators (300A,0340) is non-zero.
>>>Referenced Range Modulator Number (300C,0104) 1 Uniquely references Range Modulator described by Range Modulator Number (300A,0344) in Range Modulator Sequence (300A,0342).
>>>Range Modulator Gating Start Value (300A,0382) 1C Start position defines the range modulator position at which the beam is switched on. Required if Range Modulator Type (300A,0348) of the range modulator referenced by Referenced Range Modulator Number (300C,0104) is WHL_MODWEIGHTS or WHL_FIXEDWEIGHTS
>>>Range Modulator Gating Stop Value (300A,0384) 1C Stop position defines the range modulator position at which the beam is switched off. Required if Range Modulator Type (300A,0348) of the range modulator referenced by Referenced Range Modulator Number (300C,0104) is WHL_MODWEIGHTS or WHL_FIXEDWEIGHTS
>>Gantry Angle (300A,011E) 1C Treatment machine gantry angle, i.e. orientation of IEC GANTRY coordinate system with respect to IEC FIXED REFERENCE coordinate system (degrees). Required for Control Point 0 of Ion Control Point Delivery Sequence (3008,0041) or if Gantry Angle changes during beam administration.
>>Gantry Rotation Direction (300A,011F) 1C Direction of Gantry Rotation when viewing gantry from isocenter, for segment beginning at current Control Point. Required for Control Point 0 of Ion Control Point Delivery Sequence (3008,0041), or if Gantry Rotation Direction changes during beam administration. Enumerated Values: CW = clockwise CC = counter-clockwise NONE = no rotation
>>Gantry Pitch Angle (300A,014A) 2C Gantry Pitch Angle. i.e. the rotation of the IEC GANTRY coordinate system about the X-axis of the IEC GANTRY coordinate system (degrees). Required for first item of Control Point Sequence, or if Gantry PitchRotation Angle changes during Beam. See C.8.8.25.6.5.
>>Gantry Pitch Rotation Direction (300A,014C) 2C Direction of Gantry PitchAngle when viewing along the positive X-axis of the IEC GANTRY coordinate system, for segment following Control Point. Required for first item of Control Point Sequence, or if Gantry PitchRotation Direction changes during Beam. See C.8.8.14.8 and C.8.8.25.6.5. Enumerated Values: CW = clockwise CC = counter-clockwise NONE = no rotation
>>Beam Limiting Device Angle (300A,0120) 1C Beam Limiting Device (collimator) angle, i.e. orientation of IEC BEAM LIMITING DEVICE coordinate system with respect to IEC GANTRY coordinate system (degrees). Required for Control Point 0 of Ion Control Point Delivery Sequence (3008,0041) or if beam limiting device (collimator) angle changes during beam administration.
>>Beam Limiting Device Rotation Direction (300A,0121) 1C Direction of Beam Limiting Device Rotation when viewing beam limiting device (collimator) from radiation source, for segment beginning at current Control Point. Required for Control Point 0 of Ion Control Point Delivery Sequence (3008,0041) or if Beam Limiting Device Rotation Direction changes during beam administration. Enumerated Values: CW = clockwise CC = counter-clockwise NONE = no rotation
>>Scan Spot Tune ID (300A,0390) 1C User-supplied or machine code identifier for machine configuration to produce beam spot. This may be the nominal spot size or some other machine specific value. Required if Scan Mode (300A,0308) is MODULATED.
>>Number of Scan Spot Positions (300A,0392) 1C Number of spot positions used to specify scanning pattern for current segment beginning at control point. Required if Scan Mode (300A,0308) is MODULATED.
>>Scan Spot Position Map (300A,0394) 1C The x and y coordinates of the scan spots are defined as projected onto the machine isocentric plane in the IEC GANTRY coordinate system (mm). Required if Scan Mode (300A,0308) is MODULATED. Contains 2N values were N is the Number of Scan Spot Positions (300A,0392).
>>Scan Spot Metersets Delivered (3008,0047) 1C A data set of metersets delivered to the scan spot positions. The order of metersets matches the positions in Scan Spot Position Map (300A,0394). The sum contained in all metersets shall match the difference of the Delivered Meterset of the current control point to the following control point. Required if Scan Mode (300A,0308) is MODULATED.
>>Scanning Spot Size (300A,0398) 3 The Scanning Spot Size as calculated using the Full Width Half Maximum (FWHM). Specified by a numeric pair - the size measured in air at isocenter in IEC GANTRY X direction followed by the size in the IEC GANTRY Y direction (mm).
>>Number of Paintings (300A,039A) 1C The intended number of times the scan pattern given by Scan Spot Position Map (300A,0394) and Scan Spot Meterset Weights (300A,0396) in the Referenced RT Plan was to be applied at the current control point. Note: The actual number of paintings is not known or recorded. The Scan Spot Metersets Delivered (3008,0047) contains the sum of all complete and partial repaints. Required if Scan Mode (300A,0308) is MODULATED.
>>Patient Support Angle (300A,0122) 1C Patient Support angle, i.e. orientation of IEC PATIENT SUPPORT (turntable) coordinate system with respect to IEC FIXED REFERENCE coordinate system (degrees). Required for Control Point 0 of Ion Control Point Delivery Sequence (3008,0041) or if Patient Support Angle changes during beam administration.
>>Patient Support Rotation Direction (300A,0123) 1C Direction of Patient Support Rotation when viewing table from above, for segment beginning at current Control Point. Required for Control Point 0 of Ion Control Point Delivery Sequence (3008,0041), or if Patient Support Rotation Direction changes during beam administration. Enumerated Values: CW = clockwise CC = counter-clockwise NONE = no rotation
>>Table Top Pitch Angle (300A,0140) 2C Table Top Pitch Angle, i.e. the rotation of the IEC TABLE TOP coordinate system about the X-axis of the IEC TABLE TOP coordinate system (degrees). Required for first item of Control Point Sequence, or if Table Top Pitch Angle changes during Beam. See section C.8.8.25.6.2.
>>Table Top Pitch Rotation Direction (300A,0142) 2C Direction of Table Top Pitch Rotation when viewing the table along the positive X-axis of the IEC TABLE TOP coordinate system, for segment following Control Point. Required for first item of Control Point Sequence, or if Table Top Pitch Rotation Direction changes during Beam. See C.8.8.14.8 and C.8.8.25.6.2. Enumerated Values: CW = clockwise CC = counter-clockwise NONE = no rotation
>>Table Top Roll Angle (300A,0144) 2C Table Top Roll Angle, i.e. the rotation of the IEC TABLE TOP coordinate system about the Y-axis of the IEC TABLE TOP coordinate system (degrees). Required for first item of Control Point Sequence, or if Table Top Roll Angle changes during Beam. See section C.8.8.25.6.2.
>>Table Top Roll Rotation Direction (300A,0146) 2C Direction of Table Top Roll Rotation when viewing the table along the positive Y-axis of the IEC TABLE TOP coordinate system, for segment following Control Point. Required for first item of Control Point Sequence, or if Table Top Roll Rotation Direction changes during Beam. See C.8.8.14.8 and C.8.8.25.6.2. Enumerated Values: CW = clockwise CC = counter-clockwise NONE = no rotation
>>Head Fixation Angle (300A,0148) 3 Angle (in degrees) of the head fixation for eye treatments with respect to the Table Top Pitch Angle (300A,0140) coordinate system. Positive head fixation angle is the same direction as positive Table Top Pitch. See section C.8.8.25.6.4.
>>Table Top Vertical Position (300A,0128) 2C Table Top Vertical position in IEC TABLE TOP coordinate system (mm). This value is interpreted as an absolute, rather than relative, Table setting. Required for Control Point 0 of Ion Control Point Delivery Sequence (3008,0041) or if Table Top Vertical Position changes during beam administration.
>>Table Top Longitudinal Position (300A,0129) 2C Table Top Longitudinal position in IEC TABLE TOP coordinate system (mm). This value is interpreted as an absolute, rather than relative, Table setting. Required for Control Point 0 of Ion Control Point Delivery Sequence (3008,0041) or if Table Top Longitudinal Position changes during beam administration.
>>Table Top Lateral Position (300A,012A) 2C Table Top Lateral position in IEC TABLE TOP coordinate system (mm). This value is interpreted as an absolute, rather than relative, Table setting. Required for Control Point 0 of Ion Control Point Delivery Sequence (3008,0041) or if Table Top Lateral Position changes during beam administration.
>>Snout Position (300A,030D) 2C Axial position of the snout (in mm) measured from isocenter to the downstream side of the snout (without consideration of variable length elements such as blocks, MLC and/or compensators). Required for Control Point 0 of Ion Control Point Delivery Sequence (3008,0041) or if Snout Position changes during beam administration.
>>Corrected Parameter Sequence (3008,0068) 3 Introduces a sequence of items describing corrections made to any attributes prior to delivery of the next control point. One or more Items are permitted in this sequence.
>>>Parameter Sequence Pointer (3008,0061) 1 Contains the Data Element Tag of the parent sequence containing the attribute that was corrected. The value is limited in scope to the Treatment Session Ion Beam Sequence (3008,0021) and all nested sequences therein.
>>>Parameter Item Index (3008,0063) 1 Contains the ones-based sequence item index of the corrected attribute within its parent sequence as indicated by Parameter Sequence Pointer (3008,0061).
>>>Parameter Pointer (3008,0065) 1 Contains the Data Element Tag of the attribute that was corrected.
>>>Correction Value (3008,006A) 1 The value that was added the value referenced by the Parameter Sequence Pointer (3008,0061), Parameter Item Index (3008,0063) and Parameter Pointer (3008,0065).
>>Override Sequence (3008,0060) 3 Introduces sequence of parameters that were overridden during the administration of the beam segment immediately prior to the current control point. One or more Items are permitted in this sequence.
>>>Parameter Sequence Pointer (3008,0061) 1 Contains the Data Element Tag of the parent sequence containing the attribute that was overriden. The value is limited in scope to the Treatment Session Ion Beam Sequence (3008,0021) and all nested sequences therein.
>>>Override Parameter Pointer (3008,0062) 1 Contains the Data Element Tag of the attribute that was overridden.
>>>Parameter Item Index (3008,0063) 1 Contains the ones-based sequence item index of the overriden attributes within it’s parent sequence. The value is limited in scope to the Treatment Session Ion Beam Sequence (3008,0021) and all nested sequences therein.
>>>Operators’ Name (0008,1070) 2 Name of operator who authorized override.
>>>Override Reason (3008,0066) 3 User-defined description of reason for override of parameter specified by Override Parameter Pointer (3008,0062).

C.8.8.26.1 Specified and Delivered Meterset Values

Specified and Delivered Meterset values on beam and control point level shall be handled as specified for RT Beams Session records in Section C.8.8.21.2.

C.8.8.27 Beam Limiting Device Position Macro

Table C.8.8.27-1 specifies the attributes that specify the Beam Limiting Device Sequence.

Table C.8.8.27-1BEAM LIMITING DEVICE POSITION MACRO ATTRIBUTES

Attribute Name Tag Type Description
Beam Limiting Device Position Sequence (300A,011A) 1C Introduces sequence of beam limiting device (collimator) jaw or leaf (element) positions. One or more items shall be included in this sequence. Required if Ion Beam Limiting Device Sequence (300A,03A4) or Beam Limiting Device Leaf Pairs Sequence (3008,00A0) is included in this SOP instance and for first item of Ion Control Point Sequence, or if Beam Limiting Device changes during Beam.
>RT Beam Limiting Device Type (300A,00B8) 1 Type of beam limiting device (collimator). The value of this attribute shall correspond to RT Beam Limiting Device Type (300A,00B8) defined in an item of Ion Beam Limiting Device Sequence (300A,03A4). Enumerated Values: X = symmetric jaw pair in IEC X direction Y = symmetric jaw pair in IEC Y direction ASYMX = asymmetric jaw pair in IEC X direction ASYMY = asymmetric pair in IEC Y direction MLCX = multileaf (multi-element) jaw pair in IEC X direction MLCY = multileaf (multi-element) jaw pair in IEC Y direction
>Leaf/Jaw Positions (300A,011C) 1 Positions of beam limiting device (collimator) leaf (element) or jaw pairs (in mm) in IEC BEAM LIMITING DEVICE coordinate axis appropriate to RT Beam Limiting Device Type (300A,00B8), e.g. X-axis for MLCX, Y-axis for MLCY. Contains 2N values, where N is the Number of Leaf/Jaw Pairs (300A,00BC) in Ion Beam Limiting Device Sequence (300A,03A4). Values shall be listed in IEC leaf (element) subscript order 101, 102, ... 1N, 201, 202, ... 2N. See section C.8.8.25.3.

C.8.8.28 Patient Support Identification Macro

Table C.8.8.28-1 specifies the attributes that identify the Patient Support System.

Table C.8.8.28-1PATIENT SUPPORT IDENTIFICATION MACRO ATTRIBUTES

Attribute Name Tag Type Description
Patient Support Type (300A,0350) 1 Defined terms: TABLE = Treatment delivery system table CHAIR = Treatment delivery system chair See section C.8.8.25.6.3.
Patient Support ID (300A,0352) 3 User-specified identifier for manufacturer specific patient support devices.
Patient Support Accessory Code (300A,0354) 3 A Patient Support accessory identifier to be read by a device such as a bar code reader.

C.8.8.29 RT Beams Delivery Instruction Module

The RT Beams Delivery Instruction Module contains additional information required by a Treatment Delivery System (TDS) when specifying delivery of an external beam radiotherapy treatment. This information is supplied by a Treatment Management System (TMS) when it creates an RT Beams Delivery Instruction SOP Instance, a composite SOP Instance in turn referenced by a Unified Procedure Step (UPS) in the Unified Procedure Step model.

The RT Beams Delivery Instruction Module consists of a sequence of one or more beam tasks, where each beam task may also specify one or more Delivery Verification images to be acquired prior to, during, or after the treatment delivery.

Table C.8.8.29-1 RT BEAMS DELIVERY INSTRUCTION MODULE ATTRIBUTES

Attribute Name Tag Type Description
Referenced RT Plan Sequence (300C,0002) 1 Reference to a single RT Plan or RT Ion Plan SOP Instance (whose UID is also supplied in the Input Information Sequence – see PS3.4) containing all the Beams and the Fraction Group referenced in this SOP Instance. Only a single item shall be included in this sequence.
>Include 'SOP Instance Reference Macro' Table 10-11
Beam Task Sequence (0074,1020) 1 Specification of beams to be delivered and/or verified. One or more Items shall be included in this sequence.
>Beam Task Type (0074,1022) 1 Indication whether beam is to be verified, treated (delivered), or both. Enumerated Values: VERIFY = Beam verification only TREAT = Beam treatment only VERIFY_AND_TREAT = Beam verification and treatment
>Treatment Delivery Type (300A,00CE) 1 Delivery Type of treatment. Enumerated Values: TREATMENT = normal patient treatment CONTINUATION = continuation of interrupted treatment
>Primary Dosimeter Unit (300A,00B3) 1C Measurement unit of machine dosimeter. Enumerated Values: MU = Monitor Unit MINUTE = minute NP = Number of Particles This value shall be the same as in the referenced RT Plan. It applies only to the Continuation Start Meterset (0074,0120) and Continuation End Meterset (0074,0121). Required if Delivery Type (300A,00CE) is CONTINUATION.
>Continuation Start Meterset (0074,0120) 1C Meterset within Beam referenced by Referenced Beam Number (300C,0006) at which treatment delivery starts, in units specified by Primary Dosimeter Unit (300A,00B3). Required if Delivery Type (300A,00CE) is CONTINUATION.
>Continuation End Meterset (0074,0121) 1C Meterset within Beam referenced by Referenced Beam Number (300C,0006) at which treatment delivery ends, in units specified by Primary Dosimeter Unit (300A,00B3). Required if Delivery Type (300A,00CE) is CONTINUATION.
>Current Fraction Number (3008,0022) 1 The index of the fraction that is to be delivered or completed in this session. See C.8.8.29.1.
>Referenced Fraction Group Number (300C,0022) 1C Indicates which fraction group of the referenced plan is to be treated in the treatment session. Only one Fraction Group shall be specified per Delivery Instruction SOP Instance. Required if the referenced plan has more than one Fraction Group Sequence (300A,0070) item.
>Referenced Beam Number (300C,0006) 1 Uniquely identifies the Beam which is specified by Beam Number (300A,00C0) within Beam Sequence (300A,00B0) in RT Beams Module of referenced RT Plan or RT Ion Plan.
>Beam Order Index (0074,1024) 3 Identifies required ordering of beam delivery, monotonically increasing by 1, starting from 1.
>Table Top Vertical Adjusted Position (0074,0126) 2 Adjusted Table Top Vertical position in the IEC TABLE TOP coordinate system in mm for patient setup. See C.8.8.29.2.
>Table Top Longitudinal Adjusted Position (0074,0127) 2 Adjusted Table Top Longitudinal position in the IEC TABLE TOP coordinate system in mm for patient setup. See C.8.8.29.2.
>Table Top Lateral Adjusted Position (0074,0128) 2 Adjusted Table Top Lateral position in the IEC TABLE TOP coordinate system in mm for patient setup. See C.8.8.29.2.
>Patient Support Adjusted Angle (0074,102A) 2 Adjusted Patient Support angle for patient setup, i.e. orientation of the IEC PATIENT SUPPORT coordinate system with respect to the IEC FIXED REFERENCE coordinate system in degrees. See C.8.8.29.2.
>Table Top Eccentric Adjusted Angle (0074,102B) 2 Adjusted Table Top (non-isocentric) angle for patient setup, i.e. orientation of the IEC TABLE TOP ECCENTRIC coordinate system with respect to the IEC PATIENT SUPPORT system in degrees. See C.8.8.29.2.
>Table Top Pitch Adjusted Angle (0074,102C) 2 Adjusted Table Top Pitch Angle for patient setup, i.e. the rotation of the IEC TABLE TOP coordinate system about the X-axis of the IEC TABLE TOP coordinate system in degrees. See C.8.8.29.2.
>Table Top Roll Adjusted Angle (0074,102D) 2 Adjusted Table Top Roll Angle for patient setup, i.e. the rotation of the IEC TABLE TOP coordinate system about the Y-axis of the IEC TABLE TOP coordinate system in degrees. See C.8.8.29.2.
>Table Top Vertical Setup Displacement (300A,01D2) 2 Vertical Displacement in the IEC TABLE TOP coordinate system in mm relative to initial Setup Position, i.e. vertical offset between patient positioning performed using setup and treatment position.
>Table Top Longitudinal Setup Displacement (300A,01D4) 2 Longitudinal Displacement in the IEC TABLE TOP coordinate system in mm relative to initial Setup Position, i.e. longitudinal offset between patient positioning performed using setup and treatment position.
>Table Top Lateral Setup Displacement (300A,01D6) 2 Lateral Displacement in the IEC TABLE TOP coordinate system in mm relative to initial Setup Position, i.e. lateral offset between patient positioning performed using setup and treatment position.
>Delivery Verification Image Sequence (0074,1030) 2C Beam verification images to be acquired for current beam. Required if Beam Task Type (0074,1022) is VERIFY or VERIFY_AND_TREAT. Zero or one Item shall be included in this sequence if Beam Task Type (0074,1022) is VERIFY. Zero or more Items shall be included in this sequence if Beam Task Type (0074,1022) is VERIFY_AND_TREAT.
>>Verification Image Timing (0074,1032) 1 Indicates the temporal relationship of the verification image with respect to the current treatment beam delivery. Value shall be DURING_BEAM for Beams with a Beam Task Type (0074,1022) of VERIFY. Enumerated Values: BEFORE_BEAM DURING_BEAM AFTER_BEAM
>>Start Cumulative Meterset Weight (300C,0008) 1C Cumulative Meterset Weight within current Beam at which image acquisition will start. Required if Verification Image Timing (0074,1032) is DURING_BEAM.
>>Meterset Exposure (3002,0032) 2C Treatment machine Meterset duration over which image is to be acquired, specified in Monitor units (MU) or minutes as defined by Primary Dosimeter Unit (300A,00B3) specified in the Referenced RT Plan Sequence (300C,0002). Required if Verification Image Timing (0074,1032) is BEFORE_BEAM or AFTER_BEAM. See C.8.8.29.3.
>>End Cumulative Meterset Weight (300C,0009) 2C Cumulative Meterset Weight within current Beam at which image acquisition will end. Required if Verification Image Timing (0074,1032) is DURING_BEAM.
>>Double Exposure Flag (0074,1034) 1 Indicates whether the current verification image is a single or double exposure. Enumerated Values: SINGLE = single exposure DOUBLE = double exposure
>>Double Exposure Ordering (0074,1036) 1C Indicates the ordering of the open (double exposure) field with respect to the primary (collimated) field in a double exposure. Defined terms: OPEN_FIRST = Open field first OPEN_SECOND = Open field second Required if Double Exposure Flag (0074,1034) is DOUBLE.
>>Double Exposure Meterset (0074,1038) 2C If this field is present, an additional exposure with the indicated Meterset is requested. Required if Double Exposure Flag (0074,1034) is DOUBLE.
>>Double Exposure Field Delta (0074,103A) 2C Offsets of field-defining edges in mm for the double exposure in the IEC BEAM LIMITING DEVICE coordinate system in the IEC order X1, X2, Y1, Y2. Negative values for X1 and Y1 indicate an enlarged field, negative values for X2 and Y2 indicate a reduced field. Required if Double Exposure Flag (0074,1034) is DOUBLE. See C.8.8.29.4.
>>X-Ray Image Receptor Translation (3002,000D) 2 Position in (x,y,z) coordinates in mm of origin of the IEC X-RAY IMAGE RECEPTOR System in the IEC GANTRY coordinate system.
>>Related Reference RT Image Sequence (0074,1040) 3 Uniquely identifies Reference Images to which planned verification image is related. All items in this sequence shall be RT Image SOP Instances. One or more items are permitted in this sequence.
>>>Include 'SOP Instance Reference Macro' Table 10-11

C.8.8.29.1 Current Fraction Number

For beams with a Treatment Delivery Type (300A,00CE) of CONTINUATION, the Current Fraction Number (3008,0022) is that of the original fraction to be completed by the current beam.

C.8.8.29.2 Adjusted Table Positions and Angles

Adjusted Table positions and angles serve as a facility to communicate a shift (often systematic) that has been detected from previous treatments. They define a new initial patient position, which is near and aligned to the actual patient position during beam delivery. These attributes do not affect the original relationship between the beams and the planning image patient anatomy.

C.8.8.29.3 Meterset Exposure

Meterset Exposure (3002,0032) can be interpreted as the ‘maximum’ meterset duration in cases where an automatic exposure is taken.

C.8.8.29.4 Double Exposure Field Delta

The following diagram illustrates the case where the second X aperture in a double exposure is larger than the initial aperture. In this case ∆X1 is negative and ∆X2 is positive. If a field edge is defined by a multileaf collimator, then the field delta is to be applied to the most open leaf, such that all leaves can be moved to that position.

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