C.8 Modality specific modules

C.8.1 Computed Radiography Modules

This Section describes Computed Radiography Series and Image Modules. These Modules contain Attributes that are specific to Computed Radiography images. There is no Computed Radiography Equipment Module.

C.8.1.1 CR Series Module

Table C.8-1 contains IOD Attributes that describe a computed radiography series performed on the patient.

Table C.8-1CR SERIES MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Body Part Examined (0018,0015) 2 Text description of the part of the body examined. See PS 3.16 Annexes on Correspondence of Anatomic Region Codes and Body Part Examined for Humans and for Animals for Defined Terms
View Position (0018,5101) 2 Radiographic view associated with Patient Position (0018,5100). Defined Terms for humans: AP = Anterior/Posterior PA = Posterior/Anterior LL = Left Lateral RL = Right Lateral RLD = Right Lateral Decubitus LLD = Left Lateral Decubitus RLO = Right Lateral Oblique LLO = Left Lateral Oblique For animals, capitalized versions with hypens replaced by underscores of the abbreviations defined in “Smallwood et al. A Nomenclature For Radiographic Projections Used In Veterinary Medicine” shall be used. See PS 3.16 CID 7484 DX View for Animals, in which these abbreviations are listed. Notes: 1. For example, the Defined Term “CD10DI_CRPRO” would be used for a “Cd10Di-CrPrO” or “caudal 10-degree distal-cranioproximal oblique”. 2. The Code String value representation for this attribute constrains the characters to uppercase, digits and underscore.
Filter Type (0018,1160) 3 Label for the type of filter inserted into the x-ray beam
Collimator/grid Name (0018,1180) 3 Label describing any grid inserted.
Focal Spot (0018,1190) 3 Size of the focal spot in mm. For devices with variable focal spot or multiple focal spots, small dimension followed by large dimension.
Plate Type (0018,1260) 3 Label of the type of storage phosphor plates used in this series
Phosphor Type (0018,1261) 3 Label of type of phosphor on the plates

C.8.1.2 CR Image Module

Table C.8-2 contains IOD Attributes that describe computed radiography images.

Table C.8-2CR IMAGE MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Photometric Interpretation (0028,0004) 1 Specifies the intended interpretation of the pixel data. Shall have one of the following Enumerated Values: MONOCHROME1 MONOCHROME2
KVP (0018,0060) 3 Peak kilo voltage output of the x-ray generator used
Plate ID (0018,1004) 3 The ID or serial number of the sensing plate upon which the image was acquired
Distance Source to Detector (0018,1110) 3 Distance in mm from source to detector center. Note: This value is traditionally referred to as Source Image Receptor Distance (SID).
Distance Source to Patient (0018,1111) 3 Distance in mm from source to isocenter (center of field of view) . Note: This value is traditionally referred to as Source Object Distance (SOD).
Exposure Time (0018,1150) 3 Time of x-ray exposure in msec
X-Ray Tube Current (0018,1151) 3 X-Ray Tube Current in mA.
Exposure (0018,1152) 3 The exposure expressed in mAs, for example calculated from Exposure Time and X-Ray Tube Current.
Exposure in µAs (0018,1153) 3 The exposure expressed in µAs, for example calculated from Exposure Time and X-Ray Tube Current.
Imager Pixel Spacing (0018,1164) 3 Physical distance measured at the front plane of the Image Receptor housing between the center of each pixel. Specified by a numeric pair - row spacing value (delimiter) column spacing value - in mm. In the case of CR, the front plane is defined to be the external surface of the CR plate closest to the patient and radiation source.
Include Basic Pixel Spacing Calibration Macro (Table 10-10)
Generator Power (0018,1170) 3 Power in kW to the x-ray generator.
Acquisition Device Processing Description (0018,1400) 3 Describes device-specific processing associated with the image (e.g. Organ Description)
Acquisition Device Processing Code (0018,1401) 3 Code representing the device-specific processing associated with the image (e.g. CR Organ Filtering code)
Cassette Orientation (0018,1402) 3 Orientation of cassette, used to properly position the image for display. Enumerated Values: LANDSCAPE PORTRAIT
Cassette Size (0018,1403) 3 Size of cassette. Defined Terms: 18CMX24CM 8INX10IN 24CMX30CM 10INX12IN 30CMX35CM 30CMX40CM 11INX14IN 35CMX35CM 14INX14IN 35CMX43CM 14INX17IN
Exposures on Plate (0018,1404) 3 Total number of x-ray exposures that have been made on the plate identified in Plate ID (0018,1004)
Relative X-Ray Exposure (0018,1405) 3 Relative x-ray exposure on the plate. Meaning of values is implementation specific. May be used to adjust the dynamic range of the plate digitizer (scanner). Note: This value is manufacturer-specific. DICOM specifies standard Attributes in Table 10-23 ‘Exposure Index Macro’ which are recommended.
Sensitivity (0018,6000) 3 Read out sensitivity. Note: This value is manufacturer-specific. DICOM specifies standard Attributes in Table 10-23 ‘Exposure Index Macro’ which are recommended.
Include 'General Anatomy Optional Macro' Table 10-7 Defined Context ID for the Anatomic Region Sequence is 4009 for humans, and 7482 for animals.
Include Table 10-23 ‘Exposure Index Macro’

C.8.2 CT Modules

This Section describes the CT Image Module. This Module contains all Attributes that are specific to CT images.

C.8.2.1 CT Image Module

The table in this Section contains IOD Attributes that describe CT images.

Table C.8-3CT IMAGE MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Image Type (0008,0008) 1 Image identification characteristics. See C.8.2.1.1.1 for specialization.
Samples per Pixel (0028,0002) 1 Number of samples (planes) in this image. See C.8.2.1.1.2 for specialization.
Photometric Interpretation (0028,0004) 1 Specifies the intended interpretation of the pixel data. See C.8.2.1.1.3 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.8.2.1.1.4 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.8.2.1.1.5 for specialization.
High Bit (0028,0102) 1 Most significant bit for pixel sample data. Each sample shall have the same high bit. See C.8.2.1.1.6 for specialization.
Rescale Intercept (0028,1052) 1 The value b in relationship between stored values (SV) and the output units. Output units = m*SV+b If Image Type (0008,0008) Value 1 is ORIGINAL and Value 3 is not LOCALIZER, output units shall be Hounsfield Units (HU).
Rescale Slope (0028,1053) 1 m in the equation specified in Rescale Intercept (0028,1052).
Rescale Type (0028,1054) 1C Specifies the output units of Rescale Slope (0028,1053) and Rescale Intercept (0028,1052). See C.11.1.1.2 for Defined Terms and further explanation. Required if the Rescale Type is not HU (Hounsfield Units). May be present otherwise.
KVP (0018,0060) 2 Peak kilo voltage output of the x-ray generator used
Acquisition Number (0020,0012) 2 A number identifying the single continuous gathering of data over a period of time which resulted in this image
Scan Options (0018,0022) 3 Parameters of scanning sequence.
Data Collection Diameter (0018,0090) 3 The diameter in mm of the region over which data were collected
Data Collection Center (Patient) (0018,9313) 3 The x, y, and z coordinates (in the patient coordinate system) in mm of the center of the region in which data were collected. See C.8.15.3.6.1.
Reconstruction Diameter (0018,1100) 3 Diameter in mm of the region from within which data were used in creating the reconstruction of the image. Data may exist outside this region and portions of the patient may exist outside this region.
Reconstruction Target Center (Patient) (0018,9318) 3 The x, y, and z coordinates (in the patient coordinate system) of the reconstruction center target point as used for reconstruction in mm. See C.8.15.3.6.1. Note: If the reconstructed image is not magnified or panned the value corresponds with the Data Collection Center (Patient) (0018,9313) attribute.
Distance Source to Detector (0018,1110) 3 Distance in mm from source to detector center. Note: This value is traditionally referred to as Source Image Receptor Distance (SID).
Distance Source to Patient (0018,1111) 3 Distance in mm from source to isocenter (center of field of view). Note: This value is traditionally referred to as Source Object Distance (SOD).
Gantry/Detector Tilt (0018,1120) 3 Nominal angle of tilt in degrees of the scanning gantry. Not intended for mathematical computations.
Table Height (0018,1130) 3 The distance in mm of the top of the patient table to the center of rotation; below the center is positive.
Rotation Direction (0018,1140) 3 Direction of rotation of the source when relevant, about nearest principal axis of equipment. Enumerated Values: CW = clockwise CC = counter clockwise
Exposure Time (0018,1150) 3 Time of x-ray exposure in msec. If Acquisition Type (0018,9302) equals SPIRAL, the value of this attribute shall be Revolution Time (0018,9305) divided by the Spiral Pitch Factor (0018,9311). See C.8.15.3.8.1 and C.8.15.3.2.1.
X-Ray Tube Current (0018,1151) 3 X-Ray Tube Current in mA.
Exposure (0018,1152) 3 The exposure expressed in mAs, for example calculated from Exposure Time and X-Ray Tube Current.
Exposure in µAs (0018,1153) 3 The exposure expressed in µAs, for example calculated from Exposure Time and X-Ray Tube Current.
Filter Type (0018,1160) 3 Label for the type of filter inserted into the x-ray beam.
Generator Power (0018,1170) 3 Power in kW to the x-ray generator.
Focal Spot (0018,1190) 3 Size of the focal spot in mm. For devices with variable focal spot or multiple focal spots, small dimension followed by large dimension.
Convolution Kernel (0018,1210) 3 A label describing the convolution kernel or algorithm used to reconstruct the data
Revolution Time (0018,9305) 3 The time in seconds of a complete revolution of the source around the gantry orbit.
Single Collimation Width (0018,9306) 3 The width of a single row of acquired data (in mm). Note: Adjacent physical detector rows may have been combined to form a single effective acquisition row.
Total Collimation Width (0018,9307) 3 The width of the total collimation (in mm) over the area of active x-ray detection. Note: This will be equal the number of effective detector rows multiplied by single collimation width.
Table Speed (0018,9309) 3 The distance in mm that the table moves in one second during the gathering of data that resulted in this image.
Table Feed per Rotation (0018,9310) 3 Motion of the table (in mm) during a complete revolution of the source around the gantry orbit.
Spiral Pitch Factor (0018,9311) 3 Ratio of the Table Feed per Rotation (0018,9310) to the Total Collimation Width (0018,9307).
Exposure Modulation Type (0018,9323) 3 A label describing the type of exposure modulation used for the purpose of limiting the dose. Defined Terms: NONE
Estimated Dose Saving (0018,9324) 3 A percent value of dose saving due to the use of Exposure Modulation Type (0018,9323). A negative percent value of dose savings reflects an increase of exposure.
CTDIvol (0018,9345) 3 Computed Tomography Dose Index (CTDIvol), im mGy according to IEC 60601-2-44, Ed.2.1 (Clause 29.1.103.4), The Volume CTDIvol. It describes the average dose for this image for the selected CT conditions of operation.
CTDI Phantom Type Code Sequence (0018,9346) 3 The type of phantom used for CTDI measurement according to IEC 60601-2-44. Only a single Item is permitted in this Sequence.
>Include Code Sequence Macro Table 8.8-1 Defined CID 4052
Include 'General Anatomy Optional Macro' Table 10-7 Defined Context ID for the Anatomic Region Sequence is CID 4030.
Calcium Scoring Mass Factor Patient (0018,9351) 3 The calibration factor for the calcium mass score. These factors incorporate the effects of KV value of the CT image the patient size. machine specific corrections See C.8.2.1.1.7.
Calcium Scoring Mass Factor Device (0018,9352) 3 The calibration factors for the calcium mass score of the device. These factors incorporate the effects of KV value of the CT image machine specific corrections This a multi-value attribute, the first value specifies the mass factor for a small patient size, the second value for a medium patient size and the third value for a large patient size. See C.8.2.1.1.7.
Energy Weighting Factor (0018,9353) 1C The weighting factor of the data from the primary source in a multiple energy composition image. This factor incorporates the effects of the specific X-Ray source and kV value examination specific characteristics. Required if one Derivation Code Sequence (0008,9215) Item value is (113097, DCM, “Multi-energy proportional weighting”). May be present otherwise.
CT Additional X-Ray Source Sequence (0018,9360) 3 Contains the attributes describing additional acquisition parameters beyond the primary source in a multiple X-Ray source system or a multi-energy acquisition. The primary X-Ray source is specified in other attributes of this module. One or more Items are permitted in this sequence.
>kVP (0018,0060) 1 Peak kilo voltage output of the X-Ray generator used.
>X-Ray Tube Current in mA (0018,9330) 1 Nominal X-Ray tube current in milliamperes.
>Data Collection Diameter (0018,0090) 1 The diameter in mm of the region over which data were collected.
>Focal Spot(s) (0018,1190) 1 Used nominal size of the focal spot in mm.
>Filter Type (0018,1160) 1 Type of filter(s) inserted into the X-Ray beam.
>Filter Material (0018,7050) 1 The X-Ray absorbing material used in the filter.
>Exposure in mAs (0018,9332) 3 The exposure expressed in milliampere seconds, for example calculated from exposure time and X-Ray tube current.
>Energy Weighting Factor (0018,9353) 1C The weighting factor of the data from this additional source in a multiple energy composition image. This factor incorporates the effects of the specific X-Ray source and kV value examination specific characteristics. Required if one Derivation Code Sequence (0008,9215) Item value is (113097, DCM, “Multi-energy proportional weighting”). May be present otherwise.

C.8.2.1.1 CT Image Attribute Descriptions

C.8.2.1.1.1 Image Type

For CT Images, Image Type (0008,0008) is specified to be Type 1 and uses one of the following Defined Terms for Value 3:

AXIAL identifies a CT Axial Image

LOCALIZER identifies a CT Localizer Image

Note: Axial in this context means any cross-sectional image, and includes transverse, coronal, sagittal and oblique images.

C.8.2.1.1.2 Samples Per Pixel

For CT Images, Samples per Pixel (0028,0002) shall have an Enumerated Value of 1.

C.8.2.1.1.3 Photometric Interpretation

For CT Images, Photometric Interpretation (0028,0004) shall have one of the following Enumerated Values:

MONOCHROME1

MONOCHROME2

See C.7.6.3.1.1.2 for definition of these terms.

C.8.2.1.1.4 Bits Allocated

For CT Images, Bits Allocated (0028,0100) shall have the Enumerated Value of 16.

C.8.2.1.1.5 Bits Stored

For CT Images, Bits Stored (0028,0101) shall have the Enumerated Values of 12 to 16.

C.8.2.1.1.6 High Bit

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

C.8.2.1.1.7 Calcium Scoring Mass Factor Patient and Calcium Scoring Mass Factor Device

The calibration factors for the Calcium Scoring Mass Factor Patient (0018,9351) and Calcium Scoring Mass Factor Device (0018,9352) attributes are defined by the International Consortium for Multi-Detector CT Evaluation of Coronary Calcium, see McCollough, C.H. “A multi-institutional, multi-manufacturer, international standard for the quantification of coronary artery calcium using cardiac CT”.

C.8.3 MR Modules

This Section describes the MR Image Module. This Module contains all Attributes that are specific to MR images.

C.8.3.1 MR Image Module

Table C.8-4 contains the Attributes that describe MR images.

Table C.8-4MR IMAGE MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Image Type (0008,0008) 1 Image identification characteristics. See C.8.3.1.1.1 for specialization.
Samples per Pixel (0028,0002) 1 Number of samples (planes) in this image. See C.8.3.1.1.2 for specialization.
Photometric Interpretation (0028,0004) 1 Specifies the intended interpretation of the pixel data. See C.8.3.1.1.3 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.8.3.1.1.4 for specialization.
Scanning Sequence (0018,0020) 1 Description of the type of data taken. Enumerated Values: SE = Spin Echo IR = Inversion Recovery GR = Gradient Recalled EP = Echo Planar RM = Research Mode Note: Multi-valued, but not all combinations are valid (e.g. SE/GR, etc.).
Sequence Variant (0018,0021) 1 Variant of the Scanning Sequence. Defined Terms: SK = segmented k-space MTC = magnetization transfer contrast SS = steady state TRSS = time reversed steady state SP = spoiled MP = MAG prepared OSP = oversampling phase NONE = no sequence variant
Scan Options (0018,0022) 2 Parameters of scanning sequence. Defined Terms: PER = Phase Encode Reordering RG = Respiratory Gating CG = Cardiac Gating PPG = Peripheral Pulse Gating FC = Flow Compensation PFF = Partial Fourier - Frequency PFP = Partial Fourier - Phase SP = Spatial Presaturation FS = Fat Saturation
MR Acquisition Type (0018,0023) 2 Identification of data encoding scheme. Enumerated Values: 2D = frequency x phase 3D = frequency x phase x phase
Repetition Time (0018,0080) 2C The period of time in msec between the beginning of a pulse sequence and the beginning of the succeeding (essentially identical) pulse sequence. Required except when Scanning Sequence (0018,0020) is EP and Sequence Variant (0018,0021) is not SK.
Echo Time (0018,0081) 2 Time in ms between the middle of the excitation pulse and the peak of the echo produced (kx=0). In the case of segmented k-space, the TE(eff) is the time between the middle of the excitation pulse to the peak of the echo that is used to cover the center of k-space (i.e.-kx=0, ky=0).
Echo Train Length (0018,0091) 2 Number of lines in k-space acquired per excitation per image.
Inversion Time (0018,0082) 2C Time in msec after the middle of inverting RF pulse to middle of excitation pulse to detect the amount of longitudinal magnetization. Required if Scanning Sequence (0018,0020) has values of IR.
Trigger Time (0018,1060) 2C Time, in msec, between peak of the R wave and the peak of the echo produced. In the case of segmented k-space, the TE(eff) is the time between the peak of the echo that is used to cover the center of k-space. Required for Scan Options (0018,0022) which include heart gating (e.g. CG, PPG, etc.)
Sequence Name (0018,0024) 3 User defined name for the Scanning Sequence (0018,0020) and Sequence Variant (0018,0021) combination.
Angio Flag (0018,0025) 3 Angio Image Indicator. Primary image for Angio processing. Enumerated Values: Y = Image is Angio N = Image is not Angio
Number of Averages (0018,0083) 3 Number of times a given pulse sequence is repeated before any parameter is changed
Imaging Frequency (0018,0084) 3 Precession frequency in MHz of the nucleus being addressed
Imaged Nucleus (0018,0085) 3 Nucleus that is resonant at the imaging frequency. Examples: 31P, 1H
Echo Number (0018,0086) 3 The echo number used in generating this image. In the case of segmented k-space, it is the effective Echo Number.
Magnetic Field Strength (0018,0087) 3 Nominal field strength of MR magnet, in Tesla
Spacing Between Slices (0018,0088) 3 Spacing between slices, in mm. The spacing is measured from the center-to-center of each slice.
Number of Phase Encoding Steps (0018,0089) 3 Total number of lines in k-space in the 'y' direction collected during acquisition.
Percent Sampling (0018,0093) 3 Fraction of acquisition matrix lines acquired, expressed as a percent.
Percent Phase Field of View (0018,0094) 3 Ratio of field of view dimension in phase direction to field of view dimension in frequency direction, expressed as a percent.
Pixel Bandwidth (0018,0095) 3 Reciprocal of the total sampling period, in hertz per pixel.
Nominal Interval (0018,1062) 3 Average R-R interval used for the scans, in msec
Beat Rejection Flag (0018,1080) 3 Beat length sorting has been applied. Enumerated Values: Y = yes N = No
Low R-R Value (0018,1081) 3 R-R interval low limit for beat rejection, in msec
High R-R Value (0018,1082) 3 R-R interval high limit for beat rejection, in msec
Intervals Acquired (0018,1083) 3 Number of R-R intervals acquired.
Intervals Rejected (0018,1084) 3 Number of R-R intervals rejected.
PVC Rejection (0018,1085) 3 Description of type of PVC rejection criteria used.
Skip Beats (0018,1086) 3 Number of beats skipped after a detected arrhythmia.
Heart Rate (0018,1088) 3 Beats per minute.
Cardiac Number of Images (0018,1090) 3 Number of images per cardiac cycle.
Trigger Window (0018,1094) 3 Percent of R-R interval, based on Heart Rate (0018,1088), prescribed as a window for a valid/usable trigger.
Reconstruction Diameter (0018,1100) 3 Diameter in mm. of the region from within which data were used in creating the reconstruction of the image. Data may exist outside this region and portions of the patient may exist outside this region.
Receive Coil Name (0018,1250) 3 Receive coil used.
Transmit Coil Name (0018,1251) 3 Transmit coil used.
Acquisition Matrix (0018,1310) 3 Dimensions of the acquired frequency /phase data before reconstruction. Multi-valued: frequency rows\frequency columns\phase rows\phase columns.
In-plane Phase Encoding Direction (0018,1312) 3 The axis of phase encoding with respect to the image. Enumerated Values: ROW = phase encoded in rows. COL = phase encoded in columns.
Flip Angle (0018,1314) 3 Steady state angle in degrees to which the magnetic vector is flipped from the magnetic vector of the primary field.
SAR (0018,1316) 3 Calculated whole body Specific Absorption Rate in watts/kilogram.
Variable Flip Angle Flag (0018,1315) 3 Flip angle variation applied during image acquisition. Enumerated Values: Y = yes N = no
dB/dt (0018,1318) 3 The rate of change of the gradient coil magnetic flux density with time (T/s).
Temporal Position Identifier (0020,0100) 3 Temporal order of a dynamic or functional set of Images.
Number of Temporal Positions (0020,0105) 3 Total number of temporal positions prescribed.
Temporal Resolution (0020,0110) 3 Time delta between Images in a dynamic or functional set of Images.
Include 'General Anatomy Optional Macro' Table 10-7 Defined Context ID for the Anatomic Region Sequence is 4030.

C.8.3.1.1 MR Image Attribute Descriptions

C.8.3.1.1.1 Image Type

For MR Images, Image Type (0008,0008) is specified to be Type 1 and use one of the following Defined Terms for Value 3:

MPR PROJECTION IMAGE T1 MAP
T2 MAP DIFFUSION MAP DENSITY MAP
PHASE MAP VELOCITY MAP IMAGE ADDITION
PHASE SUBTRACT MODULUS SUBTRACT OTHER

C.8.3.1.1.2 Samples Per Pixel

For MR Images, Samples per Pixel (0028,0002) shall have an Enumerated Value of 1.

C.8.3.1.1.3 Photometric Interpretation

For MR Images, Photometric Interpretation (0028,0004) shall have one of the following Enumerated Values:

MONOCHROME1

MONOCHROME2

See C.7.6.3.1.2 for definition of these terms.

C.8.3.1.1.4 Bits Allocated

For MR Images, Bits Allocated (0028,0100) shall have the Enumerated Value of 16.

C.8.4 Nuclear Medicine Modules

This Section describes Nuclear Medicine Series, Equipment, and Image Modules. These Modules contain Attributes that are specific to the NM Image IOD.

Note: There are some cases where it may be necessary to use several SOP Instances to encode a single NM acquisition. For example, the matrix size must remain constant within a SOP instance. Multiple matrix sizes require multiple SOP instances. Similarly, multiple gated stress levels require separate SOP instances for each stress level. However, a receiving AE is not expected to recombine them.

C.8.4.1 NM Series Module (Retired)

Section C.8.4.1 was defined in a previous version of the DICOM Standard. The Section is now retired.

C.8.4.2 NM Equipment Module (Retired)

Section C.8.4.2 was defined in a previous version of the DICOM Standard. The Section is now retired.

C.8.4.3 NM Image Module (Retired)

Section C.8.4.3 was defined in a previous version of the DICOM Standard. The Section is now retired.

C.8.4.4 NM SPECT Acquisition Image Module (Retired)

Section C.8.4.4 was defined in a previous version of the DICOM Standard. The Section is now retired.

C.8.4.5 NM Multi-gated Acquisition Image Module (Retired)

Section C.8.4.5 was defined in a previous version of the DICOM Standard. The Section is now retired.

C.8.4.6 NM/PET Patient Orientation Module

Table C.8-5 specifies the Attributes that describe the NM/PET Patient Orientation.

Table C.8-5NM/PET PATIENT ORIENTATION MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Patient Orientation Code Sequence (0054,0410) 2 Sequence that describes the orientation of the patient with respect to gravity. See C.8.4.6.1.1 for further explanation. Zero or one item shall be included in this sequence.
>Include ‘Code Sequence Macro’ Table 8.8-1 Baseline CID 19. The Coding Scheme Designator (0008,0102) shall have an Enumerated Value of “99SDM” for historical reasons. Code Meaning (0008,0104) shall be Type 3 for historical reasons.
>Patient Orientation Modifier Code Sequence (0054,0412) 2C Patient Orientation Modifier. Required if needed to fully specify the orientation of the patient with respect to gravity. See C.8.4.6.1.2 for further explanation. Zero or one item shall be included in this sequence.
>>Include ‘Code Sequence Macro’ Table 8.8-1 Baseline CID 20. The Coding Scheme Designator (0008,0102) shall have an Enumerated Value of “99SDM” for historical reasons. Code Meaning (0008,0104) shall be Type 3 for historical reasons.
Patient Gantry Relationship Code Sequence (0054,0414) 2 Sequence which describes the orientation of the patient with respect to the gantry. See Section C.8.4.6.1.3 for further explanation. Zero or one item shall be included in this sequence.
>Include ‘Code Sequence Macro’ Table 8.8-1 Baseline CID 21. The Coding Scheme Designator (0008,0102) shall have an Enumerated Value of “99SDM” for historical reasons. Code Meaning (0008,0104) shall be Type 3 for historical reasons.

C.8.4.6.1 NM/PET Patient Orientation Attribute Descriptions

C.8.4.6.1.1 Patient Orientation Code Sequence

The Patient Orientation Code Sequence (0054,0410) is used to describe the orientation of the patient with respect to gravity, and is independent of the position in the gantry.

C.8.4.6.1.2 Patient Orientation Modifier Code Sequence

The Patient Orientation Modifier Code Sequence (0054,0412) is used to modify or enhance the orientation specified by Patient Orientation Code Sequence (0054,0410).

C.8.4.6.1.3 Patient Gantry Relationship Code Sequence

Patient Gantry Relationship Code Sequence (0054,0414) is used to describe the patient direction within the gantry, such as head-first or feet-first. When imaging the extremities, these directions are related to normal anatomic position.

Example: In normal anatomic position, the fingers point towards the feet.

C.8.4.7 NM Image Pixel Module

Table C.8-6 specifies the Attributes that describe the pixel data of a NM image.

Table C.8-6NM IMAGE PIXEL MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Samples per Pixel (0028,0002) 1 Number of samples (color planes) in this image. The value shall be 1.
Photometric Interpretation (0028,0004) 1 Specifies the intended interpretation of the pixel data. See C.8.4.7.1.1 for further explanation.
Bits Allocated (0028,0100) 1 Number of bits allocated for each pixel sample. Each sample shall have the same number of bits allocated. Enumerated Values: 8, 16.
Bits Stored (0028,0101) 1 Number of bits stored for each pixel sample. Each sample shall have the same number of bits stored. The value shall be the same as the value in Bits Allocated (0028,0100).
High Bit (0028,0102) 1 Most significant bit for pixel sample data. Each sample shall have the same high bit. Shall be one less than the value in Bits Stored (0028,0101).
Pixel Spacing (0028,0030) 2 Physical distance in the patient between the center of each pixel, specified by a numeric pair - adjacent row spacing (delimiter) adjacent column spacing, in mm. See 10.7.1.3 for further explanation of the value order.

C.8.4.7.1 NM Image Pixel Attribute Descriptions

C.8.4.7.1.1 Photometric Interpretation

For NM Images, Photometric Interpretation (0028,0004) shall have one of the following Enumerated Values:

MONOCHROME2

PALETTE COLOR

See C.7.6.3.1.2 for definition of these terms.

C.8.4.8 NM Multi-frame Module

Table C.8-7 specifies the Attributes of a NM Multi-frame Image. This module is always included in a NM SOP instance, even if there is only one frame in the image.

A NM Image object is always a multi-dimensional multi-frame image. The order and organization of the frames within each image is defined by the Frame Increment Pointer (0028,0009). The Frame Increment Pointer (0028,0009) references one or more indexing vectors. An indexing vector is a 1 dimensional array with exactly one element for each frame in the image. The value of the nth element in the indexing vector represents the index for the nth frame, in that dimension. Indices are always numbered starting from 1.

Note: The scheme for encoding a multi-dimensional array of frames into a single image object is as follows. First, the definition of the data element called the Frame Increment Pointer is changed so that it can be multi-valued (i.e. its VM is now 1-n). Each value of the Frame Increment Pointer represents one of the dimensions of the array, with the last value representing the most rapidly changing index.Each value of the Frame Increment Pointer is the tag of a data element which is an indexing vector. An indexing vector is a 1 dimensional array with exactly one element for each frame in the image. The value of the n th element in the indexing vector represents the index for the n th frame, in that dimension. For example, suppose you are encoding a Dynamic image consisting of 2 phases (containing 5 and 2 frames, respectively), from each of two detectors, using one isotope, which gives a total of 14 frames in the image. For a Dynamic image, the Frame Increment Pointer is defined as:Frame Increment Pointer = Energy Window Vector (0054,0010) \ Detector Vector (0054,0020) \ Phase Vector (0054,0030) \ Time Slice Vector (0054,0100)The Pixel Data (7FE0,0010) would contain the frames in the following order:

Frame 1 2 3
Frame Increment Pointer (0028,0009) 1 Contains the Data Element Tags of one or more frame index vectors. See C.8.4.8.1.1 for further specialization.
Energy Window Vector (0054,0010) 1C An array which contains the energy window number for each frame. Required if the value of the Frame Increment Pointer (0028,0009) includes the Tag for Energy Window Vector (0054,0010). See C.8.4.8.1.2 for specialization.
Number of Energy Windows (0054,0011) 1 Number of energy window groupings. See C.8.4.8.1.2 for specialization.
Detector Vector (0054,0020) 1C An array which contains the detector number for each frame. Required if the value of the Frame Increment Pointer (0028,0009) includes the Tag for Detector Vector (0054,0020). See C.8.4.8.1.3 for specialization.
Number of Detectors (0054,0021) 1 Number of detectors. See C.8.4.8.1.3 for specialization.
Phase Vector (0054,0030) 1C An array which contains the phase number for each frame. Required if the value of the Frame Increment Pointer (0028,0009) includes the Tag for Phase Vector (0054,0030). See C.8.4.8.1.4 for specialization.
Number of Phases (0054,0031) 1C Number of phases. Required if the value of the Frame Increment Pointer (0028,0009) includes the Tag for Phase Vector (0054,0030). See C.8.4.8.1.4 for specialization.
Rotation Vector (0054,0050) 1C An array which contains the rotation number for each frame. Required if the value of the Frame Increment Pointer (0028,0009) includes the Tag for Rotation Vector (0054,0050). See C.8.4.8.1.5 for specialization.
Number of Rotations (0054,0051) 1C Number of rotations. Required if Image Type (0008,0008), Value 3 is TOMO, GATED TOMO, RECON TOMO, or RECON GATED TOMO. See C.8.4.8.1.5 for specialization.
R-R Interval Vector (0054,0060) 1C An array which contains the R-R interval number for each frame. Required if the value of the Frame Increment Pointer (0028,0009) includes the Tag for R-R Interval Vector (0054,0060). See C.8.4.8.1.6 for specialization.
Number of R-R Intervals (0054,0061) 1C Number of R-R intervals. Required if the value of the Frame Increment Pointer (0028,0009) includes the Tag for R-R Interval Vector (0054,0060). See C.8.4.8.1.6 for specialization.
Time Slot Vector (0054,0070) 1C An array which contains the time slot number for each frame. Required if the value of the Frame Increment Pointer (0028,0009) includes the Tag for Time Slot Vector (0054,0070). See C.8.4.8.1.7 for specialization.
Number of Time Slots (0054,0071) 1C Number of time slots. Required if the value of the Frame Increment Pointer (0028,0009) includes the Tag for Time Slot Vector (0054,0070). See C.8.4.8.1.7 for specialization.
Slice Vector (0054,0080) 1C An array which contains the spatial slice number for each frame. Required if the value of the Frame Increment Pointer (0028,0009) includes the Tag for Slice Vector (0054,0080). See C.8.4.8.1.8 for specialization.
Number of Slices (0054,0081) 1C Number of slices. Required if the value of the Frame Increment Pointer (0028,0009) includes the Tag for Slice Vector (0054,0080). See C.8.4.8.1.8 for specialization.
Angular View Vector (0054,0090) 1C An array which contains the angular view number for each frame. Required if the value of the Frame Increment Pointer (0028,0009) includes the Tag for Angular View Vector (0054,0090). See C.8.4.8.1.9 for specialization.
Time Slice Vector (0054,0100) 1C An array which contains the time slice number for each frame. Required if the value of the Frame Increment Pointer (0028,0009) includes the Tag for Time Slice Vector (0054,0100). See C.8.4.8.1.10 for specialization.

Note: Per the rules in PS 3.5, if a data element of Type 1C or 2C is not required, it shall not be included.

C.8.4.8.1 NM Multi-Frame Attribute Descriptions

C.8.4.8.1.1 Frame Increment Pointer

By definition, NM Images are multi-dimensional Multi-frame Images. The value of the Frame Increment Pointer (0028,0009) contains the Tag for one or more frame indexing vectors. This determines the number of dimensions of frame indices in the image, and the order in which these indices vary from one frame to the next, with the last Tag indicating the most rapidly changing index. The Enumerated Values for the Frame Increment Pointer (0028,0009) are determined by the Image Type (0008,0008), Value 3, as shown in Table C.8-8.

Table C.8-8ENUMERATED VALUES FOR FRAME INCREMENT POINTER

Image Type (0008,0008), Value 3 Frame Increment Pointer (0028,0009)
STATIC or WHOLE BODY 0054H 0010H \ 0054H 0020H Sequencing is by Energy Window Vector (0054,0010), Detector Vector (0054,0020).
DYNAMIC 0054H 0010H \ 0054H 0020H \ 0054H 0030H \ 0054H 0100H Sequencing is by Energy Window Vector (0054,0010), Detector Vector (0054,0020), Phase Vector (0054,0030), Time Slice Vector (0054,0100)
GATED 0054H 0010H \ 0054H 0020H \ 0054H 0060H \ 0054H 0070H Sequencing is by Energy Window Vector (0054,0010), Detector Vector (0054,0020), R-R Interval Vector(0054,0060), Time Slot Vector (0054,0070)
TOMO 0054H 0010H \ 0054H 0020H \ 0054H 0050H \ 0054H 0090H Sequencing is by Energy Window Vector (0054,0010), Detector Vector (0054,0020), Rotation Vector (0054,0050), Angular View Vector (0054,0090)
GATED TOMO 0054H 0010H \ 0054H 0020H \ 0054H 0050H \ 0054H 0060H \ 0054H 0070H \ 0054H 0090H Sequencing is by Energy Window Vector (0054,0010), Detector Vector (0054,0020), Rotation Vector (0054,0050), R-R Interval Vector (0054,0060), Time Slot Vector (0054,0070), Angular View Vector (0054,0090).
RECON TOMO 0054H 0080H Sequencing is by Slice Vector (0054,0080)
RECON GATED TOMO 0054H 0060H \ 0054H 0070H \ 0054H 0080H Sequencing is by R-R Interval Vector (0054,0060), Time Slot Vector (0054,0070), Slice Vector (0054,0080)

C.8.4.8.1.2 Number of Energy Windows and Energy Window Vector

Number of Energy Windows (0054,0011) is the number of distinct energy window groupings acquired in this image. See C.8.4.10.1. When Image Type (0008,0008), Value 3, is RECON TOMO or RECON GATED TOMO, then the Number of Energy Windows (0054,0011) shall be 1.

Energy Window Vector (0054,0010) is an indexing vector. The value of the nth element of this vector is the energy window number for the nth frame in this image, and shall have a value from 1 to Number of Energy Windows (0054,0011).

C.8.4.8.1.3 Number of Detectors and Detector Vector

Number of Detectors (0054,0021) is the number of separate detectors which differentiate the frames in this image. When Image Type (0008,0008), Value 3, is RECON TOMO or RECON GATED TOMO, then the Number of Detectors (0054,0021) shall be 1.

Note: Number of Detectors (0054,0021) does not necessarily represent the actual number of detectors used during data acquisition.

Example 1: In a TOMO acquisition in which frames from 2 or more detectors are interleaved to form one continuous set of frames, then no distinction is made between frames on the basis of which detector created them. In this case, the Number of Detectors (0054,0021) would be 1.

Example 2: In a WHOLE BODY acquisition in which a single detector acquires anterior and posterior views in two separate passes, the Number of Detectors (0054,0021) would be 2.

Detector Vector (0054,0020) is an indexing vector. The value of the nth element of this vector is the detector number of the nth frame in this image, and shall have a value from 1 to Number of Detectors (0054,0021).

C.8.4.8.1.4 Number of Phases and Phase Vector

Number of Phases (0054,0031) is the number of dynamic phases, independent of the number of Detectors and Isotopes. See Section C.8.4.14 for definition of a phase.

Phase Vector (0054,0030) is an indexing vector. The value of the nth element of this vector is the phase number of the nth frame in this image, and shall have a value from 1 to Number of Phases (0054,0031).

C.8.4.8.1.5 Number of Rotations and Rotation Vector

Number of Rotations (0054,0051) is the number of separate rotations. See Section C.8.4.12 for definition of a rotation. When Image Type (0008,0008), Value 3, is RECON TOMO, GATED TOMO or RECON GATED TOMO, then the Number of Rotations (0054,0051) shall be 1.

Rotation Vector (0054,0050) is an indexing vector. The value of the nth element of this vector is the rotation number of the nth frame in this image, and shall have a value from 1 to Number of Rotations (0054,0051).

C.8.4.8.1.6 Number of R-R Intervals and R-R Interval Vector

Number of R-R Intervals (0054,0061) is the number of ranges of heartbeat durations collected. A gated acquisition may employ one R-R Interval to collect data from normal beats, a second R-R Interval to collect data from ectopic beats, and possibly others. Each R-R Interval accepts beats whose duration is greater than its Low R-R Value (0018,1081) and shorter than its High R-R Value (0018,1082). Beats which do not fall within these ranges may be accepted by another R-R Interval, or may be rejected.

The Number of R-R Intervals (0054,0061) is the total number of such ranges.

R-R Interval Vector (0054,0060) is an indexing vector. The value of the nth element of this vector is the interval number of the nth frame in this image, and shall have a value from 1 to Number of R-R Intervals (0054,0061).

C.8.4.8.1.7 Number of Time Slots and Time Slot Vector

Number of Time Slots (0054,0071) is the number of frames into which each gating event is divided in a gated acquisition. For example, in a cardiac gated acquisition, data from a number of heartbeats are then combined by summing together the first frames from all beats into a summed first frame, all the second frames into a summed second frame, and so on. The result has the same number of frames as the Number of Time Slots in each beat.

Time Slot Vector (0054,0070) is an indexing vector. The value of the nth element of this vector is the time slot number of the nth frame in this image, and shall have a value from 1 to Number of Time Slots (0054,0071).

C.8.4.8.1.8 Number of Slices and Slice Vector

Number of Slices (0054,0081) is the number of slices in each separate volume.

Note: For images with Image Type (0008,0008), Value 3, equal to RECON GATED TOMO this implies that Number of Slices (0054,0081) is the same for all R-R Intervals and Time Slots.

Slice Vector (0054,0080) is an indexing vector. The value of the nth element of this vector is the slice number of the nth frame in this image, and shall have a value from 1 to Number of Slices (0054,0081).

C.8.4.8.1.9 Angular View Vector

Angular View Vector (0054,0090) is an indexing vector. The value of the nth element of this vector is the angular view number of the nth frame in this image. If Image Type (0008,0008), Value 3, is TOMO or GATED TOMO, then the value shall be from 1 to Number of Frames in Rotation (0054,0053).

C.8.4.8.1.10 Time Slice Vector

Time Slice Vector (0054,0100) is an indexing vector. The value of the nth element of this vector is the time slice number of the nth frame in this image, and shall have a value from 1 to Number of Frames in Phase (0054,0033).

C.8.4.9 NM Image Module

Table C.8-9 contains the Attributes that describe Nuclear Medicine Images.

Table C.8-9NM IMAGE MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Image Type (0008,0008) 1 Image identification characteristics. See C.8.4.9.1.1 for specialization.
Image ID (0054,0400) 3 User or equipment generated Image identifier.
Lossy Image Compression (0028,2110) 1C Specifies whether an Image has undergone lossy compression. Enumerated Values: 00 = Image has NOT been subjected to lossy compression. 01 = Image has been subjected to lossy compression. See C.7.6.1.1.5 Required if Lossy Compression has been performed on the Image.
Counts Accumulated (0018,0070) 2 Sum of all gamma events for all frames in the image. See C.8.4.9.1.2 for specialization.
Acquisition Termination Condition (0018,0071) 3 Description of how the data collection was stopped. Defined Terms: CNTS = counts DENS = density MANU = manual OVFL = data overflow TIME = time TRIG = physiological trigger See C.8.4.9.1.3 for specialization.
Table Height (0018,1130) 3 The height of the patient table in mm. The range and values of this element are determined by the manufacturer. Should not be included if Image Type (0008,0008), Value 3, is TOMO, GATED TOMO, RECON TOMO or RECON GATED TOMO.
Table Traverse (0018,1131) 3 Location of the patient table (or gantry relative to the table) in mm. The range and values of this element are determined by the manufacturer. Should not be included if Image Type (0008,0008), Value 3, is TOMO, GATED TOMO, RECON TOMO or RECON GATED TOMO.
Actual Frame Duration (0018,1242) 1C Elapsed time for data acquisition in msec. Required if Image Type (0008,0008) Value 3 is: WHOLE BODY or STATIC. See C.8.4.9.1.4 for specialization.
Count Rate (0018,1243) 3 Maximum count rate achieved during the acquisition in counts/sec.
Processing Function (0018,5020) 3 Code or description of processing functions applied to the data.
Corrected Image (0028,0051) 3 One or more values that indicate which, if any, corrections have been applied to the image. Corrections are applied to all frames in the image. Defined Terms: UNIF = flood corrected COR = center of rotation corrected NCO = non-circular orbit corrected DECY = decay corrected ATTN = attenuation corrected SCAT = scatter corrected DTIM = dead time corrected NRGY = energy corrected LIN = linearity corrected MOTN = motion corrected CLN = count loss normalization; Any type of normalization applied to correct for count loss in Time Slots.
Whole Body Technique (0018,1301) 3 The type of scan performed. Used only if Image Type (0008,0008), Value 3, contains the value WHOLE BODY. Enumerated Values: 1PS = one pass 2PS = two pass PCN = patient contour following employed MSP = multiple static frames collected into a whole body frame.
Scan Velocity (0018,1300) 2C The speed of the camera motion over the body in mm/sec. Required if Image Type (0008,0008) Value 3 contains the value WHOLE BODY.
Scan Length (0018,1302) 2C Size of the imaged area in the direction of scanning motion, in mm. Required if Image Type (0008,0008) Value 3 contains the value WHOLE BODY.
Trigger Source or Type (0018,1061) 3 Text indicating trigger source. Defined Term: EKG
Include 'General Anatomy Optional Macro' Table 10-7 No Context ID for the Anatomic Region Sequence is defined.
Referenced Image Real World Value Mapping Sequence (0040,9094) 3 A sequence of real world value mapping items. One or more Items are permitted in this sequence. Each item defines a single mapping and a list of images to which the mapping applies.
>Include Real World Value Mapping Macro Table C.7.6.16-12 Defined Context ID for Measurement Units Code Sequence is 84 “PET Units for Real World Value Mapping”.

Notes: 1. Content Date (0008,0023) and Content Time (0008,0033) are included in the General Image Module, Table C.7-7, whenever the images are temporally related. For this purpose, all NM Images are considered temporally related, so that these elements are included in an NM Image.

2. Referenced Overlay Sequence (0008,1130) and Referenced Curve Sequence (0008,1145) were previously included in this Module as optional Attributes but have been retired. See PS 3.3 2004.

C.8.4.9.1 NM Image Module Attribute Descriptions

C.8.4.9.1.1 Image Type

For NM images, Image Type (0008,0008) Value 3 is specified to be Type 1 and use one of the following Enumerated Values:

STATIC

DYNAMIC

GATED

WHOLE BODY

TOMO

GATED TOMO

RECON TOMO

RECON GATED TOMO

For NM images, Image Type (0008,0008) Value 4 is specified to use one of the following Enumerated Values:

EMISSION

TRANSMISSION

Note: For NM images, Image Type (0008,0008) Value 1 will be ORIGINAL for all raw data and reconstructed images. DERIVED may be appropriate for some other results images.

For NM images, Image Type (0008,0008) Value 2 will be PRIMARY.

C.8.4.9.1.2 Counts Accumulated

Counts Accumulated (0018,0070) is the total of all gamma events accumulated in all frames of this Image. This attribute applies to acquisition data, and often does not apply to processed images (DERIVED, SECONDARY).

C.8.4.9.1.3 Acquisition Termination Condition

Acquisition Termination Condition (0018,0071) is the method of acquisition termination which was actually applied to the data collection. The Defined Terms and definitions are:

CNTS = preset count limit was reached

DENS = preset count density was reached

MANU = acquisition was terminated manually

OVFL = acquisition was terminated automatically by pixel data overflow condition

TIME = preset time limit was reached

TRIG = preset number of physiological triggers was reached

C.8.4.9.1.4 Actual Frame Duration

Actual Frame Duration (0018,1242) is defined as the elapsed time in msec for a single frame of an acquisition. For some types of multi-frame images, Actual Frame Duration (0018,1242) may have a more specialized meaning as defined in the appropriate IOD Module.

C.8.4.10 NM Isotope Module

Table C.8-10 contains Attributes that describe the isotope administered for the acquisition.

Table C.8-10NM ISOTOPE MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Energy Window Information Sequence (0054,0012) 2 Sequence of Items that describe the energy window groups used. Zero or more Items shall be included in this sequence. The number of items shall be equal to Number of Energy Windows (0054,0011). The first item corresponds to frames with value of 1 in the Energy Window Vector (0054,0010), the second item with value 2, etc.
>Energy Window Name (0054,0018) 3 A user defined name which describes this Energy Window.
>Energy Window Range Sequence (0054,0013) 3 Sequence of Items that describes this energy window group. One or more Items are permitted in this Sequence.
>>Energy Window Lower Limit (0054,0014) 3 The lower limit of the energy window in KeV. See C.8.4.10.1.1 for further explanation.
>>Energy Window Upper Limit (0054,0015) 3 The upper limit of the energy window in KeV. See C.8.4.10.1.2 for further explanation.
Radiopharmaceutical Information Sequence (0054,0016) 2 Sequence of Items that describe isotope information. Zero or more Items shall be included in this sequence.
>Radionuclide Code Sequence (0054,0300) 2 Sequence that identifies the radionuclide. Zero or one item shall be included in this sequence.
>>Include ‘Code Sequence Macro’ Table 8.8-1 Baseline CID 18. The Coding Scheme Designator (0008,0102) shall have an Enumerated Value of “99SDM” for historical reasons. Code Meaning (0008,0104) shall be Type 3 for historical reasons.
>Radiopharmaceutical Route (0018,1070) 3 Route of injection.
>Administration Route Code Sequence (0054,0302) 3 Sequence that identifies the administration route for the radiopharmaceutical. Only a single Item is permitted in this sequence.
>>Include ‘Code Sequence Macro’ Table 8.8-1 Baseline CID 11. Code Meaning (0008,0104) shall be Type 3 for historical reasons.
>Radiopharmaceutical Volume (0018,1071) 3 Volume of injection in cubic cm.
>Radiopharmaceutical Start Time (0018,1072) 3 Time of start of injection. See C.8.4.10.1.5 for further explanation.
>Radiopharmaceutical Stop Time (0018,1073) 3 Time of end of injection. See C.8.4.10.1.6 for further explanation.
>Radionuclide Total Dose (0018,1074) 3 Total amount of radionuclide injected. See C.8.4.10.1.7 for further explanation.
>Calibration Data Sequence (0054,0306) 3 Sequence that contains calibration data. One or more Items are permitted in this Sequence.
>>Energy Window Number (0054,0308) 1 The Item number in the Energy Window Information Sequence to which the following calibration data relates. The Items are numbered starting from 1.
>>Syringe Counts (0018,1045) 3 Pre-injection syringe count rate in counts/sec. See C.8.4.10.1.8 for further explanation.
>>Residual Syringe Counts (0054,0017) 3 Post-injection residue syringe count rate in counts/sec. See C.8.4.10.1.9 for further explanation.
>Radiopharmaceutical (0018,0031) 3 Name of the radiopharmaceutical.
>Radiopharmaceutical Code Sequence (0054,0304) 3 Sequence that identifies the radiopharmaceutical. Only a single Item is permitted in this sequence.
>>Include ‘Code Sequence Macro’ Table 8.8-1 Baseline CID 25. Code Meaning (0008,0104) shall be Type 3 for historical reasons.
Intervention Drug Information Sequence (0018,0026) 3 Sequence of Items that describes the intervention drugs used. One or more Items are permitted in this sequence.
>Intervention Drug Name (0018,0034) 3 Name of intervention drug.
>Intervention Drug Code Sequence (0018,0029) 3 Sequence that identifies the intervention drug name. Only a single Item is permitted in this Sequence.
>>Include ‘Code Sequence Macro’ Table 8.8-1 Baseline CID 10. Code Meaning (0008,0104) shall be Type 3 for historical reasons.
>Administration Route Code Sequence (0054,0302) 3 Sequence that identifies the administration route for the intervention drug. Only a single Item is permitted in this sequence.
>>Include ‘Code Sequence Macro’ Table 8.8-1 Baseline CID 11. Code Meaning (0008,0104) shall be Type 3 for historical reasons.
>Intervention Drug Start Time (0018,0035) 3 Time of administration of the intervention drug, using the same time base as for the Acquisition Start Time (0008,0032).
>Intervention Drug Stop Time (0018,0027) 3 Time of completion of administration of the intervention drug, using the same time base as for the Acquisition Start Time (0008,0032).
>Intervention Drug Dose (0018,0028) 3 Intervention drug dose, in mg.

C.8.4.10.1 NM Isotope Module Attribute Descriptions

C.8.4.10.1.1 Energy Window Lower Limit

Energy Window Lower Limit (0054,0014) is the acquisition energy window lower limit in KeV for acceptance of scintillation events into this Isotope.

C.8.4.10.1.2 Energy Window Upper Limit

Energy Window Upper Limit (0054,0015) is the acquisition energy window upper limit in KeV for acceptance of scintillation events into this Isotope.

C.8.4.10.1.3 (Retired)

C.8.4.10.1.4 (Retired)

C.8.4.10.1.5 Radiopharmaceutical Start Time

Radiopharmaceutical Start Time (0018,1072) is the actual time of radiopharmaceutical administration to the patient for imaging purposes, using the same time base as for the Acquisition Start Time (0008,0032).

C.8.4.10.1.6 Radiopharmaceutical Stop Time

Radiopharmaceutical Stop Time (0018,1073) is the actual ending time of radiopharmaceutical administration to the patient for imaging purposes, using the same time base as for the Acquisition Start Time (0008,0032).

C.8.4.10.1.7 Radionuclide Total Dose

Radionuclide Total Dose (0018,1074) is the radiopharmaceutical dose administered to the patient measured in MegaBecquerels (Mbq) at the Radiopharmaceutical Start Time.

C.8.4.10.1.8 Syringe Counts

Syringe Counts (0018,1045) is the pre-injection syringe acquisition count rate measured in counts/sec, corrected to the Acquisition Start Time (0008,0032) if necessary.

C.8.4.10.1.9 Residual Syringe Counts

Residual Syringe Counts (0054,0017) is the syringe acquisition count rate following patient injection, measured in counts/sec, corrected to the Acquisition Start Time (0008,0032) if necessary.

C.8.4.10.1.10 (Retired)

C.8.4.10.1.11 (Retired)

C.8.4.11 NM Detector Module

Table C.8-11 contains IOD Attributes that describe Nuclear Medicine Detectors used to produce an image.

Table C.8-11NM DETECTOR MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Detector Information Sequence (0054,0022) 2 Sequence of Items that describe the detectors used. Zero or more Items shall be included in this sequence. The number of items shall be equal to Number of Detectors (0054,0021). The first item corresponds to frames with value of 1 in the Detector Vector (0054,0020), the second item with value 2, etc.
>Collimator/Grid Name (0018,1180) 3 Label describing the collimator used (LEAP, hires, etc.)
>Collimator Type (0018,1181) 2 Collimator type. Defined Terms: PARA = Parallel (default) PINH = Pinhole FANB = Fan-beam CONE = Cone-beam SLNT = Slant hole ASTG = Astigmatic DIVG = Diverging NONE = No collimator UNKN = Unknown
>Field of View Shape (0018,1147) 3 Shape of the field of view of the Nuclear Medicine detector. Defined Terms: RECTANGLE ROUND HEXAGONAL
>Field of View Dimension(s) (0018,1149) 3 Dimensions of the field of view, in mm. If Field of View Shape (0018,1147) is: RECTANGLE: row dimension followed by column. ROUND: diameter. HEXAGONAL: diameter of a circumscribed circle.
>Focal Distance (0018,1182) 2 Focal distance, in mm. A value of 0 means infinite distance for parallel collimation. See C.8.4.11.1.1 for further specialization.
>X Focus Center (0018,1183) 3 Center of focus along a row. See C.8.4.11.1.2 for further explanation.
>Y Focus Center (0018,1184) 3 Center of focus along a column. See C.8.4.11.1.2 for further explanation.
>Zoom Center (0028,0032) 3 The amount of offset from (0,0) applied to each pixel in the image before application of the zoom factor, specified by a numeric pair: row value (delimiter) column value (in mm). See C.8.4.11.1.3 for further explanation.
>Zoom Factor (0028,0031) 3 The amount of magnification applied to each pixel in the image, specified by a numeric pair: row value (delimiter) column value. See C.8.4.11.1.4 for further explanation.
>Center of Rotation Offset (0018,1145) 3 Average center of rotation offset of Nuclear Medicine detector in mm. See C.8.4.11.1.5 for further explanation.
>Gantry/Detector Tilt (0018,1120) 3 Angle of tilt in degrees of the detector. See C.8.4.11.1.6 for further explanation.
>Distance Source to Detector (0018,1110) 2C Distance in mm from transmission source to the detector face. Required if Image Type (0008,0008) Value 4 is TRANSMISSION and Value 3 is not any of: TOMO, GATED TOMO, RECON TOMO or RECON GATED TOMO.
>Start Angle (0054,0200) 3 Position of the detector about the patient for the start of the acquisition, in degrees. Zero degrees is referenced to the origin at the patient's back. Viewing from the patient's feet, angle increases in a counter-clockwise direction (detector normal rotating from the patient's back towards the patient's left side). Should not be included if Image Type (0008,0008), Value 3, is TOMO, GATED TOMO, RECON TOMO or RECON GATED TOMO.
>Radial Position (0018,1142) 3 Radial distance of the detector from the center of rotation, in mm. Should not be included if Image Type (0008,0008), Value 3, is TOMO, GATED TOMO, RECON TOMO or RECON GATED TOMO.
>Image Orientation (Patient) (0020,0037) 2 The direction cosines of the first row and the first column with respect to the patient. See C.7.6.2.1.1 for further explanation.
>Image Position (Patient) (0020,0032) 2 The x, y, and z coordinates of the upper left hand corner (center of the first voxel transmitted) of the image, in mm. See C.7.6.2.1.1 for further explanation.
>View Code Sequence (0054,0220) 3 Sequence that describes the projection of the anatomic region of interest on the image receptor. Only a single Item is permitted in this sequence.
>>Include ‘Code Sequence Macro’ Table 8.8-1 Baseline CID 26 . Code Meaning (0008,0104) shall be Type 3 for historical reasons.
>>View Modifier Code Sequence (0054,0222) 2C View Modifier. Required if needed to fully specify the View. Zero or one Item shall be included in this sequence.
>>>Include ‘Code Sequence Macro’ Table 8.8-1 Baseline CID 23. Code Meaning (0008,0104) shall be Type 3 for historical reasons.

C.8.4.11.1 NM Detector Attribute Descriptions

C.8.4.11.1.1 Focal Distance

Focal Distance (0018,1182) for NM Image data is the focal distance, in mm for converging or diverging collimators, measured from the front face of the detector to the focus. Positive values indicate converging and negative values indicate diverging collimators. A value of 0 means infinite distance for parallel collimation.

C.8.4.11.1.2 Focus Center

X Focus Center (0018,1183) and Y Focus Center (0018,1184) for NM Image data is used to define the projection of the focus for a converging or diverging collimator within the un-zoomed Field of View. It is defined in mm for row and column relative to the center of the un-zoomed Field of View.

C.8.4.11.1.3 Zoom Center

Zoom Center (0028,0032) is the offset between the un-zoomed camera field of view and field of view, measured from the center of the un-zoomed camera field of view to the center the of the zoomed field of view. The offset is measured in mm in the un-zoomed camera FOV dimensions. Positive values are to the right and down from the un-zoomed center, as viewed from the image plane. When this attribute is not given, the Zoom Center is assumed to be 0\0.

C.8.4.11.1.4 Zoom Factor

Zoom Factor (0028,0031) is the magnification factor that was used during the acquisition. When this attribute is not given, it is assumed to be 1.0\1.0.

Note: Zoom Factor (0028,0031) is informational only. Pixel Spacing (0028,0030) already takes account of this and any other changes to pixel size.

C.8.4.11.1.5 Center of Rotation Offset

Center of Rotation Offset (0018,1145) is the average amount of offset in mm between the Detector Field of View center and the physical center of rotation of the gantry for circular orbital scans. Positive values indicate the physical center is to the right of the image plane center.

If:

1) Image Type (0008,0008) Value 3 is TOMO or GATED TOMO, and

2) Corrected Image (0028,0051) does not include the value "COR", and

3) Center of Rotation Offset (0018,1145) is non-zero,

then the receiver should assume that Center of Rotation correction has not already been done.

If the Center of Rotation Offset is zero, no correction shall be applied.

C.8.4.11.1.6 Gantry/Detector Tilt

Gantry/Detector Tilt (0018,1120) for NM Image data is the angle in degrees of the detector face relative to the patient's major (Head to Feet) axis (or the table supporting the patient). Positive tilt is towards the patient’s feet.

C.8.4.12 NM TOMO Acquisition Module

This Module applies to a TOMO Multi-frame Image. This module is present when the Image Type (0008,0008) Value 3, is equal to TOMO, GATED TOMO, RECON TOMO, or RECON GATED TOMO. The elements found in this module describe the acquisition of the Image.

Table C.8-12NM TOMO ACQUISITION MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Rotation Information Sequence (0054,0052) 2 Sequence of Items that describe TOMO rotational groups. A new rotation is defined whenever the direction of the detector motion changes, or the Table Traverse (0018,1131) changes. Zero or more Items shall be included in this sequence. The number of items shall be equal to Number of Rotations (0054,0051). If Rotation Vector (0054,0050) is present, the first item corresponds to frames with value of 1 in the Rotation Vector (0054,0050), the second item with value 2, etc.
>Start Angle (0054,0200) 1 Position of the detector about the patient for the start of this rotation, in degrees. Zero degrees is referenced to the origin at the patient's back. Viewing from the patient's feet, angle increases in a counter-clockwise direction (detector normal rotating from the patient's back towards the patient's left side).
>Angular Step (0018,1144) 1 The angular scan arc step between views of the TOMO acquisition, in degrees. See C.8.4.12.1.1 for further explanation.
>Rotation Direction (0018,1140) 1 Direction of rotation of the detector about the patient. See Start Angle (0054,0200) for further explanation of direction. Enumerated Values: CW = clockwise (decreasing angle) CC = counter-clockwise (increasing angle).
>Scan Arc (0018,1143) 1 The effective angular range of the scan data in degrees. The value shall be positive.
>Actual Frame Duration (0018,1242) 1 Nominal acquisition time per angular position, in msec.
>Radial Position (0018,1142) 3 Radial distance of the detector from the center of rotation, in mm. It shall have a single value which is an average value for this rotation, or it shall have one value per angular view.
>Distance Source to Detector (0018,1110) 2C Distance in mm from transmission source to the detector face. Required if Image Type (0008,0008) Value 4 is TRANSMISSION.
>Number of Frames in Rotation (0054,0053) 1 Number of angular views in this rotation.
>Table Traverse (0018,1131) 3 Location of the patient table (or gantry relative to the table) in mm.The range and values of this element are determined by the manufacturer.
>Table Height (0018,1130) 3 The distance in mm of the top of the patient table to the center of rotation. Table height below the center of rotation has a positive value.
Type of Detector Motion (0054,0202) 3 Describes the detector motion during acquisition. Enumerated Values: STEP AND SHOOT = Interrupted motion, acquire only while stationary. CONTINUOUS = Gantry motion and acquisition are simultaneous and continuous. ACQ DURING STEP = Interrupted motion, acquisition is continuous.

C.8.4.12.1 NM TOMO Acquisition Attribute Descriptions

C.8.4.12.1.1 Angular Step

Angular Step (0018,1144) is the nominal frame-to-frame incremental angle for TOMO and GATED TOMO acquisition images, defined in degrees. The Angular Step (0018,1144) shall be a positive number. Summation of Angular Step values is not defined to give accurate Angular Position or Scan Arc values. The Angular Step is the effective angular spacing between resultant frames of the Multi-framed planar image data.

C.8.4.13 NM Multi-gated Acquisition Module

Table C.8-13 contains Attributes that describe a multi-gated acquisition image performed on the patient. This refers to frames acquired while the patient is connected to a gating device.

Table C.8-13NM MULTI-GATED ACQUISITION MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Beat Rejection Flag (0018,1080) 3 Heart beat duration sorting has been applied. Enumerated Values: Y = yes N = no
PVC Rejection (0018,1085) 3 Description of type of arrhythmic beat rejection criteria used.
Skip Beats (0018,1086) 3 Number of beats skipped after a detected arrhythmia
Heart Rate (0018,1088) 3 Average number of heart beats per minute for the collection period for these frames. This shall include all accepted beats as well as rejected beats.
Gated Information Sequence (0054,0062) 2C Sequence of Items that describe R-R intervals. Each gated interval is defined by an upper and lower range of heart beat durations. Required if the Frame Increment Pointer (0028,0009) contains the Tag for R-R Interval Vector (0054,0060). Zero or more Items shall be included in this sequence. The number of items shall be equal to Number of R-R Intervals (0054,0061). The first item corresponds to frames with value of 1 in the R-R Interval Vector (0054,0060), the second item with value 2, etc.
>Trigger Time (0018,1060) 3 Time interval measured in msec from the start of the R-wave to the beginning of the data taking.
>Cardiac Framing Type (0018,1064) 3 Description of type of framing performed. See C.7.6.18.1.1.1 for description and Defined Terms.
>Data Information Sequence (0054,0063) 2 Sequence of Items that describe gating criteria. Zero or more Items shall be included in this sequence. See C.8.4.13.1.1.
>>Frame Time (0018,1063) 1 Nominal time per individual frame in msec.
>>Nominal Interval (0018,1062) 3 Average duration of accepted beats, in msec.
>>Low R-R Value (0018,1081) 3 R-R interval lower limit for beat rejection, in msec
>>High R-R Value (0018,1082) 3 R-R interval upper limit for beat rejection, in msec
>>Intervals Acquired (0018,1083) 3 Number of heartbeats that fall within Low R-R Value (0018,1081) and High R-R Value (0018,1082), and were therefore accepted and contribute gamma events to this R-R Interval.
>>Intervals Rejected (0018,1084) 3 Number of heartbeats that fall outside Low R-R (0018,1081) and High R-R Value (0018,1082), and do not contribute gamma events to this R-R Interval. However, they may contribute gamma events to other R-R Intervals.
>>Time Slot Information Sequence (0054,0072) 2C Sequence of Items that describe Time Slot Information. Required if the Frame Increment Pointer (0028,0009) contains the Tag for Time Slot Vector (0054,0070). Zero or more Items shall be included in this sequence. The number of items shall be equal to Number of Time Slots (0054,0071). The first item corresponds to frames with value of 1 in the Time Slot Vector (0054,0070), the second item with value 2, etc.
>>>Time Slot Time (0054,0073) 3 The total amount of time, in msec, that the acquisition accumulates gamma events into this frame. See C.8.4.13.1.2.

C.8.4.13.1 NM Multi-gated Acquisition Attribute Descriptions

C.8.4.13.1.1 Data Information Sequence

Data Information Sequence (0054,0063) shall contain a single sequence item which applies to the sum of all angular views, except when Image Type (0008,0008) Value 3 is GATED TOMO. In this case it shall have either a single item which applies to the sum of all angular views, or it shall have one item for each angular view.

C.8.4.13.1.2 Time Slot Time

The Time Slot Time (0054,0073) records the effective imaging time of each Time Slot. For example, if some of the accepted beats are shorter than others then the last frames may not receive a contribution from the shorter beats. The Time Slot Time for a Time Slot is the total acquisition time for that Time Slot. It is approximately equal to the Frame Time (0018,1063) multiplied by the number of accepted beats contributing to the Time Slot.

C.8.4.14 NM Phase Module

Table C.8-14 contains Attributes that describe dynamic phases of a dynamic acquisition image performed on the patient. This module is present only when Image Type (0008,0008), Value 3, is equal to DYNAMIC. A phase is defined as a collection of frames in which the acquisition time per frame and the time delay between frames remains constant. A new phase shall be defined whenever there is a change in the time between frames, the acquisition time per frame, or the position of the patient relative to the detector.

Table C.8-14NM PHASE MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Phase Information Sequence (0054,0032) 2C Sequence of Items that describes each dynamic phase. Required if the Frame Increment Pointer (0028,0009) contains the Tag for Phase Vector (0054,0030). Zero or more Items shall be included in this sequence. The number of items shall be equal to Number of Phases (0054,0031). The first item corresponds to frames with value of 1 in the Phase Vector (0054,0030), the second item with value 2, etc.
>Phase Delay (0054,0036) 1 Time paused between the last frame of the previous phase and the first frame of this phase, in msec.
>Actual Frame Duration (0018,1242) 1 Nominal time of acquisition per individual frame, in msec.
>Pause Between Frames (0054,0038) 1 Time paused between each frame of this phase (in msec).
>Number of Frames in Phase (0054,0033) 1 Number of frames in this phase.
>Trigger Vector (0054,0210) 3 An array of trigger times when gating information is acquired simultaneously with the dynamic image data. See Section C.8.4.14.1.1 for further explanation.
>Number of Triggers in Phase (0054,0211) 1C The number of entries in the Trigger Vector (0054,0210) for this phase. Required if Trigger Vector (0054,0210) is present.
>Phase Description (0054,0039) 3 Description of this phase of the Dynamic image. Defined Terms: FLOW WASHOUT UPTAKE EMPTYING EXCRETION

C.8.4.14.1 NM Phase Module Attributes Description

C.8.4.14.1.1 Trigger Vector

Trigger Vector (0054,0210) is an array containing a list of the inter-trigger interval times in milliseconds in the order in which they were acquired, with the first being measured from the start time of the first frame of the image data in the Phase. If this element is used, the start times are required to be the same so that a mathematical correlation can be made between trigger times and frame start times.

C.8.4.15 NM Reconstruction Module

Table C.8-15 contains Attributes that describe Nuclear Medicine reconstructed volumes. Reconstructed volumes are created by applying a transformation (reconstruction) process to the acquired TOMO frames. This module is present only when the Image Type (0008,0008), Value 3, is equal to RECON TOMO or RECON GATED TOMO .

Table C.8-15 NM RECONSTRUCTION MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Spacing Between Slices (0018,0088) 2 Spacing between slices, in mm, measured from center-to-center of each slice along the normal to the first image. The sign of the Spacing Between Slices (0018,0088) determines the direction of stacking. The normal is determined by the cross product of the direction cosines of the first row and first column of the first frame, such that a positive spacing indicates slices are stacked behind the first slice and a negative spacing indicates slices are stacked in front of the first slice. See Image Orientation (0020,0037) in the NM Detector module.
Reconstruction Diameter (0018,1100) 3 Diameter, in mm, of the region from within which the data was used in creating the reconstruction of the image. Data may exist outside this region and portions of the patient may exist outside this region.
Convolution Kernel (0018,1210) 3 A label describing the convolution kernel or algorithm used to reconstruct the data.
Slice Thickness (0018,0050) 2 Nominal slice thickness, in mm.
Slice Location (0020,1041) 3 Relative position of the image plane expressed in mm. See C.7.6.2.1.2 for further explanation.
Slice Progression Direction (0054,0500) 3 Describes the anatomical direction that slices are progressing as the slices are considered in order (as defined by the Slice Vector (0054,0080)). Meaningful only for cardiac images. When View Code Sequence (0054,0220) indicates a short axis view, then Enumerated Values are: APEX_TO_BASE BASE_TO_APEX

C.8.5 Ultrasound Modules

This Section describes Ultrasound Frame of Reference and Image Modules. These Modules contain Attributes that are specific to Ultrasound images.

C.8.5.1 US Frame of Reference Module (Retired)

Section C.8.4.1 was defined in a previous version of the DICOM Standard. The Section is now retired.

C.8.5.2 US Region Calibration (Retired)

Section C.8.4.2 was defined in a previous version of the DICOM Standard. The Section is now retired.

C.8.5.3 US Image Module (Retired)

Section C.8.4.3 was defined in a previous version of the DICOM Standard. The Section is now retired.

C.8.5.4 US Frame of Reference Module

Section C.8.5.4 was defined in a previous version of the DICOM Standard. The Section is now retired. See PS 3.3 2003.

C.8.5.5 US Region Calibration Module

The US Region Calibration Module has been introduced into the ultrasound IOD to provide access to the full range of data that may be present in a single US image. US images often contain multiple regions that have independent data regions, e.g. quad screen loops that may have different calibration information. The data presented in the various regions of a US image can represent a multiplicity of physical parameters, e.g., spatial distance, blood velocity, time, volume, etc., and these are often contained in the value of the pixel itself. It is therefore imperative that physical information be available for the various regions of a single region independent of each other.

Table C.8-17 contains IOD Attributes that describe an ultrasound region calibration.

Table C.8-17US REGION CALIBRATION MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Sequence of Ultrasound Regions (0018,6011) 1 Defines a sequence of Ultrasound Regions. One or more Items shall be included in this Sequence.
>Region Location Min x0 (0018,6018) 1 The bounds of a rectangle specifying the location of the region, x0,y0,x1,y1. See C.8.5.5.1.14 for further explanation.
>Region Location Min y0 (0018,601A) 1 The bounds of a rectangle specifying the location of the region, x0,y0,x1,y1. See C.8.5.5.1.14 for further explanation.
>Region Location Max x1 (0018,601C) 1 The bounds of a rectangle specifying the location of the region, x0,y0,x1,y1. See C.8.5.5.1.14 for further explanation.
>Region Location Max y1 (0018,601E) 1 The bounds of a rectangle specifying the location of the region, x0,y0,x1,y1. See C.8.5.5.1.14 for further explanation.
>Physical Units X Direction (0018,6024) 1 The physical units of the dimensions of the region. See C.8.5.5.1.15 for Enumerated Values.
>Physical Units Y Direction (0018,6026) 1 The physical units of the dimensions of the region. See C.8.5.5.1.15 for Enumerated Values.
>Physical Delta X (0018,602C) 1 The physical value increments per positive X pixel increment. The units are as specified in the Physical Units X Direction (0018,6024). See C.8.5.5.1.17 for further explanation.
>Physical Delta Y (0018,602E) 1 The physical value increments per positive Y pixel increment. The units are as specified in the Physical Units Y Direction (0018,6026). See C.8.5.5.1.17 for further explanation.
>Reference Pixel x0 (0018,6020) 3 This coordinate pair, x0,y0 defines the location of a virtual "reference" pixel. See C.8.5.5.1.16 for further explanation.
>Reference Pixel y0 (0018,6022) 3 This coordinate pair, x0,y0 defines the location of a virtual "reference" pixel. See C.8.5.5.1.16 for further explanation.
>Ref. Pixel Physical Value X (0018,6028) 3 The Physical Value at the reference pixel x location. The units are specified in the Physical Units field.
>Ref. Pixel Physical Value Y (0018,602A) 3 The Physical Value at the reference pixel y location. The units are specified in the Physical Units field.
>Region Spatial Format (0018,6012) 1 The spatial organization of the data within the region. See C.8.5.5.1.1 for Enumerated Values.
>Region Data Type (0018,6014) 1 The type of data within the region. See C.8.5.5.1.2 for Enumerated Values.
>Region Flags (0018,6016) 1 Flags used for special handling of the region. See C.8.5.5.1.3 for Enumerated Values and further explanation.
>Pixel Component Organization (0018,6044) 1C Describes how the components of a pixel can be described. Required if pixel component calibration exists for this region. See C.8.5.5.1.4 for Enumerated Values and further explanation.
>Pixel Component Mask (0018,6046) 1C This value is ANDed with the composite pixel code for each pixel within the region, then shifted right by the number of contiguous least significant zeros in the mask to obtain what will be referred to as the "Shifted Masked Composite Pixel Code" (SMCPC). Required if Pixel Component Organization = Bit aligned. See C.8.5.5.1.5 for further explanation.
>Pixel Component Range Start (0018,6048) 1C Defines the start of the numeric range of values within the composite pixel where calibration is to be defined by the "pixel physical calibration table". To be used only when ranges are used to describe the portion of the composite pixel. Required if Pixel Component Organization = Ranges.
>Pixel Component Range Stop (0018,604A) 1C Defines the stop of the numeric range of values within the composite pixel where calibration is to be defined by the "pixel physical calibration table". To be used only when ranges are used to describe the portion of the composite pixel. Required if Pixel Component Organization = Ranges.
>Pixel Component Physical Units (0018,604C) 1C The physical units to be applied to the pixel component. Required if Pixel Component Organization exists. See C.8.5.5.1.6 for further explanation.
>Pixel Component Data Type (0018,604E) 1C The type of data for the pixel component. Required if Pixel Component Organization exists. See C.8.5.5.1.7 for further explanation.
>Number of Table Break Points (0018,6050) 1C The number of break point coordinate pairs used to describe a piece wise linear curve. Required if Pixel Component Organization equals 0 or 1. Otherwise not used. See C.8.5.5.1.8 for further explanation.
>Table of X Break Points (0018,6052) 1C An array of X values used to create the piece wise linear curve. Required if Pixel Component Organization equals 0 or 1. Otherwise not used. See C.8.5.5.1.9 for further explanation.
>Table of Y Break Points (0018,6054) 1C An array of Y values used to create the piece wise linear curve. Required if Pixel Component Organization equals 0 or 1. Otherwise not used. See C.8.5.5.1.9 for further explanation.
>Number of Table Entries (0018,6056) 1C The number of entries in the Table of Pixel Values. Required if the value of Pixel Component Organization (0018,6044) is 2 or 3. Otherwise not used. See C.8.5.5.1.11 for further explanation.
>Table of Pixel Values (0018,6058) 1C A table of Pixel Values used in conjunction with the Table of Parameter Values (0018,605A) or Pixel Value Mapping Code Sequence (0040,9098) to provide a mapping from Pixel Value to a real world value. Required if the Pixel Component Organization equals 2. Otherwise not used. See C.8.5.5.1.12 for further explanation.
>Table of Parameter Values (0018,605A) 1C A table of Parameter Values used in conjunction with the Table of Pixel Values (0018,6058) to provide a mapping from Pixel Value to Parameter Value. Required if the value of Pixel Component Organization (0018,6044) is 2. Otherwise not used. See C.8.5.5.1.13 for further explanation
>Pixel Value Mapping Code Sequence (0040,9098) 1C Sequence that, in conjunction with the Table of Pixel Values (0018,6058), provides a mapping from a Pixel Value to an associated Coded Concept. One or more Items shall included in this sequence. The number of Items shall be equal to the value of Number of Table Entries (0018,6056). Required if the value of Pixel Component Organization (0018,6044) is 3 (Code Sequence look up). See Sections C.8.5.6.1.18 for further explanation.
>>Include ‘Code Sequence Macro’ Table 8.8-1 Baseline Context ID for IVUS is 3497; no Context ID is otherwise defined.
>Tranducer Frequency (0018,6030) 3 The manufacturer defined description of center frequency of the interrogating ultrasound energy. The units are kilohertz.
>Pulse Repetition Frequency (0018,6032) 3 The ultrasound pulse repetition frequency, as defined by the manufacturer, used to collect data in the region. The units are in hertz.
>Doppler Correction Angle (0018,6034) 3 The Doppler correction angle. The units are degrees.
>Steering Angle (0018,6036) 3 The steering angle, as defined by the manufacturer, used for a steered 2D image. The units are degrees.
>Doppler Sample Volume X Position (0018,6039) 3 The x displacement, in pixels, from the Reference pixel to the center of the Doppler sample volume.
>Doppler Sample Volume Y Position (0018,603B) 3 The y displacement, in pixels, from the Reference pixel to the center of the Doppler sample volume.
>TM-Line Position x0 (0018,603D) 3 The starting and ending coordinates pairs of the m-line. Where the X0,Y0 are the starting point and X1,Y1 are the end point of the tm-line. See C.8.5.5.1.10 for further explanation.
>TM-Line Position y0 (0018,603F) 3 The starting and ending coordinates pairs of the m-line. Where the X0,Y0 are the starting point and X1,Y1 are the end point of the tm-line. See C.8.5.5.1.10 for further explanation.
>TM-Line Position x1 (0018,6041) 3 The starting and ending coordinates pairs of the m-line. Where the X0,Y0 are the starting point and X1,Y1 are the end point of the tm-line. See C.8.5.5.1.10 for further explanation.
>TM-Line Position y1 (0018,6043) 3 The starting and ending coordinates pairs of the m-line. Where the X0,Y0 are the starting point and X1,Y1 are the end point of the tm-line. See C.8.5.5.1.10 for further explanation.

C.8.5.5.1 US Region Calibration Attribute Descriptions

C.8.5.5.1.1 Region Spatial Format

Enumerated Values for Region Spatial Format (0018,6012) indicate the spatial organization of the data within the region.

Value Meaning Value Meaning
0000H None or not applicable 0001H 2D(tissue or flow)
0002H M-Mode(tissue or flow) 0003H Spectral(CW or PW Doppler)
0004H Wave form(physiological traces, doppler traces,....) 0005H Graphics

C.8.5.5.1.2 Region Data Type

Enumerated Values for Region Data Type (0018,6014) indicate the type of data within the region.

Value Meaning Value Meaning
0000H None or not applicable 0001H Tissue
0002H Color Flow 0003H PW Spectral Doppler
0004H CW Spectral Doppler 0005H Doppler Mean Trace
0006H Doppler Mode Trace 0007H Doppler Max Trace
0008H Volume Trace 0009H d(volume)/dt Trace
000AH ECG Trace 000BH Pulse Trace
000CH Phonocardiogram Trace 000DH Gray bar
000EH Color bar 000FH Integrated Backscatter
0010H Area Trace 0011H d(area)/dt
0012H Other Physiological (Amplitude vs. Time) input

C.8.5.5.1.3 Region Flags

Region Flags (0018,6016) specify characteristics of US Regions.

Bit 0 of the Region Flags specifies the relative priority of the pixel component calibration specified by an US Region in the case where the US Region intersects with other US Regions. The calibration supplied by one or more of the regions may not be valid in the area that they intersect. Enumerated Values for Bit 0 (lsb):

1 = Region pixels are low priority

0 = Region pixels are high priority

A high priority region overwrites data of a low priority region when they overlap, thus invalidating any pixel component calibration specified for a low priority region. pixel component calibration of overlapping regions of the same priority is indeterminate where they overlap. Figure C.8-6 shows an example of intersecting regions.

[pic]

Figure C.8-6 Intersecting Spatial Format Regions and Overlapping Measurement

In this example, Region B is Color Flow while Region A is Tissue Echo. If Region B Color Flow values share the same bit planes as Region A Tissue Echo values, then it is indeterminate whether a pixel in this region is a Color Flow pixel or a Tissue Echo pixel. Since the pixels of the Color Flow region overwrite those of the Tissue Echo region, the Region Flag of the Tissue Echo region is assigned low priority and the Region Flag of the color region is assigned high priority. This means that if both the Tissue Echo and Color Flow regions define pixel component calibration that only the calibration specified by the Color Flow region can be applied to the pixel data value at Point X.

The measurement in Figure C.8-6 is a line between Point Y and Point Z. Both points are in Region A so the distance between them can be calculated using the Region A scaling (assuming that Region A defines both the Physical Units X Direction and Y Direction as being cm). If the points are in Region B, and hence also in Region A, it is still possible to calculate the distance because the region scaling is identical in both regions. The lower priority of Region B only applies to its pixel component calibration, not its X and Y direction scaling.

Enumerated Values for Bit 1 Scaling Protection:

1 = Protected

0 = Not Protected

Ultrasound systems should set this to 1 if the image is scaled automatically by the ultrasound system. If the image is frame-grabbed and scaling is not available then it should be set to 0. If the region is protected, the region can not be manually rescaled. That is the data defined by the region calibration Module can not be overridden by a reader of that image.

Enumerated Values for Bit 2 Doppler Scale Type:

1 = Frequency

0 = Velocity

Valid for PW and CW regions only. Indicates which type of Doppler scale is used.

Enumerated Values for Bit 3-4 Scrolling Region:

00 = Unspecified

01 = Scrolling

10 = Sweeping

11 = Sweeping then Scrolling

Bit 5-31 Reserved for future use, shall be set to zero.

C.8.5.5.1.4 Pixel Component Organization

Pixel Component Organization (0018,6044) provides an Enumerated Value describing how the components of a pixel can be described. The absence of this data element means that pixel component calibration does not exist for this region. Where:

0 = Bit aligned positions

1 = Ranges

2 = Table look up

3 = Code Sequence look up

Other values reserved for future use.

Pixel Component Organization defines the way in which the composite pixel values are mapped into real world values with physical units, as illustrated in Figure C.8-7.

[pic]

Figure C.8-7 Pixel Component Calibration

An example of Component Calibration for an ultrasound image is shown in Figure C.8-8.

[pic]

Figure C.8-8Pixel Component Calibration Example

In this example, some pixels lie within two Regions. One Region specifies pixel component calibration for Doppler velocity values. The second Region specifies pixel component calibration for Doppler magnitude. A particular Pixel Data (7FE0,0010) value will thus map to a displayed value, a Doppler velocity and magnitude value.

The example has a Palette Color Photometric Interpretation with 16 Bits Allocated and Bits Stored per sample. The Palette Color Lookup Tables also have 16 bits for each entry. The fact that the example has just one sample per pixel means that each composite pixel value is identical to the single Pixel Data value. An example Pixel Data value is shown in brackets along with the output values resulting from each step where it is processed.

The Pixel Data value is mapped to red, green, and blue values from the supplied Palette Color Lookup Tables before being displayed. The display device supports 8 bits per sample and thus requires the scaling of the output values from the 16 bit per entry LUTs.

The Doppler Velocity Region maps each pixel value in the Region to the Doppler velocity. The Pixel Component Organization (0018,6044) has a value of zero, indicating bit aligned positions with a bit mask. The Pixel Component Mask (0018,6046) specifies that the least significant 4 bits of the most significant byte convey the Doppler velocity of each pixel. The Pixel Component Physical Units (0018,604C) are cm/sec, and the Pixel Component Data Type (0018,604E) indicates color flow velocity. The Table of X Break Points (0018,6052) and Table of Y Break Points (0018,6054) map each masked composite pixel value to a Doppler velocity value in cm/sec.

The Doppler Magnitude Region maps each pixel value in the Region to the Doppler magnitude. The Pixel Component Organization (0018,6044) has a value of zero, indicating bit aligned positions with a bit mask. The Pixel Component Mask (0018,6046) specifies that the most significant 4 bits of the most significant byte convey the Doppler magnitude of each pixel. The Pixel Component Physical Units (0018,604C) is set to dB, and the Pixel Component Data Type (0018,604E) indicates color flow magnitude. The Table of X Break Points (0018,6052) and Table of Y Break Points (0018,6054) map each masked composite pixel value to a Doppler magnitude value in dB.

C.8.5.5.1.5 Pixel Component Mask

Pixel Component Mask (0018,6046) is ANDed with the Composite Pixel Code (see Section C.7.6.3.1.1) for each pixel within the region, then shifted right by the number of contiguous least significant zeros in the mask to obtain what will be referred to as the "Shifted Masked Composite Pixel Code".

The mask will most likely (but not necessarily) contain a block of contiguous ones, surrounded by leading and trailing zeros. The purpose of this mask is to keep only those bits within the composite pixel code that pertain to the region. It is to be used only when Pixel Organization is bit aligned positions.

C.8.5.5.1.6 Pixel Component Physical Units

For Pixel Component Physical Units (0018,604C), the Enumerated Values describing the physical units to be applied to the pixel component are:

Value Meaning Value Meaning
0000H None or not applicable 0001H Percent
0002H dB 0003H cm
0004H seconds 0005H hertz(seconds-1)
0006H dB/seconds 0007H cm/sec
0008H cm2 0009H cm2/sec
000AH cm3 000BH cm3/sec
000CH degrees

C.8.5.5.1.7 Pixel Component Data Type

For Pixel Component Data Type (0018,604E), the Enumerated Values indicating the type of data for the pixel component are:

Value Meaning Value Meaning
0000H None or not applicable 0001H Tissue
0002H Spectral doppler 0003H Color Flow Velocity
0004H Color Flow Variance 0005H Color Flow Intensity
0006H Gray bar 0007H Color bar
0008H Integrated Backscatter 0009H Computed Border

000AH Tissue Classification

C.8.5.5.1.8 Number of Table Break Points

The Number of Table Break Points (0018,6050) gives the number of entries in each of two tables: the Table of X Break Points (0018,6052) and Table of Y Break Points (0018,6054). These tables are used to designate a curve mapping the value of a pixel component to its actual physical value, as described in Section C.8.5.5.1.9.

C.8.5.5.1.9 Table of X Break Points and Table of Y Break Points

Table of X Break Points (0018,6052) and Table of Y Break Points (0018,6054) are individual arrays of coordinates which interpreted together are used to create a piecewise linear curve. Each X value from the Table of X Break Points is matched with the corresponding Y value from the Table of Y Break Points yielding an (X,Y) coordinate. The set of (X,Y) coordinates describes a piecewise linear curve mapping the value of a pixel component to its actual physical value (in units defined in Pixel Component Physical Units data element (0018,604C) ).

The X direction on the curve has no units, and represents actual pixel component values. If the Pixel Component Organization (0018,6044) is "Bit aligned positions", and the width of the Pixel Component Mask is n bits then the X coordinates are in the range 0 through 2n -1. If the Pixel Component Organization is Ranges , then the X coordinates are in the range 0 through 2 number of bits in the composite pixel - 1.

Note: The X value is NOT relative to the Pixel Component Range Start (0018,6048). Not all possible X values in the range need be covered by the curve.

For any pixel component value in the range of the curve described by this table, the corresponding Y value is the actual physical value for that pixel, in units specified in the Pixel Component Physical Units data element (0018,604C). If the pixel component value is NOT within the range of specified X values for the curve, then no pixel calibration is defined by this region. It may be possible for pixel calibration to be defined by other spatial regions intersecting this one.

C.8.5.5.1.10 TM Line Position X0, TM-Line Position Y0

The TM-Line Position X 0 (0018,603D) and TM-Line Position Y0 (0018,603F) are the coordinates of the starting point and TM-Line Position X1 (0018,6041), TM-Line Position Y1 (0018,6043) are the coordinates of the end point of the TM-line. The coordinate is defined as the displacement, in pixels, from the Reference pixel. Typically used for M-mode line and CW Doppler.

C.8.5.5.1.11 Number of Table Entries

The Number of Table Entries (0018,6056) gives the number of entries in the Table of Pixel Values, the number of entries in the Table of Parameter Values (0018,605A), if present, and the number of items in the Pixel Value Mapping Code Sequence (0040,9098) , if present.

C.8.5.5.1.12 Table of Pixel Values

The Table of Pixel Values (0018,6058) specifies the pixel values that are mapped to real world parameter values or coded concepts (tissue characterizations). The number of entries in the table is given by Number of Table Entries (0018,6056).

A pixel is calibrated (mapped to a real-world value) by finding an entry in the Table of Pixel Values that matches its Composite Pixel Code (see Section C.7.6.3.1.1). The offset index of this entry is used as an index into the Parameter Value Table (0018,605A) or as a sequence item number in the Pixel Value Mapping Code Sequence (0040,9098) to select the real world value. The first Table of Pixel Values entry corresponds to sequence item 1.

Note: If a Composite Pixel Code has no matching value in the Pixel Value Table then there is no unambiguous way to determine the corresponding Parameter Value. A method may exist to determine a valid Parameter Value but the specification of such a method is outside the scope of the DICOM standard. No assumption should be made that linear interpolation will produce a valid result.

C.8.5.5.1.13 Table of Parameter Values

The Table of Parameter Values (0018,605A) provides the real world values for pixel values identified in the Table of Pixel Values (0018,6058). The number of table entries is given by Number of Table Entries (0018,6056) and the physical units are given by Pixel Component Physical Units (0018,604C). Values may repeat when a parameter value is associated with more than one Composite Pixel Code value.

C.8.5.5.1.14 Region Location Min x0, Region Location Min y0, Region Location Max x1 , Region Location Max y1

These attributes specify the location of the region, Region Location Min x0 (0018,6018), Region Location Min y0 (0018,601A), Region Location Max x1 (0018,601C), Region Location Max y1 (0018,601E) expressed as offsets to the pixel coordinates. The upper left corner of the entire image is x=0,y=0 and the lower right corner is x=image width - 1, and y=image length - 1. Thus, a region will be specified as within these bounds. Where x0,y0 is the coordinate of the upper left corner of the region and x1,y1 is the coordinate of the lower right corner of the region.

C.8.5.5.1.15 Physical Units X Direction And Physical Units Y Direction

Physical Units X Direction (0018,6024) and Physical Units Y Direction (0018,6026) provide Enumerated Values indicating the physical units of the dimensions of the region.

Value Meaning Value Meaning
0000H = None or not applicable 0001H = Percent
0002H = dB 0003H = cm
0004H = seconds 0005H = hertz(seconds-1 )
0006H = dB/seconds 0007H = cm/sec
0008H = cm2 0009H = cm2/sec
000AH = cm3 000BH = cm3/sec
000CH = degrees

C.8.5.5.1.16 Reference Pixel x0 and Reference Pixel y0

This coordinate pair, Reference Pixel x0 (0018,6020), Reference Pixel y0 (0018,6022) defines the location of a virtual "reference" pixel. This reference pixel location is used to tie the image's pixel coordinate system to the physical coordinate system. For example, the reference pixel could be defined where a depth of zero centimeters occurs in the 2D image, or it could define where the baseline (i.e.: zero frequency) resides in a spectral display. The reference pixel location is the relative offset from the Region Location Min x0 (0018,6018) and Region Location Min y0 (0018,601A), not the image origin. The location is not required to be within the region or even within the image boundary. For this reason, the Reference Pixel x0 and Reference Pixel y0values can be positive or negative.

The reference pixel location varies depending on the type and spatial organization of the data within the region.

C.8.5.5.1.16.1 2D - Tissue or Color Flow

Tissue data is tissue echo intensity displayed as grayscale. The Region Data Type (0018,6014) value is 0001H (Tissue). Color flow is Doppler signal displayed as color and encoded as some function of Doppler magnitude and velocity of blood flow or tissue motion. The Region Data Type value is 0002H (Color flow). For 2D, the Region Spatial Format (0018,6012) is 0001H (2D), meaning that the region is a tomographic image. For such 2D regions the reference pixel location is typically at the center of the transducer face on the tissue-transducer interface (skin line).

Figure C.8-1 shows 2D attribute values of reference pixel location along with Region Location Min and Region Location Max. for 2D-Tissue and 2D-Color Flow Regions:

[pic]

Figure C.8-12D Regions with Reference Pixel

Both the 2D regions-Tissue and Color Flow-share the same physical location at the skin line but the reference pixel location values (Reference Pixel x 0 and Reference Pixel y0) are relative to their respective region origins at the skin line.

C.8.5.5.1.16.2 Spectral - CW or PW Doppler or Doppler Trace

Spectral Doppler is the time varying magnitude of Doppler signal as function of frequency. Region Data Type (0018,6014) value is 0003H (pulsed wave Doppler) or 0004H (continuous wave Doppler). Spectral Doppler regions display the magnitude of Doppler signal with frequency or velocity as the vertical dimension and time as the horizontal dimension. Spectral Doppler regions have a Region Spatial Format (0018,6012) of 0003H (Spectral). The time dimension for the Region Spatial Format displays horizontally with data scrolling toward the left or sweeping toward the right. The reference pixel location is the pixel in the frame where:

Figure C.8-2 shows an example of reference pixel locations in an image with both a Tissue and a scrolling Spectral (CW or PW Doppler) Region. The user adjusts the depth and position of the Doppler sample volume. The system annotates the sample volume position on the 2D region and specifies the location in Doppler Sample Volume X Position (0018,6039) and Doppler Sample Volume Y Position (0018,603B).

[pic]

Figure C.8-22D & Doppler Regions with Reference Pixel

The scrolling Spectral Region reference pixel location specifies the horizontal location at the time of the current image frame. Data to the left of this location in the Spectral Region was acquired in the past. Because time increases to the right, the Physical Delta X (0018,602C) for this Region is positive. To specify the location of the most recent data the Reference Pixel x0 specifies the time of acquisition, and the Ref. Pixel Physical Value X (0018,6028) specifies the reference time to be zero. The Physical Units X Direction (0018,6024) is seconds. For an explanation of how to handle sweeping regions refer to C.8.5.5.1.16.7 Treatment of Sweeping Regions.

The Ref. Pixel Physical Value Y (0018,602A) value specifies the baseline where velocity or frequency are zero. Typically spectral Doppler regions display positive velocity (cm/Sec) or frequency shift (Hz) above the baseline. This indicates flow toward the transducer face. Negative velocity or frequency information is displayed below the baseline. This indicates flow away from the transducer face. The Physical Delta Y (0018,602E) value is therefore negative because vertical coordinates increment downward.

C.8.5.5.1.16.3 M-Mode - Tissue or Color Flow

M-Mode is tissue or color flow with a Region Spatial Format (0018,6012) of 0002H (M-mode). The vertical reference pixel location is the transducer face.

The horizontal reference pixel location is the pixel in the frame where:

Figure C.8-3 shows an example of reference pixel locations for 2D Tissue and M-Mode Regions within the same image frame. The system annotates the sample line position on the 2D tissue region and specifies its position with the TM-Line Position attributes (0018,603D), (0018,603F), (0018,6041), and (0018,6043).

[pic]

Figure C.8-32D & M-Mode Regions with Reference Pixel Example

The physical length of the TM-Line corresponds directly to the physical height of the M-Mode Region. The M-Mode region’s Reference Pixel y0 can be used to calculate the depth of the M-Mode region and facilitate depth measurements. In this example the M-Mode Region Reference Pixel y0 has a negative value corresponding to the distance between the face of the ultrasound probe and the TM-Line starting point. Note that the negative offset in pixel units is determined using the pixel height-width scaling of the M-Mode - Tissue Region as this could differ from the scaling of the 2D - Tissue Region (as it does in this example).

C.8.5.5.1.16.4 Waveform - ECG, Phonocardiogram and Pulse Traces

Waveforms are traces with a Region Spatial Format (0018,6012) value of 0004H (Waveform). The Reference Pixel x0 (0018,6020) specifies the time origin as the time of frame capture. There is typically no baseline position for ECG traces; the Reference Pixel y0 (0018,6022) is arbitrary.

Figure C.8-4 shows an example of reference pixel location for 2D Tissue, M-Mode, and ECG Waveform Regions within the same image frame:

[pic]

Figure C.8-42D, M-Mode, & Waveform Regions with Reference Pixel

C.8.5.5.1.16.5 Waveform - Doppler Mode, Mean and Max Trace

Doppler Traces have a Region Spatial Format (0018,6012) value of 0004H (Waveform) and a Region Data Type value of 0005H (Doppler Mean Trace), 0006H (Doppler Mode Trace) or 0007H (Doppler Max Trace). The Reference Pixel x0 (0018,6020) specifies the time origin as the time of frame capture. The Reference Pixel y0 (0018,6022) is the Doppler Baseline position (zero velocity / frequency position).

C.8.5.5.1.16.6 Graphics Spatial Formats

For regions with Region Spatial Format (0018,6012) value of 0005H (Graphics) the reference pixel location has no meaning.

C.8.5.5.1.16.7 Treatment of Sweeping Regions

Time-based display of data may scroll the acquired data from a fixed horizontal location to the left. Alternatively, sweep-based display increments the horizontal location of the acquired data, overwriting previously acquired data to the right. When the horizontal location corresponding to zero time has completely swept over the older data, writing wraps from the left of the region. Thus, sweep-based displays have a time discontinuity. The measurement of time intervals across the discontinuity requires special treatment. The time interval between two points across the discontinuity is equal to the region’s time width minus the point separation. The sweeping area can be treated as a single region. The Reference Pixel x0 should indicate the time origin for the multi-frame image, which will be the location of the sweeping region's discontinuity line for the first frame of the multi-frame image. In order to specify that this is actually the location of the discontinuity line, the Ref. Pixel Physical Value X (0018,6028) must be set to 0 seconds. This indicates that this location corresponds to the time at which the first frame was acquired.

It is useful to be able to calculate the location of the discontinuity line for subsequent frames of a multi-frame image. This is necessary if one is to determine whether two points are on opposite sides of the discontinuity line and also to correctly calculate the difference in time between such points. The x-axis location of the discontinuity line, x, for a given frame number, y, can be calculated from the Reference Pixel x0, x0, the Reference Pixel x1, x1, the time offset for frame y, t, (determined from the Frame Time Vector (0018,1065) or Frame Time (0018,1063)) and the Physical Delta X (0018,602C), p x , as follows:

x = x0 + modulus( (t / p x ) / (x1 - x0) )

Alternatively, two regions can be used, one on each side of the time discontinuity. Figure C.8-5 shows the use of two regions. Note that the two region approach is not valid for multi-frame images, as the same region scaling must apply to all the frames.

[pic]

Figure C.8-5Sweep Example using Two Regions

The two region approach may also be used in Doppler or physiological sweeping regions.

Time-based display of data may also be a combination of sweeping and scrolling. Sweep-based display is used at the start of acquisition, incrementing the horizontal location of the acquired data from left to right. After the horizontal location corresponding to zero time has completely swept to the right hand limit of the region, writing scrolls to the left from the right hand limit rather than wrapping from the left. A single region should be specified when this combination of behavior is used. The x-axis (zero time) location, x, for a given frame number, y, can be calculated from the Reference Pixel x0, x0, the Reference Pixel x1, x1, the time offset for frame y, t, (determined from the Frame Time Vector (0018,1065) or Frame Time (0018,1063)) and the Physical Delta X, p x , as follows:

X = Min ( x0 + (t / p x ), x1)

C.8.5.5.1.17 Physical Delta X And Physical Delta Y

The Physical Delta X (0018,602C) is the physical value increment per positive X pixel increment, which is left to right. The Physical Delta Y (0018,602E) is the physical value increment per positive Y pixel increment which is top to bottom.

Note: When displaying Doppler data, ultrasound applications typically display the Doppler strip horizontally, with data sweeping (moving time origin) from left (oldest) to right (newest) or scrolling (static time origin) from right to left. The default display of positive velocity values normally indicates flow toward the transducer; negative velocity values indicate flow away from the transducer. In this case a negative Physical Delta Y is required to specify that the direction of positive velocities or frequencies is upward.

C.8.5.5.1.18 Pixel Value Mapping Code Sequence

The Pixel Value Mapping Code Sequence (0040,9098) provides the real world values for pixel values identified in the Table of Pixel Values (0018,6058). The number of items in the sequence is given by Number of Table Entries (0018,6056).

Note: Pixel Component Physical Units (0018,604C) does not apply to Sequence of Pixel Value Codes and should be set to 0000H (none or not applicable).

C.8.5.6 US Image Module

Table C.8-18 specifies the Attributes that describe ultrasound images.

Table C.8-18US IMAGE MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Samples Per Pixel (0028,0002) 1 Number of samples (planes) in this image. See C.8.5.6.1.12 for specialization
Photometric Interpretation (0028,0004) 1 Specifies the intended interpretation of the pixel data. See C.8.5.6.1.2 for specialization.
Bits Allocated (0028,0100) 1 Number of bits allocated for each pixel sample. See C.8.5.6.1.13 for specialization.
Bits Stored (0028,0101) 1 Number of bits stored for each pixel sample. See C.8.5.6.1.14 for specialization.
High Bit (0028,0102) 1 Most significant bit for pixel sample data. See C.8.5.6.1.15 for specialization.
Planar Configuration (0028,0006) 1C Indicates whether the pixel data are sent color-by-plane or color-by-pixel. Required if Samples per Pixel (0028,0002) has a value greater than 1. See C.8.5.6.1.16 for specialization.
Pixel Representation (0028,0103) 1 Data representation of pixel samples. See C.8.5.6.1.3 for specialization.
Frame Increment Pointer (0028,0009) 1C Contains the Data Element Tag of the attribute which is used as the frame increment in Multi-frame pixel data (see C.7.6.6). Required if Number of Frames is sent. See C.8.5.6.1.4 for specialization.
Image Type (0008,0008) 2 Image identification characteristics. See C.8.5.6.1.1 for specialization.
Lossy Image Compression (0028,2110) 1C Specifies whether an Image has undergone lossy compression. Enumerated Values: 00 = Image has NOT been subjected to lossy compression. 01 = Image has been subjected to lossy compression. See C.7.6.1.1.5 Required if Lossy Compression has been performed on the Image.
Number of Stages (0008,2124) 2C Number of Stages in this protocol. Required if image was acquired in a Staged protocol.
Number of Views in Stage (0008,212A) 2C Number of views in this Stage. Required if image was acquired in a Staged protocol.
R Wave Time Vector (0018,6060) 3 The time offset(s) of the reported R Wave peaks, each relative to the time of the start of the acquisition of the first frame in msec. Multi-valued, with one value per reported R Wave.
Ultrasound Color Data Present (0028,0014) 3 This element indicates if any ultrasound color data is present in an image. Enumerated Values: 00 = Ultrasound color data not present in image 01 = Ultrasound color data is present in image. See C.8.5.6.1.10
Stage Name (0008,2120) 3 A Stage is a particular time slice of a protocol in which a set of images are collected. The names can be free form text. Recommended text for Stress Echo stage names are: PRE-EXERCISE, POST-EXERCISE, PEAK-EXERCISE, RECOVERY, BASELINE, LOW DOSE, PEAK DOSE
Stage Code Sequence (0040,000A) 3 Sequence of items describing the performed Ultrasound Protocol Stage(s). One or more Items are permitted in this Sequence.
>Include “Code Sequence Macro” Table 8.8-1. Baseline CID 12002.
Stage Number (0008,2122) 3 A number that identifies the Stage. Stage Number starts at one.
View Name (0008,2127) 3 A View is a particular combination of the position and orientation when a set of images are acquired. Images are acquired at the same View in different Stages for the purpose of comparison.
View Number (0008,2128) 3 A number that identifies the View. View Number starts at one.
Number of Event Timers (0008,2129) 3 The number of event timers used at the time of acquisition of a Multi-frame image.
Event Elapsed Time(s) (0008,2130) 3 An array of values associated with each event timer. Units in milliseconds.
Event Timer Name(s) (0008,2132) 3 Name that identifies the event timer.
Include 'General Anatomy Optional Macro' Table 10-7 For intravascular ultrasound, Defined CID 3010 and Defined CID 3015 are specified for the Anatomic Region Sequence and Defined CID 3019 is specified for the Anatomic Region Modifier Sequence. No other Context IDs are specified.
View Code Sequence (0054,0220) 3 Sequence that describes the view of the patient anatomy in this image. Only a single Item is permitted in this Sequence. See Section C.8.5.6.1.19.
>Include ‘Code Sequence Macro’ Table 8.8-1 See Section C.8.5.6.1.19 for Context Group IDs.
>View Modifier Code Sequence (0054,0222) 3 Sequence that provides modifiers for the view of the patient anatomy. One or more Items are permitted in this Sequence. See Section C.8.5.6.1.19.
>>Include ‘Code Sequence Macro’ Table 8.8-1 See Section C.8.5.6.1.19 for Context Group IDs.
Acquisition DateTime (0008,002A) 1C The date and time that the acquisition of data that resulted in this image started. Required if Modality (0008,0060) = IVUS May be present otherwise. Note: The synchronization of this time with an external clock is specified in the Synchronization Module in Acquisition Time Synchronized (0018,1800).
Trigger Time (0018,1060) 3 Time interval measured in msec from the start of the R-wave to the beginning of data taking
Nominal Interval (0018,1062) 3 Average R-R interval used for these data, in msec
Beat Rejection Flag (0018,1080) 3 Beat length sorting has been applied. Enumerated Values: Y = yes N = no
Low R-R Value (0018,1081) 3 R-R interval low limit for beat rejection, in msec
High R-R Value (0018,1082) 3 R-R interval high limit for beat rejection, in msec
Heart Rate (0018,1088) 3 Beats per minute.
IVUS Acquisition (0018,3100) 1C Defined Terms: MOTOR_PULLBACK MANUAL_PULLBACK SELECTIVE GATED_PULLBACK See C.8.5.6.1.21 Required if Modality (0008,0060) = IVUS
IVUS Pullback Rate (0018,3101) 1C Required if IVUS Acquisition (0018,3100) value is MOTOR_PULLBACK. Specified in units of mm/sec. See C.8.5.6.1.22
IVUS Gated Rate (0018,3102) 1C Required if IVUS Acquisition (0018,3100) value is GATED_PULLBACK. Specified in units of mm/beat. See C.8.5.6.1.23
IVUS Pullback Start Frame Number (0018,3103) 1C Required if IVUS Acquisition (0018,3100) value is MOTOR_PULLBACK or GATED_PULLBACK. See C.8.5.6.1.24
IVUS Pullback Stop Frame Number (0018,3104) 1C Required if IVUS Acquisition (0018,3100) value is MOTOR_PULLBACK or GATED_PULLBACK. See C.8.5.6.1.25
Lesion Number (0018,3105) 3 Identifier(s) of the lesion(s) of interest imaged within the current SOP Instance. Each lesion shall have a unique numeric integer identifier within the study. See C.8.5.6.1.26.
Output Power (0018,5000) 3 Manufacturer defined character string description of ultrasound output level(s) used in generating a given image. Data may be expressed in dB, %, W/cm2, etc.
Transducer Data (0018,5010) 3 Manufacturer defined code or description of ultrasound transducer used.
Transducer Type (0018,6031) 3 Defined Terms: SECTOR_PHASED SECTOR_MECH SECTOR_ANNULAR LINEAR CURVED LINEAR SINGLE CRYSTAL SPLIT XTAL CWD IV_PHASED IV_ROT XTAL IV_ROT MIRROR ENDOCAV_PA ENDOCAV_MECH ENDOCAV_CLA ENDOCAV_AA ENDOCAV_LINEAR VECTOR_PHASED
Focus Depth (0018,5012) 3 The depth, from the transducer face, of the manufacturer defined beam focus used for the image, in cm.
Processing Function (0018,5020) 3 Manufacturer defined description of processing of echo information. Data may include code or description of gain (initial, overall, TGC, dynamic range, etc.), preprocessing, postprocessing, Doppler processing parameters, e.g. cutoff filters, etc., as used in generating a given image.
Mechanical Index (0018,5022) 3 See C.8.5.6.1.8 for Description.
Bone Thermal Index (0018,5024) 3 See C.8.5.6.1.8 for Description.
Cranial Thermal Index (0018,5026) 3 See C.8.5.6.1.8 for Description.
Soft Tissue Thermal Index (0018,5027) 3 See C.8.5.6.1.8 for Description.
Soft Tissue-focus Thermal Index (0018,5028) 3 See C.8.5.6.1.8 for Description.
Soft Tissue-surface Thermal Index (0018,5029) 3 See C.8.5.6.1.8 for Description.
Depth of Scan Field (0018,5050) 3 The depth, in mm, from the transducer face to the deepest point included in the displayed image- the field of view.
Overlay Subtype (60xx,0045) 3 Defined term which identifies the intended purpose of the ROI Overlay Type. See C.8.5.6.1.11 for specialization.

Note: Referenced Overlay Sequence (0008,1130) and Referenced Curve Sequence (0008,1145) were previously included in this Module as optional Attributes but have been retired. See PS 3.3 2004.

C.8.5.6.1 US Image Attribute Descriptions

C.8.5.6.1.1 Image Type

For US Images, Image Type (0008,0008) is specified to be Type 2. The Defined Terms for Value 3 are:

ABDOMINAL BREAST CHEST
ENDOCAVITARY ENDORECTAL ENDOVAGINAL
EPICARDIAL FETAL HEART GYNECOLOGY
INTRACARDIAC INTRAOPERATIVE INTRAVASCULAR
MUSCULOSKELETAL NEONATAL HEAD OBSTETRICAL
OPHTHALMIC PEDIATRIC PELVIC
RETROPERITONEAL SCROTAL SMALL PARTS
TEE THYROID TRANSCRANIAL
TTE US BIOPSY VASCULAR

Value 4 is constructed as a modality bit map to allow for a description of multi-modality displays. In using this bit map, the sum of the values of the various modalities will unambiguously determine the constituent modalities.

0001 = 2D Imaging 0002 = M-Mode 0004 = CW Doppler
0008 = PW Doppler 0010 = Color Doppler 0020 = Color M-Mode
0040 = 3D Rendering 0100 = Color Power Mode 0200 = Tissue Characterization
0400 = Spatially-related frames

Notes: 1. All Values are hexadecimal encoded as a CS. See PS 3.5.

2. For example, Color Flow with CW spectral Doppler would have a value 4 = 0015. Note that no assumption should be made in Color Doppler or Color M-Mode regarding underlying B or M-Mode, respectively.

3. See Section A.59.1 for the relationship between a 3D volume set and the 3D Rendering, 3D MPR View, and Spatially-related frames image types. In the case of “3D Rendering”, Derivation Code Sequence (0008,9215) should be used to describe the specific type of 3D rendering (volume rendering, surface rendering, multiplanar reformatting, etc.).

C.8.5.6.1.2 Photometric Interpretation

For US Images, Photometric Interpretation (0028,0004) is specified to use the following Defined Terms:

MONOCHROME2 PALETTE COLOR RGB
ARGB (retired) YBR_FULL YBR_FULL_422
YBR_PARTIAL_422 YBR_RCT YBR_ICT
YBR_PARTIAL_420

Note: It is recommended that future implementations should not use ARGB photometric interpretation.

See PS 3.5 for restrictions imposed by compressed Transfer Syntaxes.

C.8.5.6.1.3 Pixel Representation

For US Images, Pixel Representation (0028,0103) is specified to use the following Enumerated Value:

0000H = unsigned integer

C.8.5.6.1.4 Frame Increment Pointer

For US Multi-frame images, the Attribute Frame Increment Pointer (0028,0009) of the Multi-frame Module (see Section C.7.6.6) is specified by the following Defined Terms:

00181063 = sequencing by Frame Time (0018,1063)

00181065 = sequencing by Frame Time Vector (0018,1065)

C.8.5.6.1.5 Retired

C.8.5.6.1.6 Retired

C.8.5.6.1.7 Retired

C.8.5.6.1.8 Mechanical Index, Bone Thermal Index, Cranial Thermal Index, Soft Tissue Thermal Index

The thermal and/or mechanical indices, when made available by a manufacturer, are defined according to the Standard for Real-Time Display of Thermal and Mechanical Acoustic Output Indices on Diagnostic Ultrasound Equipment , a voluntary performance standard jointly published by AIUM and NEMA.

C.8.5.6.1.9 Image Transformation Matrix and Image Translation Vector

This section was defined in a previous version of the DICOM Standard. The Section is now retired. See PS 3.3 2003.

C.8.5.6.1.10 Ultrasound Color Data Present

Note: This data element can be used to indicate if an image contains any Ultrasound color data.

For example: Some Ultrasound images may have a Photometric Interpretation equal to RGB but the image will have no color information if R=G=B for all pixels.

For consistency within a particular implementation Monochrome Ultrasound images may be coded using a color photometric interpretation. In that case inclusion of this data element can significantly speed up processing. Since all components are known to be equal only one need be handled. The enhancements can be significant when compressed Transfer Syntaxes are used.

C.8.5.6.1.11 Overlay Subtype

For US Images, Overlay Subtype (60xx,0045) shall use the following Defined Terms:

ACTIVE 2D/BMODE IMAGE AREA = identification of the active area of a 2D/B-mode image.

C.8.5.6.1.12 Samples Per Pixel

For US Images, Samples Per Pixel (0028,0002) is specified to use the following values for specific Photometric Interpretations:

Table C.8-19US SAMPLES PER PIXEL

Photometric Interpretation Samples Per Pixel Value
MONOCHROME2 1
RGB 3
YBR_FULL 3
YBR_FULL_422 3
YBR_PARTIAL_422 3
YBR_RCT 3
YBR_ICT 3
YBR_PARTIAL_420 3
PALETTE COLOR 1

C.8.5.6.1.13 Bits Allocated

For US Images, Bits Allocated (0028,0100) is specified to use the following values for specific Photometric Interpretations:

Table C.8-20US BITS ALLOCATED

Photometric Interpretation Bits Allocated Value
MONOCHROME2 8
RGB 8
YBR_FULL 8
YBR_FULL_422 8
YBR_PARTIAL_422 8
YBR_RCT 8
YBR_ICT 8
YBR_PARTIAL_420 8
PALETTE COLOR 8 - 8 bit palette, or 16 - 16 bit palette

C.8.5.6.1.14 Bits Stored

For US Images, Bits Stored (0028,0101) is specified to use the following values for specific Photometric Interpretations:

Table C.8-21US BITS STORED

Photometric Interpretation Bits Stored Value
MONOCHROME2 8
RGB 8
YBR_FULL 8
YBR_FULL_422 8
YBR_PARTIAL_422 8
YBR_RCT 8
YBR_ICT 8
YBR_PARTIAL_420 8
PALETTE COLOR 8 - 8 bit palette, or 16 - 16 bit palette

C.8.5.6.1.15 High Bit

For US Images, High Bit (0028,0102) is specified to use the following values for specific Photometric Interpretations:

Table C.8-22US HIGH BIT

Photometric Interpretation High Bit Value
MONOCHROME2 7
RGB 7
YBR_FULL 7
YBR_FULL_422 7
YBR_PARTIAL_422 7
YBR_RCT 7
YBR_ICT 7
YBR_PARTIAL_420 7
PALETTE COLOR 7 - 8 bit palette, or 15 - 16 bit palette

C.8.5.6.1.16 Planar Configuration

For US Images, Planar Configuration (0028,0006) is specified to use the following values for specific Photometric Interpretations:

Table C.8-23US PLANAR CONFIGURATION

Photometric Interpretation Planar Configuration Value
RGB 0 - color-by-pixel, or 1 - color-by-plane
YBR_FULL 1
YBR_FULL_422 0
YBR_PARTIAL_422 0
YBR_RCT 0
YBR_ICT 0
YBR_PARTIAL_420 0

C.8.5.6.1.19 View Code Sequence

The view of the patient anatomy may be described using coded terminology in the View Code Sequence (0054,0220). The view is typically specified by transducer position relative to the patient anatomy and/or transducer orientation,

The view may be described by a single Code Sequence Item, or by combination of post-coordinated Code Sequence Items. The principal coded item is specified in View Code Sequence, and modifier terms in the View Modifier Code Sequence (0054,0222). The Baseline Context IDs for post-coordinated encoding of view are:

Any of these Context Groups may be used in either the View Code Sequence or the View Modifier Code Sequence.

For cardiac imaging, a Baseline Context ID with pre-coordinated view codes is specified:

Note: Transducer Position Sequence (0008,2240) and Transducer Orientation Sequence (0008,2244), defined in this module in an earlier edition of the Standard (see PS3.3-2004), are retired.

C.8.5.6.1.20 (Retired)

C.8.5.6.1.21 IVUS Acquisition

This attribute denotes which of the following defined terms describes the method used to acquire the IVUS Images.

MOTOR_PULLBACK: The IVUS imaging catheter is positioned in the blood vessel under examination distal to the anatomical structures to be examined. Then the catheter is attached to a motorized mechanism capable of withdrawing the catheter through the vessel at a constant velocity specified by the attribute IVUS Pullback Rate (0018,3101) from the defined IVUS Pullback Start Frame Number (0018,3103) (see C.8.5.6.1.24) to the IVUS Pullback Stop Frame Number (0018,3104) (see C.8.5.6.1.25).

MANUAL_PULLBACK: The IVUS imaging catheter is positioned in the blood vessel under examination distal to the anatomical structures to be examined. Then the catheter is manually withdrawn through the vessel region of interest.

SELECTIVE: The IVUS imaging catheter is positioned in the blood vessel under examination near the anatomical structures to be examined. Then the catheter is manually withdrawn or advanced through the vessel region of interest.

GATED_PULLBACK: The IVUS imaging catheter is positioned in the blood vessel under examination distal to the anatomical structures to be examined. Then the catheter is attached to a motorized mechanism capable of withdrawing the catheter through the vessel at a rate specified by the attribute IVUS Gated Rate (0018,3102), once per heart cycle, from the defined IVUS Pullback Start Frame Number (0018,3103) (see C.8.5.6.1.24) to the IVUS Pullback Stop Frame Number (0018,3104) (see C.8.5.6.1.25).

C.8.5.6.1.22 IVUS Pullback Rate

The attribute IVUS Pullback Rate (0018,3101) is required when IVUS Acquisition (0018,3100) is MOTOR_PULLBACK and it specifies the velocity of withdrawal of the IVUS imaging catheter in millimeters per second.

C.8.5.6.1.23 IVUS Gated Rate

The attribute IVUS Gated Rate (0018,3102) is required when IVUS Acquisition (0018,3100) is GATED_PULLBACK and it specifies the velocity of withdrawal of the IVUS imaging catheter in millimeters per beat.

C.8.5.6.1.24 IVUS Pullback Start Frame Number

The IVUS Pullback Start Frame Number (0018,3103) specifies the frame number of a IVUS multi-frame acquisition upon which motorized or gated pullback begins.

C.8.5.6.1.25 IVUS Pullback Stop Frame Number

The IVUS Pullback Stop Frame Number (0018,3104) specifies the frame number of a IVUS multi-frame acquisition upon which motorized or gated pullback ends.

C.8.5.6.1.26 Lesion Number

Attribute Lesion Number identifies the lesion(s) of interest imaged within the current SOP Instance. Each lesion shall have a unique numeric integer identifier within the study. If during a study the same lesion is imaged more than once, the same Lesion Number should be used for both SOP Instances.

Notes: 1.Lesion Number is not a DICOM UID.

2.An IVUS pullback may contain multiple values in Lesion Number.

C.8.6 Secondary Capture Modules

C.8.6.1 SC Equipment Module

This Module describes equipment used to convert images into a DICOM format.

Table C.8-24SC EQUIPMENT MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Conversion Type (0008,0064) 1 Describes the kind of image conversion. Defined Terms : DV = Digitized Video DI = Digital Interface DF = Digitized Film WSD = Workstation SD = Scanned Document SI = Scanned Image DRW = Drawing SYN = Synthetic Image
Modality (0008,0060) 3 Source equipment for the image. This type definition shall override the definition in the General Series Module. See C.7.3.1.1.1 for Defined Terms.
Secondary Capture Device ID (0018,1010) 3 User defined identification of the device that converted the image
Secondary Capture Device Manufacturer (0018,1016) 3 Manufacturer of the Secondary Capture Device
Secondary Capture Device Manufacturer's Model Name (0018,1018) 3 Manufacturer's model number of the Secondary Capture Device
Secondary Capture Device Software Versions (0018,1019) 3 Manufacturer's designation of software version of the Secondary Capture Device
Video Image Format Acquired (0018,1022) 3 Original format of the captured video image (e.g. NTSC, PAL, Videomed-H)
Digital Image Format Acquired (0018,1023) 3 Additional information about digital interface used to acquire the image

Notes: 1. The Attributes specified in the General equipment Module (see Table C.7-6) describe the equipment which created the image being captured. The Attributes of the SC Equipment Module define the equipment that captured the image. The following table illustrates typical scenarios for different conversion types:

Conversion Type (0008,0064) General Equipment Secondary Capture Equipment
Digitized Video (DV) The equipment generating the video signal. The equipment digitizing the video signal.
Digital Interface (DI) The equipment on the sending side of the digital interface. The equipment on the receiving side of the digital interface.
Digitized Film (DF) The equipment which created the film. The equipment digitizing the film.
Workstation (WSD) Application dependent, but often the equipment which placed the image on the workstation screen, or created the modified image. The equipment which captured the image from the screen, or which placed the modified image into a DICOM SOP Instance.
Scanned Document (SD) The equipment which created the document. The equipment digitizing the document.
Scanned Image (SI) The equipment which created the image that was digitized. The equipment digitizing the image.
Drawing (DRW) The equipment which created the drawing. The equipment digitizing (or rasterizing) the drawing.
Synthetic Image (SYN) The equipment creating the original images from which the synthetic image was derived. The equipment creating the synthetic image.

2. The Attribute Modality (0008,0060) specified in the General Series Module (see Table C.7-4) has been specialized by this Module and is defined as a Type 3 Attribute.

C.8.6.2 SC Image Module

Table C.8-25 contains IOD Attributes that describe Secondary Capture Images.

Table C.8-25SC IMAGE MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Date of Secondary Capture (0018,1012) 3 The date the Secondary Capture Image was captured.
Time of Secondary Capture (0018,1014) 3 The time the Secondary Capture Image was captured.
Nominal Scanned Pixel Spacing (0018,2010) 3 Physical distance on the media being digitized or scanned between the center of each pixel, specified by a numeric pair - adjacent row spacing (delimiter) adjacent column spacing in mm. See 10.7.1.3 for further explanation of the value order. Shall be consistent with Pixel Aspect Ratio (0028,0034), if present.
Document Class Code Sequence (0040,E008) 3 Classifications of a scanned document, e.g., for Modality (0008,0060) DOC. Equivalent to HL7 v2.x TXA-2. One or more items are permitted in this sequence.
>Include ‘Code Sequence Macro’ Table 8.8-1 No Baseline Context Group
Include Basic Pixel Spacing Calibration Macro (Table 10-10)

Note: The Attributes specified in the General Image Module (see Table C.7-7) describe this image (ie. the secondary capture image). For example, Instance Number (0020,0013) is the image number of the secondary capture image. Source Image Sequence (0008,2112) may reference the DICOM image from which this image was generated.

C.8.6.3 SC Multi-frame Image Module

Table C.8-25b contains IOD Attributes that describe SC Multi-frame images.

Table C.8-25bSC MULTI-FRAME IMAGE MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Burned In Annotation (0028,0301) 1 Indicates whether or not image contains sufficient burned in annotation to identify the patient and date the image was acquired. Enumerated Values: YES NO
Recognizable Visual Features (0028,0302) 3 Indicates whether or not the image contains sufficiently recognizable visual features to allow the image or a reconstruction from a set of images to identify the patient. Enumerated Values: YES NO If this Attribute is absent, then the image may or may not contain recognizable visual features.
Presentation LUT Shape (2050,0020) 1C Specifies an identity transformation for the Presentation LUT, such that the output of all grayscale transformations defined in the IOD containing this Module are defined to be P-Values. Enumerated Values: IDENTITY - output is in P-Values. Required if Photometric Interpretation (0028,0004) is MONOCHROME2, and BitsStored (0028,0101) is greater than 1. Note: If the VOI LUT Module is required by the IOD but no VOI LUT Sequence (0028,3010) or Window Center (0028,1050) is present, then the VOI LUT stage is an identity transformation.
Illumination (2010,015E) 3 Luminance of a hypothetical viewing device illuminating a piece of monochrome transmissive film, or for the case of reflective media, luminance obtainable from diffuse reflection of the illumination present. Expressed as L0, in candelas per square meter (cd/m2). Note: May be used together with Reflected Ambient Light (2010,0160) to recover Optical Density information from P-Values. See C.8.6.3.1.
Reflected Ambient Light (2010,0160) 3 For scanned monochrome transmissive film viewed on a hypothetical viewing device, the luminance contribution due to reflected ambient light. Expressed as La, in candelas per square meter (cd/m2). Note: May be used together with Illumination (2010,015E) to recover Optical Density information from P-Values. See C.8.6.3.1.
Rescale Intercept (0028,1052) 1C The value b in the relationship between stored values (SV) in Pixel Data (7FE0,0010) and the output units specified in Rescale Type (0028,1054). Output units = m*SV + b. Enumerated Value: 0 Required if Photometric Interpretation (0028,0004) is MONOCHROME2, and BitsStored (0028,0101) is greater than 1. Note: This specifies an identity Modality LUT transformation.
Rescale Slope (0028,1053) 1C m in the equation specified by Rescale Intercept (0028,1052). Enumerated Value: 1 Required if Photometric Interpretation (0028,0004) is MONOCHROME2, and BitsStored (0028,0101) is greater than 1. Note: This specifies an identity Modality LUT transformation.
Rescale Type (0028,1054) 1C Specifies the output units of Rescale Slope (0028,1053) and Rescale Intercept (0028,1052). Enumerated Value: US = Unspecified Required if Photometric Interpretation (0028,0004) is MONOCHROME2, and BitsStored (0028,0101) is greater than 1. Note: This specifies an identity Modality LUT transformation.
Frame Increment Pointer (0028,0009) 1C Contains the Data Element Tag of the attribute which is used as the frame increment in Multi-frame pixel data. See C.7.6.6.1.2 for further explanation. Shall be present if Number of Frames is greater than 1, overriding (specializing) the Type 1 requirement on this attribute in the Multi-frame Module.
Nominal Scanned Pixel Spacing (0018,2010) 1C Physical distance on the media being digitized or scanned between the center of each pixel, specified by a numeric pair - adjacent row spacing (delimiter) adjacent column spacing in mm. See 10.7.1.3 for further explanation of the value order. Required if Conversion Type (0008,0064) is DF (Digitized Film). May also be present if Conversion Type (0008,0064) is SD (Scanned Document) or SI (Scanned Image). Shall be consistent with Pixel Aspect Ratio(0028,0034), if present.
Include Basic Pixel Spacing Calibration Macro (Table 10-10)
Digitizing Device Transport Direction (0018,2020) 3 Enumerated Values: ROW COLUMN
Rotation of Scanned Film (0018,2030) 3 Angle of the edge of the film relative to the transport direction in degrees greater than or equal to -45 and less than or equal to +45.

C.8.6.3.1 Scanned Film, Optical Density and P-Values

Illumination (2010,015E) and Reflected Ambient Light (2010,0160) may be used to recover Optical Density information from P-Values.

Monochrome media that is being digitized is often measured in Optical Density values. These values need to be converted to P-Values for storage and display. The P-Values used in an image correspond to the perception of a human observer viewing the film on a hypothetical viewing device (such as a light box), using the specified values of Illumination (2010,015E) and Reflected Ambient Light (2010,0160).

The Grayscale Standard Display Function defined in PS 3.14 is used to convert Luminance to P-Values. In the case of scanned film, the Luminance is derived from Optical Density using the specified values of Illumination (2010,015E) and Reflected Ambient Light (2010,0160). An example of this derivation, as well as typical “default” values for these parameters, is specified in PS 3.14.

C.8.6.4 SC Multi-frame Vector Module

Table C.8-25c contains IOD Attributes that may be the target of the Frame Increment Pointer (0028,0009) for SC Multi-frame images.

Table C.8-25cSC MULTI-FRAME VECTOR MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Frame Time Vector (0018,1065) 1C An array which contains the real time increments (in msec) between frames for a Multi-frame image. See C.7.6.5.1.2 for further explanation. Required if Frame Increment Pointer (0028,0009) points to Frame Time Vector (0018,1065). Note: Frame Time Vector arrays may not be properly encoded if Explicit-VR transfer syntax is used and the VL of this attribute exceeds 65534 bytes.
Page Number Vector (0018,2001) 1C An array which contains, for each of the image frames, the corresponding page numbers of the original document. Required if Frame Increment Pointer (0028,0009) points to Page Number Vector (0018,2001).
Frame Label Vector (0018,2002) 1C An array which contains, for each of the image frames, a descriptive label. Required if Frame Increment Pointer (0028,0009) points to Frame Label Vector (0018,2002).
Frame Primary Angle Vector (0018,2003) 1C An array which contains, for each of the image frames, the primary angle of rotation about an undefined axis, in degrees. May be used for annotative purposes for “cine loops” of 3D reprojected images Required if Frame Increment Pointer (0028,0009) points to Frame Primary Angle Vector (0018,2003).
Frame Secondary Angle Vector (0018,2004) 1C An array which contains, for each of the image frames, the secondary angle of rotation about an undefined axis that is orthogonal to that used for Frame Primary Angle Vector (0018,2003), in degrees. May be used for annotative purposes for “cine loops” of 3D reprojected images Required if Frame Increment Pointer (0028,0009) points to Frame Secondary Angle Vector (0018,2004).
Slice Location Vector (0018,2005) 1C An array that contains, for each of the image frames, the relative position of the image plane expressed in mm, as defined for Slice Location (0020,1041). See C.7.6.2.1.2 for further explanation. Required if Frame Increment Pointer (0028,0009) points to Slice Location Vector (0018,2005).
Display Window Label Vector (0018,2006) 1C An array which contains, for each of the image frames, a label or number of the display window of a graphical user interface from which the frame was captured. Required if Frame Increment Pointer (0028,0009) points to Display Window Label Vector (0018,2006).

C.8.7 X-Ray Modules

This Section describes Modules used in one or more X-Ray IODs. These Modules contain Attributes that are specific to X-Ray images.

C.8.7.1 X-Ray Image Module

Table C.8-26X-RAY IMAGE MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Frame Increment Pointer (0028,0009) 1C Required if Multi-Frame Image. Contains the Data Element Tag of the attribute that is used as the Frame increment in Multi-frame image pixel data (See C.7.6.6). Specialized for X-Ray as Enumerated Value: 00181063H = Frame Time (0018,1063); 00181065H = Frame Time Vector (0018,1065).
Lossy Image Compression (0028,2110) 1C Specifies whether an Image has undergone lossy compression. Enumerated Values: 00 = Image has NOT been subjected to lossy compression. 01 = Image has been subjected to lossy compression. See C.7.6.1.1.5 Required if Lossy Compression has been performed on the Image.
Image Type (0008,0008) 1 Image identification characteristics. See C.8.7.1.1.1 for specialization.
Pixel Intensity Relationship (0028,1040) 1 The relationship between the Pixel sample values and the X-Ray beam intensity. See Section C.8.7.1.1.2.
Samples per Pixel (0028,0002) 1 Number of samples (color planes) in this image shall have a value of 1.
Photometric Interpretation (0028,0004) 1 Specifies the intended interpretation of the pixel data. Only MONOCHROME2 may be used.
Bits Allocated (0028,0100) 1 Number of bits allocated for each pixel sample. See Section C.8.7.1.1.6.
Bits Stored (0028,0101) 1 Number of bits stored for each pixel sample. See Section C.8.7.1.1.7.
High Bit (0028,0102) 1 Most significant bit for pixel sample data. See Section C.8.7.1.1.8.
Pixel Representation (0028,0103) 1 Data representation of the pixel samples. Shall have the value: 0000H = Unsigned Integer.
Scan Options (0018,0022) 3 Parameters of scanning sequence. See Section C. 8.7.1.1.4.
Include 'General Anatomy Optional Macro' Table 10-7 No Context ID for the Anatomic Region Sequence is defined.
R Wave Pointer (0028,6040) 3 Marks the location(s) of the R Wave in the cardiac cycles by referencing frame numbers; frame numbers begin with 1.
Referenced Image Sequence (0008,1140) 1C Other images significantly related to this image. Shall be present if Image Type (0008,0008) Value 3 is BIPLANE A or BIPLANE B. May be present otherwise. One or more items shall be included in this sequence. See Section C.8.7.1.1.13.
>Include ‘Image SOP Instance Reference Macro’ Table 10-3
>Purpose of Reference Code Sequence (0040,A170) 3 Describes the purpose for which the reference is made. Only a single Item is permitted in this Sequence.
>>Include Code Sequence Macro Table 8.8-1 Defined Context ID 7201
Derivation Description (0008,2111) 3 A text description of how this image was derived. See C.8.7.1.1.5 for further explanation.
Acquisition Device Processing Description (0018,1400) 3 Indicates any visual processing performed on the images prior to exchange. See Section C.8.7.1.1.3.
Frame Label Vector (0018,2002) 3 A multi-valued attribute that contains a descriptive label for each of the image frames. The number of values shall equal the number of frames.
Frame Dimension Pointer (0028,000A) 3 Contains the Data Element Tags of one or more attributes that vary or increment for the frames of a multi-frame image. See C.8.7.1.1.12. Shall not be present if it would contain only one value and that value would be Frame Time (0018,1063) or Frame Time Vector (0018,1065).
Calibration Image (0050,0004) 3 Indicates whether a reference object (phantom) of known size is present in the image and was used for calibration. Enumerated Values: YES NO Device is identified using the Device module. See C.7.6.12.

C.8.7.1.1 X-Ray Image Attribute Descriptions

C.8.7.1.1.1 Image Type

The Image Type attribute identifies important image characteristics in a multiple valued data element. For X-Ray, Image Type is specialized as follows:

a. Value 1 shall identify the Pixel Data Characteristics in accordance with Section C.7.6.1.1.2; Enumerated Values are: ORIGINAL and DERIVED;

b. Value 2 shall identify the Patient Examination Characteristics in accordance with Section C.7.6.1.1.2; Enumerated Values are: PRIMARY and SECONDARY.

Note: X-Ray images generally use PRIMARY value for images captured from patient exposure.

c. Value 3 shall identify the image set in terms of the imaging planes. Enumerated Values are:

SINGLE PLANE Image is a single plane acquisition;
BIPLANE A Image is the first plane (e.g., Frontal) of a Bi-plane acquisition;
BIPLANE B Image is the second plane (e.g., Lateral) of a Bi-plane acquisition

d. Other Values are implementation specific (optional).

C.8.7.1.1.2 Pixel Intensity Relationship

Pixel Intensity Relationship (0028,1040) shall identify the relationship of the pixel values to the X-Ray beam intensity. Defined terms are:

LIN Approximately proportional to X-Ray beam intensity;
LOG Non-linear “ Log Function”; A Modality LUT shall be included with the image to allow it to be scaled back to its proportional value to X-Ray beam intensity;
DISP Ready to be displayed; A Modality LUT may be included with the image to allow it to be scaled back to its proportional value to X-Ray beam intensity. The Attribute Acquisition Device Processing Description may be used to provide some indication on the pre-processing performed to create the ready to be displayed image.

C.8.7.1.1.3 Acquisition Device Processing Description

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

C.8.7.1.1.4 Scan Options

The Scan Options attribute identifies any acquisition technique which was used during the acquisition of the image. Defined Terms are:

EKG EKG Event Trigger
PHY Physiological Event Trigger
TOMO Tomography
CHASE Bolus Chasing
STEP Stepping
ROTA Rotation

C.8.7.1.1.5 Derivation Description

If an Image is identified to be a Derived image (see C.8.7.1.1.1 Image Type), Derivation Description (0008,2111) is an optional and implementation specific text description of the way the image was derived from an original image. As applied to X-Ray images, it may be used to describe derivation operations such as edge enhancement, temporal filtering, digital subtraction, or other linear and non-linear transformations.

C.8.7.1.1.6 Bits Allocated

For X-Ray Images, Bits Allocated (0028,0100) shall have the Enumerated Value of 8 or 16.

C.8.7.1.1.7 Bits Stored

For X-Ray Images, Bits Stored (0028,0101) shall have the Enumerated Values of 8, 10, 12, or 16.

C.8.7.1.1.8 High Bit

For X-Ray Images, High Bit (0028,0102) shall have the Enumerated Value of one less than the value in Bit Stored.

C.8.7.1.1.9 Synchronization of Frame and Waveform Times

The synchronization of a multiframe X-Ray image with a waveform (e.g., ECG, pressure, or respiration) encoded in a different SOP Instance is managed through the attributes of the Synchronization Module (see Section C.7.4.2) of the Frame of Reference IE.

Note: The use of a Curve IE within the X-Ray IODs was previously defined in DICOM (see PS3.3-2004). That use has been retired in favor of encoding waveform data in a separate IOD.

C.8.7.1.1.12 Frame Dimension Pointer

Frame Dimension Pointer (0028,000A) identifies attributes that vary or increment with each frame, and which are clinically significant for viewing or processing the image. This is intended for SOP Instances whose preferred clinical presentation is dependent on frame relationships other than simply time.

Defined Terms for multiframe cine from the Cine Module (see C.7.6.5) are:

00181063H = Frame Time (0018,1063)00181065H = Frame Time Vector (0018,1065)

Defined Terms for rotational acquisition from the XA Positioner Module (see C.8.7.5) are:

00181520H = Positioner Primary Angle Increment (0018,1520)00181521H = Positioner Secondary Angle Increment (0018,1521)

Defined Terms for stepped acquisition from the X-Ray Table Module (see C.8.7.4) are:

00181135H = Table Vertical Increment (0018,1135)00181137H = Table Longitudinal Increment (0018,1137)00181136H = Table Lateral Increment (0018,1136)

Defined Terms for an arbitrary labeled increment:

00182002H = Frame Label Vector (0018,2002)

Notes: 1. Previous editions of the standard did not include the optional Frame Dimension Pointer (0028,000A), but instead depended entirely on the mandatory Frame Increment Pointer (0028,0009), and envisaged that only time and no other dimension would relate frames. Image creators that add the Frame Dimension Pointer (0028,000A) must anticipate that many implementations will ignore or discard this attribute when displaying or storing images and continue to assume that frames are temporally related.

2. Frame Time (0018,1063) or Frame Time Vector (0018,1065) will also be present and will contain appropriate values consistent with the times of acquisition of the frames.

C.8.7.1.1.13 Referenced Image Sequence

When Image Type (0008,0008) Value 3 is BIPLANE A or BIPLANE B, Referenced Image Sequence (0008,1140) shall be used to identify the corresponding SOP Instance of the Biplane acquisition. In this case, either:

The Referenced Frame Number (0008,1160) attribute shall not be present in the Item that references the corresponding SOP Instance of the Biplane acquisition.

C.8.7.2 X-Ray Acquisition Module

Table C.8-27X-RAY ACQUISITION MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
KVP (0018,0060) 2 Peak kilo voltage output of the X-Ray generator used.
Radiation Setting (0018,1155) 1 Identify the general level of X-Ray dose exposure. Enumerated values are: SC = low dose exposure generally corresponding to fluoroscopic settings (e.g. preparation for diagnostic quality image acquisition); GR = high dose for diagnostic quality image acquisition (also called digital spot or cine);
X-Ray Tube Current (0018,1151) 2C X-Ray Tube Current in mA. Required if Exposure (0018,1152) is not present. May be present otherwise.
X-Ray Tube Current in µA (0018,8151) 3 X-Ray Tube Current in µA.
Exposure Time (0018,1150) 2C Duration of X-Ray exposure in msec. See 8.7.2.1.1. Required if Exposure (0018,1152) is not present. May be present otherwise.
Exposure Time in µS (0018,8150) 3 Duration of X-Ray exposure in µsec.
Exposure (0018,1152) 2C The exposure expressed in mAs, for example calculated from Exposure Time and X-Ray Tube Current. Required if either Exposure Time (0018,1150) or X-Ray Tube Current (0018,1151) are not present. May be present otherwise.
Exposure in μAs (0018,1153) 3 The exposure expressed in μAs, for example calculated from Exposure Time and X-Ray Tube Current.
Grid (0018,1166) 3 Identify the grid. Only a single value shall be present. Defined Terms are: IN = A Grid is positioned; NONE = No Grid is used.
Average Pulse Width (0018,1154) 3 Average width of X-Ray pulse in msec.
Radiation Mode (0018,115A) 3 Specifies X-Ray radiation mode. Defined Terms: CONTINUOUS PULSED
Type of Filters (0018,1161) 3 Type of filter(s) inserted into the X-Ray beam (e.g. wedges).
Intensifier Size (0018,1162) 3 Diameter of X-Ray intensifier in mm
Field of View Shape (0018,1147) 3 Shape of the Image Intensifier Field of View. See C.8.7.2.1.2. Defined Terms are: ROUND RECTANGLE
Field of View Dimension(s) (0018,1149) 3 Dimensions of the Image Intensifier Field of View in mm. If Rectangle, row dimension followed by column; if Round, diameter.
Imager Pixel Spacing (0018,1164) 3 Physical distance measured at the front plane of the Image Receptor housing between the center of each pixel specified by a numeric pair - row spacing value(delimiter) column spacing value in mm. See 10.7.1.3 for further explanation of the value order. The value of this attribute shall never be adjusted to account for correction for the effect of geometric magnification or calibration against an object of known size; Pixel Spacing (0028,0030) is specified for that purpose.
Include Basic Pixel Spacing Calibration Macro (Table 10-10)
Focal Spot (0018,1190) 3 Nominal focal spot size in mm used to acquire this image.
Image and Fluoroscopy Area Dose Product (0018,115E) 3 X-Ray dose, measured in dGy*cm*cm, to which the patient was exposed for the acquisition of this image plus any non-digitally recorded fluoroscopy which may have been performed to prepare for the acquisition of this image. Note: The sum of the area dose product of all images of a Series or a Study may not result in the total area dose product to which the patient was exposed.

C.8.7.2.1 X-Ray Acquisition Attribute Descriptions

C.8.7.2.1.1 Exposure Time

Exposure time is the cumulative time the patient received X-Ray exposure during this image (Multi-frame image acquisition). Calculation is pulse width * number of frames.

C.8.7.2.1.2 Field of View

The Field of View Attribute describes the shape and dimensions of the Image Receptor Field of View , applicable to both Image Intensifier and Digital Detector. This could be further restricted by the Collimator. See Section C.8.7.3.

C.8.7.3 X-Ray Collimator

An X-Ray Collimator is a device placed close to the X-Ray Source to restrict the span of the X-Ray beam. It is often made of lead shutters. Figure C.8-9 presents in a graphical form its relationship with the Field Of View Dimensions (0018,1149).

Geometry of the collimator is specified with respect to a row and column coordinate system where the origin is the upper left hand pixel. This origin is specified by the values 1,1 for row/column. A row coordinate represent a number of raw spacing (vertical) and a column coordinate represents a column spacing (horizontal). Up to three different collimator shapes may be used and superimposed.

[pic]

Figure C.8-9Relationships of X-Ray Collimator

Table C.8-28 X-RAY COLLIMATOR MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Collimator Shape (0018,1700) 1 Shape(s) of the collimator. Enumerated Values: RECTANGULAR CIRCULAR POLYGONAL This multi-valued Attribute shall contain at most one of each Enumerated Value.
Include ‘X-Ray Collimator Dimensions Macro’ Table C.8-28b

Table C.8-28bX-RAY COLLIMATOR DIMENSIONS MACRO ATTRIBUTES

Attribute Name Tag Type Attribute Description
Collimator Left Vertical Edge (0018,1702) 1C Required if a value of Collimator Shape (0018,1700) is RECTANGULAR. Location of the left edge of the rectangular collimator with respect to pixels in the image given as column. See C.8.7.3.1.1.
Collimator Right Vertical Edge (0018,1704) 1C Required if a value of Collimator Shape (0018,1700) is RECTANGULAR. Location of the right edge of the rectangular collimator with respect to pixels in the image given as column. See C.8.7.3.1.1.
Collimator Upper Horizontal Edge (0018,1706) 1C Required if a value of Collimator Shape (0018,1700) is RECTANGULAR. Location of the upper edge of the rectangular collimator with respect to pixels in the image given as row. See C.8.7.3.1.1.
Collimator Lower Horizontal Edge (0018,1708) 1C Required if a value of Collimator Shape (0018,1700) is RECTANGULAR. Location of the lower edge of the rectangular collimator with respect to pixels in the image given as row. See C.8.7.3.1.1.
Center of Circular Collimator (0018,1710) 1C Required if a value of Collimator Shape (0018,1700) is CIRCULAR. Location of the center of the circular collimator with respect to pixels in the image given as row and column. See C.8.7.3.1.1.
Radius of Circular Collimator (0018,1712) 1C Required if a value of Collimator Shape (0018,1700) is CIRCULAR. Radius of the circular collimator with respect to pixels in the image given as a number of pixels along the row direction. See C.8.7.3.1.1.
Vertices of the Polygonal Collimator (0018,1720) 1C Required if a value of Collimator Shape (0018,1700) is POLYGONAL. Multiple Values where the first set of two values are: row of the origin vertex; column of the origin vertex. Two or more pairs of values follow and are the row and column coordinates of the other vertices of the polygon collimator. Polygon collimators are implicitly closed from the last vertex to the origin vertex and all edges shall be non-intersecting except at the vertices.

C.8.7.3.1 X-Ray Collimator Attribute Descriptions

C.8.7.3.1.1 Collimator Vertical and Horizontal Edges

These attributes specify the pixel row or column where the X-Ray beam is fully obscured by a rectangular collimator:

- if the left edge of the collimator is not visible, Collimator Left Vertical Edge (0018,1702) shall have a value of 0;

- if the right edge of the collimator is not visible, Collimator Right Vertical Edge (0018,1704) value shall be 1 greater than the value of the Columns (0028,0011) attribute;

- if the top edge of the collimator is not visible, Collimator Upper Horizontal Edge (0018,1706) shall have a value of 0;

- if the bottom edge of the collimator is not visible, Collimator Lower Horizontal Edge (0018,1708) value shall be 1 greater than the value of the Rows (0028,0010) attribute.

C.8.7.4 X-Ray Table Module

Table C.8-29 contains Attributes that describe X-Ray images acquired with movement of the patient imaging table.

Table C.8-29X-RAY TABLE MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Table Motion (0018,1134) 2 Defined terms: STATIC DYNAMIC
Table Vertical Increment (0018,1135) 2C Incremental change in Vertical position of the table relative to first frame of Multi-frame image given in mm. Required if Table Motion is DYNAMIC.
Table Longitudinal Increment (0018,1137) 2C Incremental change in Longitudinal position of the table relative to first frame of Multi-frame image in mm. Table motion towards +90°position of the primary angle of the positioner is positive. See C.8.7.4.1.2. Required if Table Motion is DYNAMIC.
Table Lateral Increment (0018,1136) 2C Incremental change in Lateral position of the table relative to first frame of Multi-frame image given in mm. Table motion towards +90°position of the secondary angle of the positioner is positive. See C.8.7.4.1.3. Required if Table Motion is DYNAMIC.
Table Angle (0018,1138) 3 Angle of table plane in degrees relative to horizontal plane [Gravity plane]. Positive values indicate that the head of the table is upwards.

C.8.7.4.1 X-Ray Table Attribute Descriptions

C.8.7.4.1.1 Table Motion Increments

This section is replaced by section C.8.7.4.1.4

C.8.7.4.1.2 Table Longitudinal Increment

The direction of the longitudinal movement is perpendicular to the primary axis of rotation of the positioner. A positive value of Table Longitudinal Increment (0018,1137) attributes indicates a movement towards the +90° position of the positioner, see figure C.8-9a.

[pic]

Figure C.8-9aTable Longitudinal Movement

C.8.7.4.1.3 Table Lateral Increment

The direction of the lateral movement is perpendicular to the secondary axis of rotation of the positioner. A positive value of Table Lateral Increment (0018,1136) attributes indicates a movement towards the +90° position of the positioner, see figure C.8-9b.

[pic]

Figure C.8-9b Table Lateral Movement

Note: The terms “longitudinal” and “lateral” are relative to an operator standing tableside, and facing the patient. Thus lateral movement is to the left and right of the operator, and longitudinal movement is towards or away from the operator.

C.8.7.4.1.4 Table Motion with Patient in relation to Imaging Chain

The table moves the Patient with respect to the imaging chain. This is being tracked as a motion of the imaging chain with respect to a coordinate system (X, Y, Z) attached to the patient (assumption is that the patient does not move with respect to the table). The coordinate system origin is fixed with respect to the patient at the time of the first frame. The X-axis is increasing to the left hand side of the patient. The Y-axis is increasing to the posterior side of the patient. The Z-axis is increasing toward the head of the patient (see Section C.7.6.2.1.1). The Patient Plane is then defined by the X and Z-axes as drawn in Figure C.8-10).

Notes: 1. Table motion causes the apparent locus of imaging to move in the opposite direction. For instance, with the patient supine and the table motion towards +90°of the primary axis of rotation of the positioner, the area of the patient imaged moves toward the right hand side of the patient.

2. When the patient is positioned prone or supine ( Figure C.8-2 showing the supine position) the Table Longitudinal Increment (0018,1137) table motion takes place along the patient X-axis and the Table Lateral Increment (0018,0036) along the Z-axis. For patient positioned left or right decubitus, the Table Longitudinal Increment takes place along the Y-axis, the other direction is not changed.

[pic]

Figure C.8-10 Table Motion Vector Coordinates

C.8.7.5 XA Positioner Module

Table C.8-30 contains IOD Attributes that describe a c-arm positioner typically used in acquiring X-Ray Angiographic Images. The coordinate system used to track the positioner is defined in reference to the patient. The definition of coordinates with respect to the equipment is not supported. Furthermore, this module does not describe the movement of the Patient.

Note: The scope of the XA IOD is to address images produced on acquisition equipment equipped with an X-Ray source and an image Receptor positioned by what is general called a c-arm For clinical areas other than Angiography which are using a c-arm to position the X-Ray source and image receptor (e.g. Interventional Procedures and Myelography and Biopsy/Localization), the X-Ray Angiography Image Object should be also used. Although the object is optimized for c-arm systems, it may also be used by other systems which support a similar coordinate system, such as some RF systems.

Table C.8-30XA POSITIONER MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Distance Source to Patient (0018,1111) 3 Distance in mm from source to isocenter (center of field of view). Note: This value is traditionally referred to as Source Object Distance (SOD).
Distance Source to Detector (0018,1110) 3 Distance in mm from source to detector center. Note: This value is traditionally referred to as Source Image Receptor Distance (SID).
Estimated Radiographic Magnification Factor (0018,1114) 3 Ratio of Source Image Receptor Distance (SID) over Source Object Distance (SOD).
Positioner Motion (0018,1500) 2C Used to describe the activity of the imaging devices. Defined terms: DYNAMIC, STATIC. See C.8.7.5.1.1. Required if the Pixel Data (7FE0,0010) contains more than one frame. May be present otherwise.
Positioner Primary Angle (0018,1510) 2 Position of the X-Ray Image Intensifier about the patient from the RAO to LAO direction where movement from RAO to vertical is positive. See C.8.7.5.1.2.
Positioner Secondary Angle (0018,1511) 2 Position of the X-Ray Image Intensifier about the patient from the CAU to CRA direction where movement from CAU to vertical is positive. See C.8.7.5.1.2
Positioner Primary Angle Increment (0018,1520) 2C Incremental change in primary positioner angle for each frame. See C.8.7.5.1.3. Required if Positioner Motion (0018,1500) equals DYNAMIC.
Positioner Secondary Angle Increment (0018,1521) 2C Incremental change in secondary positioner angle for each frame. See C.8.7.5.1.3. Required if Positioner Motion (0018,1500) equals DYNAMIC.
Detector Primary Angle (0018,1530) 3 Angle of the X-Ray beam in the row direction in degrees relative to the normal to the detector plane. Positive values indicate that the X-Ray beam is tilted towards higher numbered columns. Negative values indicate that the X-Ray beam is tilted towards lower numbered columns. See C.8.7.5.1.4.
Detector Secondary Angle (0018,1531) 3 Angle of the X-Ray beam in the column direction in degrees relative to the normal to the detector plane. Positive values indicate that the X-Ray beam is tilted towards lower numbered rows. Negative values indicate that the X-Ray beam is tilted towards higher numbered rows. See C.8.7.5.1.4.

C.8.7.5.1 XA Positioner Attribute Descriptions

C.8.7.5.1.1 Positioner Motion

Positioner Motion (0018,1500) attribute is STATIC if the imaging table moves during a multi-frame acquisition, but the X-Ray positioner do not move.

If Pixel Data (7FE0,0010) contains a single frame and a value of the Positioner Motion (0018,1500) attribute is provided, the value shall be STATIC.

Note: If the positioner undergoes translation (non-rotational movement) during the acquisition, then that motion shall be described by an opposite table motion (See Section C.8.7.4).

C.8.7.5.1.2 Positioner Primary and Secondary Angles

The definitions of Positioner Angles shall be with respect to the patient as illustrated in Figures C.8-11 and C.8-12 Zero degree is referenced to the origin perpendicular to the patient's chest. The Positioner Primary Angle definition is like longitude (in the equatorial plan); the Positioner Secondary Angle definition is like latitude (in the sagittal plane). The Positioner Angle attributes apply to the first frame of a multi-frame image. The valid range of Primary Positioner Angle is -180 to +180 degrees and the Secondary Positioner Angle range is -90 to + 90 degrees.

The Patient Plane is defined by the isocenter of the imaging device and slices through the patient such that it is perpendicular to the sagittal plane of the body. The Primary Axis of rotation is defined at the intersection of the Patient Plane and of the Sagittal Plane. The Positioner Primary Angle is defined in the transaxial plane at the isocenter with zero degrees in the direction perpendicular to the patient's chest and + 90 degrees at the Patient left hand side (LAO) and -90 at the Patient right hand side (RAO). The valid range of Primary Positioner Angle is -180 to +180 degrees.

The Secondary Axis is in the Patient Plane and is perpendicular to the Primary Axis at the isocenter. The Positioner Secondary Angle is defined in the Sagittal Plane at the isocenter with zero degrees in the direction perpendicular to the patient's chest. +90 degrees corresponds to the cranial direction. The Secondary Positioner Angle range is -90 to + 90 degrees.

At a 0 angle for both the Primary Angle (0018,1510) and Secondary Angle (0018,1511), the patient faces the Image Intensifier.

The Positioner Primary Angle (0018,1510) and Secondary Angle (0018,1511) apply to the first frame of a multi-frame image.

[pic]

Figure C.8-11Positioner Primary Angle

[pic]

Figure C.8-12 Positioner Secondary Angle

C.8.7.5.1.3 Positioner Angle Increments

If the positioner angles change during acquisition of a multi-frame image, the Positioner Angle Increment attributes describe the angular change per frame.

If the change in positioner angle is nominally constant for each frame, these fields may contain a single value of the average angular change per frame. Alternatively, the fields may contain a vector of offsets from the (initial) Positioner Angle attributes, with one value for each frame in the multi-frame image. The number of values in the Positioner Angle Increment attributes must be one, or must be equal to the Number of Frames attribute (0028,0008) in the Multi-Frame Module (see Section C.7.6.6).

Note: It is permissible to generate a vector of the absolute positioner angles in the Positioner Angle Increment attributes, and set the Positioner Primary and Secondary Angle attributes to value 0.

C.8.7.5.1.4 Detector Primary and Secondary Angles

Detector Angles are defined in a fashion similar to the positioner angles, except that the angle of the central x-ray beam vector is relative to the detector plane rather than the patient plane. The central x-ray beam vector is defined as the vector from the x-ray source through the isocenter to the detector plane. Zero degree is referenced to the normal to the detector plane pointing away from the x-ray source. The Detector Angle attributes apply to the first frame of a multi-frame image. The valid range of the Detector Angles is -90 to + 90 degrees.

The Primary Axis of rotation is defined along the line in the column direction of the detector plane which intersects the central x-ray beam vector. The Detector Primary Angle is defined in the plane perpendicular to the Primary Axis of rotation at the point where the central x-ray beam vector intersects the detector plane, with zero degrees in the direction normal to the detector plane and -90 degrees at the left hand side of the image (i.e., toward column 1) and +90 at the right hand side of the image (i.e., toward the highest numbered column). The valid range of Primary Detector Angle is -90 to +90 degrees.

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

C.8.7.6 XRF Positioner Module

Table C.8-31XRF POSITIONER MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Distance Source to Detector (0018,1110) 3 Distance in mm from source to detector center. Note: This value is traditionally referred to as Source Image Receptor Distance (SID).
Distance Source to Patient (0018,1111) 3 Distance in mm from source to isocenter (center of field of view). Note: This value is traditionally referred to as Source Object Distance (SOD).
Estimated Radiographic Magnification Factor (0018,1114) 3 Ratio of SID (Source Image Receptor Distance) over SOD (Source Object Distance).
Column Angulation (0018,1450) 3 Angle of the X-Ray beam in degree relative to an orthogonal axis to the detector plane. Positive values indicate that the tilt is towards the head of the table. Note: The detector plane is assumed to be parallel to the table plane.

C.8.7.7 X-Ray Tomography Acquisition Module

This Module describes the attributes of a Tomography acquisition (translation of X-Ray source during the acquisition of a single frame image).

Table C.8-32X-RAY TOMOGRAPHY ACQUISITION MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Tomo Layer Height (0018,1460) 1 Distance in mm between the table surface and the sharp image plane.
Tomo Angle (0018,1470) 3 Angle span in degrees of rotation of X-Ray Source during X-Ray acquisition.
Tomo Time (0018,1480) 3 Time in seconds the source has taken to rotate the Tomo Angle during X-Ray acquisition.
Tomo Type (0018,1490) 3 Type of tomography. Defined Terms: LINEAR SPIRAL POLYCYCLOIDAL CIRCULAR
Tomo Class (0018,1491) 3 Form of tomography: Defined Terms: MOTION TOMOSYNTHESIS
Number of Tomosynthesis Source Images (0018,1495) 3 The number of source images used to construct this tomosynthetic image. Only meaningful if Tomo Class (0018,1491) is TOMOSYNTHESIS. These may be listed in Source Image Sequence (0008,2112) of the General Image Module.

C.8.7.8 X-Ray Acquisition Dose Module

This Module describes the attributes related to dose delivery from an X-Ray source during the acquisition of an X-Ray image.

Table C.8-33X-RAY ACQUISITION DOSE MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
KVP (0018,0060) 3 Peak kilo voltage output of the X-Ray generator used.
X-Ray Tube Current (0018,1151) 3 X-Ray Tube Current in mA.
X-Ray Tube Current in µA (0018,8151) 3 X-Ray Tube Current in µA.
Exposure Time (0018,1150) 3 Duration of X-Ray exposure in msec.
Exposure Time in µS (0018,8150) 3 Duration of X-Ray exposure in µsec.
Exposure (0018,1152) 3 The exposure expressed in mAs, for example calculated from Exposure Time and X-Ray Tube Current.
Exposure in µAs (0018,1153) 3 The exposure expressed in µAs, for example calculated from Exposure Time and X-Ray Tube Current.
Distance Source to Detector (0018,1110) 3 Distance in mm from source to detector center. Note: This value is traditionally referred to as Source Image Receptor Distance (SID).
Distance Source to Patient (0018,1111) 3 Distance in mm from source to the table, support or bucky side that is closest to the Imaging Subject, as measured along the central ray of the X-Ray beam. Note: 1. This definition is less useful in terms of estimating geometric magnification than a measurement to a defined point within the Imaging Subject, but accounts for what is realistically measurable in an automated fashion in a clinical setting. 2. This measurement does not take into account any air gap between the Imaging Subject and the “front” of the table or bucky. 3. If the detector is not mounted in a table or bucky, then the actual position relative to the patient is implementation or operator defined. 4. This value is traditionally referred to as Source Object Distance (SOD).
Image and Fluoroscopy Area Dose Product (0018,115E) 3 X-Ray dose, measured in dGy*cm*cm, to which the patient was exposed for the acquisition of this image plus any non-digitally recorded fluoroscopy which may have been performed to prepare for the acquisition of this image. Notes: 1. The sum of the area dose product of all images of a Series or a Study may not result in the total area dose product to which the patient was exposed. 2. This may be an estimated value based on assumptions about the patient’s body size and habitus.
Body Part Thickness (0018,11A0) 3 The average thickness in mm of the body part examined when compressed, if compression has been applied during exposure.
Relative X-Ray Exposure (0018,1405) 3 Indication of the applied dose, in manufacturer specific units. Notes: 1. This value is intended to provide a single location where manufacturer specific information can be found for annotation on a display or film, that has meaning to a knowledgeable observer. 2. This may be a calculated or measured value. Examples are the detector entrance dose (KB), the CR sensitivity value (S), or the logarithmic median (lgM). 3. DICOM specifies standard Attributes in Table 10-23 ‘Exposure Index Macro’ which are recommended.
Entrance Dose (0040,0302) 3 Average entrance dose value measured in dGy at the surface of the patient during the acquisition of this image. Note: This may be an estimated value based on assumptions about the patient’s body size and habitus.
Entrance Dose in mGy (0040,8302) 3 Average entrance dose value measured in mGy at the surface of the patient during the acquisition of this image. Note: This may be an estimated value based on assumptions about the patient’s body size and habitus.
Exposed Area (0040,0303) 3 Typical dimension of the exposed area at the detector plane. If Rectangular: row dimension followed by column; if Round: diameter. Measured in cm. Notes: 1. The exposed area should be consistent with values specified in the X-Ray Collimator Module, if present. 2. This may be an estimated value based on assumptions about the patient’s body size and habitus. 3. This attribute is used in the Radiation Dose Module with units in mm (see Section C.4.16 Table C.4-16).
Distance Source to Entrance (0040,0306) 3 Distance in mm from the source to the surface of the patient closest to the source during the acquisition of this image. Note: This may be an estimated value based on assumptions about the patient’s body size and habitus.
Comments on Radiation Dose (0040,0310) 3 User-defined comments on any special conditions related to radiation dose encountered during the acquisition of this image.
X-Ray Output (0040,0312) 3 The X-Ray output at the patient entrance surface and kVp used to acquire the image, measured in mGy/mAs. Note: This value may be a calibrated value rather than measured during the exposure.
Half Value Layer (0040,0314) 3 The thickness of Aluminum in mm required to reduce the X-Ray Output (0040,0312) by a factor of two. Note: This value may be a calibrated value rather than measured during the exposure.
Organ Dose (0040,0316) 3 Average organ dose value measured in dGy during the acquisition of this image. Note: This may be an estimated value.
Organ Exposed (0040,0318) 3 Organ to which Organ Dose (0040,0316) applies. Defined Terms: BREAST GONADS BONE MARROW FETUS LENS Note: The anatomic regions described by these terms are those that are particularly radiosensitive and for which it is conventional to obtain organ specific dose parameters.
Anode Target Material (0018,1191) 3 The primary material in the anode of the X-Ray source. Defined Terms: TUNGSTEN MOLYBDENUM RHODIUM
Include ‘X-Ray Filtration Macro’ Table C.8.35a
Rectification Type (0018,1156) 3 Type of rectification used in the X-Ray generator. Defined Terms: SINGLE PHASE THREE PHASE CONST POTENTIAL
Include Table 10-23 ‘Exposure Index Macro’

C.8.7.9 X-Ray Generation Module

This Module describes the attributes related to generation of X-Rays during the acquisition of an X-Ray image.

Table C.8-34X-RAY GENERATION MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
KVP (0018,0060) 3 Peak kilo voltage output of the X-Ray generator used.
X-Ray Tube Current (0018,1151) 3 X-Ray Tube Current in mA.
X-Ray Tube Current in µA (0018,8151) 3 X-Ray Tube Current in µA.
Exposure Time (0018,1150) 3 Duration of X-Ray exposure in msec.
Exposure Time in µS (0018,8150) 3 Duration of X-Ray exposure in µsec.
Exposure (0018,1152) 3 The exposure expressed in mAs, for example calculated from Exposure Time and X-Ray Tube Current.
Exposure in µAs (0018,1153) 3 The exposure expressed in µAs, for example calculated from Exposure Time and X-Ray Tube Current.
Exposure Control Mode (0018,7060) 3 Type of exposure control. Defined Terms: MANUAL AUTOMATIC
Exposure Control Mode Description (0018,7062) 3 Text description of the mechanism of exposure control. May describe the number and type of exposure sensors or position of the sensitive area of the imaging detector.
Exposure Status (0018,7064) 3 Whether the exposure was normally completed or not. Defined Terms: NORMAL ABORTED
Phototimer Setting (0018,7065) 3 Nominal percentage phototimer setting, where a more positive value indicates greater exposure and a more negative value indicates less exposure.
Focal Spot (0018,1190) 3 Nominal focal spot size in mm used to acquire this image.
Anode Target Material (0018,1191) 3 The primary material in the anode of the X-Ray source. Defined Terms: TUNGSTEN MOLYBDENUM RHODIUM
Rectification Type (0018,1156) 3 Type of rectification used in the X-Ray generator. Defined Terms: SINGLE PHASE THREE PHASE CONST POTENTIAL
Generator ID (0018,1005) 3 Identifier of the generator

C.8.7.10 X-Ray Filtration Module

This Module describes the attributes related to the filtration of X-Rays during the acquisition of an X-Ray image.

Table C.8-35X-RAY FILTRATION MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Include ‘X-Ray Filtration Macro’ Table C.8.35a

Table C.8-35aX-RAY FILTRATION MACRO ATTRIBUTES

Attribute Name Tag Type Attribute Description
Filter Type (0018,1160) 3 Type of filter(s) inserted into the X-Ray beam (e.g. wedges). Defined Terms: STRIP WEDGE BUTTERFLY MULTIPLE NONE Note: Multiple type of filters can be expressed by a combination, e.g., BUTTERFLY+WEDGE.
Filter Material (0018,7050) 3 The X-Ray absorbing material used in the filter. May be multi-valued. Defined Terms: MOLYBDENUM ALUMINUM COPPER RHODIUM NIOBIUM EUROPIUM LEAD
Filter Thickness Minimum (0018,7052) 3 The minimum thickness in mm of the X-Ray absorbing material used in the filters. May be multi-valued, with values corresponding to the respective values in Filter Material (0018,7050).
Filter Thickness Maximum (0018,7054) 3 The maximum thickness in mm of the X-Ray absorbing material used in the filters. May be multi-valued, with values corresponding to the respective values in Filter Material (0018,7050).
Filter Beam Path Length Minimum (0018,7056) 3 The minimum length (in mm) of the X-Ray beam path in the Filter Material that is not blocked by collimation. May be multi-valued, with values corresponding to the respective values in Filter Material (0018,7050).
Filter Beam Path Length Maximum (0018,7058) 3 The maximum length (in mm) of the X-Ray beam path in the Filter Material that is not blocked by collimation. May be multi-valued, with values corresponding to the respective values in Filter Material (0018,7050).

C.8.7.11 X-Ray Grid Module

This Module describes the attributes related to the use of a grid to reduce scatter of X-Rays during the acquisition of an X-Ray image.

Table C.8-36X-RAY GRID MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Grid (0018,1166) 3 Identifies the grid. May be multi-valued. Defined Terms are: FIXED FOCUSED RECIPROCATING PARALLEL CROSSED NONE
Include ‘X-Ray Grid Description Macro’ Table C.8-36b

Table C.8-36bX-RAY GRID DESCRIPTION MACRO ATTRIBUTES

Attribute Name Tag Type Attribute Description
Grid Absorbing Material (0018,7040) 3 The X-Ray absorbing material used in the grid.
Grid Spacing Material (0018,7041) 3 The spacing material used in the grid.
Grid Thickness (0018,7042) 3 The thickness in mm of the X-Ray absorbing material used in the grid.
Grid Pitch (0018,7044) 3 The pitch in mm of the X-Ray absorbing material used in the grid.
Grid Aspect Ratio (0018,7046) 3 Ratio of the vertical spacing and horizontal spacing of the X-Ray absorbing material used in the grid. Specified by a pair of integer values where the first value is the vertical size, and the second value is the horizontal size.
Grid Period (0018,7048) 3 Period in mSec of reciprocation cycle. Only meaningful if a value of Grid (0018,1166) is RECIPROCATING.
Grid Focal Distance (0018,704C) 3 Focal distance in mm of a FOCUSED grid.
Grid ID (0018,1006) 3 Identifier of the grid

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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C.8.9 PET Information Module Definitions

This Section describes Positron Emission Tomography series and image Modules. These Modules contain Attributes that are specific to Positron Emission Tomography images.

C.8.9.1 PET Series Module

Table C.8-60 contains IOD Attributes that describe a PET Series.

Table C.8-60 - PET SERIES MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Series Date (0008,0021) 1 Date the Series started. See C.8.9.1.1.2 for specialization.
Series Time (0008,0031) 1 Time the Series started. See C.8.9.1.1.2 for specialization.
Units (0054,1001) 1 Pixel value units. See C.8.9.1.1.3 for explanation. Defined terms: CNTS, NONE, CM2, CM2ML, PCNT, CPS, BQML, MGMINML, UMOLMINML, MLMING, MLG, 1CM, UMOLML, PROPCNTS, PROPCPS, MLMINML, MLML, GML, STDDEV
SUV Type (0054,1006) 3 Type of Standardized Uptake Value (SUV). Enumerated Values: BSA – body surface area BW – body weight LBM – lean body mass If absent, and the Units (0054,1001) are GML, then the type of SUV shall be assumed to be BW. Note: The type of SUV cannot reliably be deduced from the units alone, i.e. SUVbw and SUVlbm both have units of GML.
Counts Source (0054,1002) 1 The primary source of counts. The primary source leads to the underlying image Units (0054,1001), as opposed to secondary sources which are used during reconstruction correction. Enumerated Values: EMISSION TRANSMISSION
Series Type (0054,1000) 1 A multi-valued indicator of the type of Series. See C.8.9.1.1.4 for explanation. Value 1 Enumerated Values: STATIC DYNAMIC GATED WHOLE BODY Value 2 Enumerated Values: IMAGE REPROJECTION
Reprojection Method (0054,1004) 2C Method for projecting volumetric data onto planar projection. Required if Series Type (0054,1000), Value 2 is REPROJECTION. Defined terms: SUM MAX PIXEL
Number of R-R Intervals (0054,0061) 1C The maximum number of R-R Intervals that may exist in this Series. Required if Series Type (0054,1000), Value 1 is GATED.
Number of Time Slots (0054,0071) 1C The maximum number of Time Slots that may exist in this Series. Required if Series Type (0054,1000), Value 1 is GATED.
Number of Time Slices (0054,0101) 1C The maximum number of Time Slices that may exist in this Series. Required if Series Type (0054,1000), Value 1 is DYNAMIC.
Number of Slices (0054,0081) 1 The maximum number of Slices that may exist in this Series.
Corrected Image (0028,0051) 2 One or more values that indicate which, if any, corrections have been applied to the images in this series. Defined terms: DECY=decay corrected ATTN=attenuation corrected SCAT=scatter corrected DTIM=dead time corrected MOTN=gantry motion corrected (e.g. wobble, clamshell) PMOT=patient motion corrected CLN=count loss normalization (correction for count loss in gated Time Slots). RAN=randoms corrected RADL=non-uniform radial sampling corrected DCAL=sensitivity calibrated using dose calibrator NORM=detector normalization
Randoms Correction Method (0054,1100) 3 Type of randoms correction processing. Defined terms: NONE = no randoms correction DLYD = delayed event subtraction SING = singles estimation
Attenuation Correction Method (0054,1101) 3 A textual description of the attenuation correction processing. e.g. measured vs. calculated, transmission source type (ring, line, point), assumed patient geometry (polygon, ellipse, segmented, attenuation coefficient, skull thickness), post-injection transmission, smoothing.
Scatter Correction Method (0054,1105) 3 A textual description of the scatter correction processing. e.g. convolution-subtraction, dual energy window, model-based, use of attenuation data.
Decay Correction (0054,1102) 1 The real-world event to which images in this Series were decay corrected. See C.8.9.1.1.5 for explanation. Defined terms: NONE = no decay correction START= acquisition start time ADMIN = radiopharmaceutical administration time
Reconstruction Diameter (0018,1100) 3 Diameter, in mm, of the region within which the data was used in creating the reconstruction of the image. Data may exist outside this region and portions of the patient may exist outside this region.
Convolution Kernel (0018,1210) 3 Textual description of the convolution kernel(s) used to reconstruct the data (e.g. name, cutoff, radial/axial/angular, mathematical form, DC handling)
Reconstruction Method (0054,1103) 3 Textual description of reconstruction processing, e.g. 2D filtered backprojection, 2D iterative, 3D PROMIS, 3D FAVOR, 3D iterative.
Detector Lines of Response Used (0054,1104) 3 Textual description of which detector lines of response were used, mashed, or otherwise processed during tomographic reconstruction.
Acquisition Start Condition (0018,0073) 3 Description of how the data collection was started. Defined terms: DENS = density (counts/sec) RDD = relative density difference (change in counts/sec) MANU = manual TIME = time AUTO = automatic, when ready TRIG = physiological trigger See C.8.9.1.1.6 for explanation.
Acquisition Start Condition Data (0018,0074) 3 Count density, change in count density, or physiological triggers causing data collection to start.
Acquisition Termination Condition (0018,0071) 3 Description of how the data collection for the series was stopped. Defined terms: CNTS = counts DENS = density (counts/sec) RDD = relative density difference (change in counts/sec) MANU = manual OVFL = data overflow TIME = time TRIG = physiological trigger See C.8.4.9.1.3 for explanation.
Acquisition Termination Condition Data (0018,0075) 3 Number of counts, count density, change in count density, or physiological triggers causing the termination.
Field of View Shape (0018,1147) 3 Shape of the field of view of the PET camera. Defined Terms: CYLINDRICAL RING HEXAGONAL MULTIPLE PLANAR
Field of View Dimensions (0018,1149) 3 Dimensions of the field of view, in mm. Transverse detector diameter followed by axial width.
Gantry/Detector Tilt (0018,1120) 3 Angle of tilt in degrees of the gantry. See C.8.9.1.1.7 for explanation.
Gantry/Detector Slew (0018,1121) 3 Angle of slew in degrees of the gantry. Positive slew is moving the gantry on the patient’s left toward the patient’s superior, when the patient is supine.
Type of Detector Motion (0054,0202) 3 Describes the detector motion during acquisition. Defined Terms: NONE = stationary gantry STEP AND SHOOT = Interrupted motion, acquire only while stationary CONTINUOUS = Gantry motion and acquisition are simultaneous and continuous WOBBLE = wobble motion CLAMSHELL = clamshell motion
Collimator Type (0018,1181) 2 Collimator Type. Defined Terms: NONE = no collimator RING = transverse septa
Collimator/Grid Name (0018,1180) 3 Label describing the collimator used.
Axial Acceptance (0054,1200) 3 Maximum axial angle accepted, in degrees.
Axial Mash (0054,1201) 3 Number of adjacent axial lines of response mashed together. See C.8.9.1.1.8 for explanation.
Transverse Mash (0054,1202) 3 Number of adjacent transverse lines of response mashed together. See C.8.9.1.1.9 for explanation.
Detector Element Size (0054,1203) 3 Size of an individual detector element, in mm. Transverse dimension followed by axial dimension. For a discrete crystal, this is the crystal size. For a continuous detector, this is the pixel bin size.
Coincidence Window Width (0054,1210) 3 The width of the coincidence timing window, in nsec. The maximum time difference accepted between two single events.
Energy Window Range Sequence (0054,0013) 3 Sequence of Items that describes the energy windows used for this Series. One or more Items are permitted in this sequence. See C.8.9.1.1.10 for explanation.
>Energy Window Lower Limit (0054,0014) 3 The lower limit of the energy window, in KeV.
>Energy Window Upper Limit (0054,0015) 3 The upper limit of the energy window, in KeV.
Secondary Counts Type (0054,1220) 3 Array defining the type of additional counts accumulated during acquisition. Defined terms: DLYD=delayed events SCAT=scattered events in secondary window SING=singles DTIM=events lost due to deadtime

C.8.9.1.1 PET Series Attribute Descriptions

Note: The meaning of a General Series in DICOM is determined by the attributes in the General Series Module and by the Source Entities (Patient, Study, Frame of Reference, Equipment) that originate the Series. The Source Entities are the single-valued entities of the 1->n relationship, where the Series is the multi-valued entity. Therefore, a Series is a group of images that: are from the same patient and study; are from the same Equipment; and, are from the same spatial Frame of Reference.

The PET Image IOD further refines a PET Series IE by the attributes in the PET Series Module, the PET Isotope Module, the PET Multi-gated Acquisition Module and the Acquisition Context Module. These are the attributes that shall not change from Image to Image. Therefore, in addition to the criteria above for a General Series (same patient, study, frame of reference, equipment), the attributes in the PET Series IE define a PET series as a group of images that: are from the same temporal frame of reference; have the same fundamental meaning (e.g. same units: either activity density, metabolism, or attenuation); are derived from the same activity source (emission or transmission); are from the same isotope and radiopharmaceutical; were derived from the same reconstruction processing; and, originated from the same acquisition setup and parameters, including the patient conditions (cardiac stress or rest) if applicable.

C.8.9.1.1.1 Specialization of Image Plane Module and Image Pixel Module Attributes

For PET Series, the following Image Pixel Module attributes shall not vary from Image to Image :

Photometric Interpretation (0028,0004) Rows (0028,0010) Columns (0028,0011) Bits Allocated (0028,0100) Bits Stored (0028,0101) Pixel Representation (0028,0103)

For PET Series, the following Image Plane Module attributes shall not vary from Image to Image :

Pixel Spacing (0028,0030)

For PET Series where Series Type (0054,1000), Value 2 is IMAGE, the following Image Plane Module attributes shall not vary from Image to Image :

Image Orientation (Patient) (0020,0037)

Note: This means that for a Series Type (0054,1000) Value 2 of IMAGE, all images in the PET Series lie on parallel planes. The images, however, may have non-uniform spacing along the normals to the planes.

For PET Series where Series Type (0054,1000), Value 2 is REPROJECTION, the Image Orientation (0020,0037) attribute shall vary such that the images rotate about a single axis. Geometrically, the normal to each image plane is defined by the cross product of its row and column vectors. Each reprojection image has one Center Normal that passes through the center of the image. Reprojection images within a PET Series shall have their Center Normals be co-planar and pass through a single point.

C.8.9.1.1.2 Series Date, Series Time

For PET Series, Series Date (0008,0021) and Series Time (0008,0031) are specified to be Type 1. The Series Date (0008,0021) and Series Time (0008,0031) are used as the reference time for all PET Image attributes that are temporally related, including activity measurements. The Series Date (0008,0021) and Series Time (0008,0031) are not tied to any real-world event (e.g. acquisition start, radiopharmaceutical administration) and their real-world meaning are implementation dependent.

C.8.9.1.1.3 Units

The units of the pixel values obtained after conversion from the stored pixel values (SV) (Pixel Data (7FE0,0010)) to pixel value units (U), as defined by Rescale Intercept (0028,1052) and Rescale Slope (0028,1053). Defined Terms:

CNTS = counts NONE = unitless CM2 = centimeter**2 PCNT = percent CPS = counts/second BQML = Becquerels/milliliter MGMINML = milligram/minute/milliliter UMOLMINML = micromole/minute/milliliter MLMING = milliliter/minute/gram MLG = milliliter/gram 1CM = 1/centimeter UMOLML = micromole/milliliter PROPCNTS = proportional to counts PROPCPS = proportional to counts/sec MLMINML = milliliter/minute/milliliter MLML = milliliter/milliliter GML = grams/milliliter STDDEV = standard deviations

C.8.9.1.1.4 Series Type

The Series Type (0054,1000), Value 1 is used to identify the spatial location and temporal nature of the images within a PET Series. The Enumerated Values and their definitions are:

STATIC = a group of images at varying spatial locations at the same time DYNAMIC = a group of images at a set of spatial locations (e.g. slices) at varying time slices, with all spatial locations acquired at all time slices GATED = a group of images at the same spatial location, same starting and ending time, but acquired in different time slots of (possibly) different R-R intervals WHOLE BODY = same as STATIC, except covering multiple transverse fields of view (and therefore acquired at a different time).

Notes: 1. Using this definition and the comments in C.8.9.1.1.1, here are some examples of PET series and the encoding of Series Type (0054,1000) Value 1.

Static acquisition: a group of n transverse images at varying superior<->inferior locations, all acquired between the same starting and ending time. Series Type = STATIC.

Dynamic acquisition: a group of n*m transverse images at n superior<->inferior locations, acquired with m different starting and ending times. Series Type = DYNAMIC.

Gated acquisition: a group of n*m*p transverse images at n superior<->inferior locations, all acquired between the same starting and ending time, acquired in m different R-R Intervals (as determined by Low R-R Value (0018,1081) and High R-R Value (0018,1082)), and acquired in p time slots of a given R-R Interval (as determined by Trigger Time (0054,1000) ). Series Type = GATED.

Whole body acquisition: a group of n transverse images at varying superior<->inferior locations covering a significant fraction of the entire body. Series Type = WHOLE BODY.

Multiple transverse fields of view: a group of n transverse images at varying superior<->inferior locations. Series Type = WHOLE BODY.

Interleaved: group of 2*n transverse images acquired at overlapped AFOVs to increase transverse sampling. Series Type = WHOLE BODY.

Sagittal (Coronal, Oblique): sagittal (coronal, oblique) re-sliced images derived by reformatting transverse images. The Series Type is STATIC, DYNAMIC, GATED, or WHOLE BODY depending on source Series Type.

Arithmetic: images derived by an arithmetic operation on operand images. The Series Type is STATIC, DYNAMIC, GATED, or WHOLE BODY depending on source Series Type.

Metabolic: images derived by a metabolic model. The Series Type is STATIC, DYNAMIC, GATED, or WHOLE BODY depending on source Series Type.

2. Using this definition, here are some images that are not stored in the same PET Series:

Two images from the same scan that were reconstructed differently.

Emission and transmission images for the same Patient and Study, even if acquired simultaneously (because emission and transmission images have different reconstruction processing).

Two images of same patient, one after NH3 injection and one after FDG injection.

Two images: an original image created from reconstructed scan data and its derived image based on a metabolic model.

The Series Type (0054,1000), Value 2 is used to identify the volumetric meaning of the images within a PET Series. The Enumerated Values and their definitions are:

IMAGE = a tomographic image slice

REPROJECTION = a projection image derived from forward projection through slices of tomographic images, using the algorithm defined in Reprojection Method (0054,1004).

C.8.9.1.1.5 Decay Correction

The Decay Correction (0054,1102) is the real-world event to which images in this Series were decay corrected. If decay correction is applied, all images in the Series shall be decay corrected to the same time. The Defined Terms and definitions are:

NONE = no decay correction START= acquisition start time, Acquisition Time (0008,0032) ADMIN = radiopharmaceutical administration time, Radiopharmaceutical Start Time (0018,1072)

The time to which images have been decay corrected can be derived from Decay Factor (0054,1321), Frame Reference Time (0054,1300), Radionuclide Half Life (0018,1075), Series Date (0008,0021), and Series Time (0008,0031).

C.8.9.1.1.6 Acquisition Start Condition

Acquisition Start Condition (0018,0073) is the method of starting acquisition data collection. The Defined Terms and definitions are:

DENS = preset count density (counts/sec) was reached RDD = preset relative count density difference (change in counts/sec) was reached MANU = acquisition was started manually TIME = preset time limit was reached AUTO = start automatically, when ready TRIG = preset number of physiological triggers was reached

C.8.9.1.1.7 Gantry/Detector Tilt

Gantry/Detector Tilt (0018,1120) for PET Image data is the angle in degrees of the gantry relative to the patient’s major (Head to Feet) axis (or the table supporting the patient). Positive tilt is moving the top of the gantry towards the patient’s feet.

C.8.9.1.1.8 Axial Mash

Axial Mash (0054,1201) is multi-valued and is defined as the number of unique axial Lines of Response (LOR) that were mashed together (center of the axial field of view only). Value 1 is the number of LORs mashed for an odd slice. Value 2 is the number of LORs mashed for an even slice. For discrete crystal scanners, each unique LOR corresponds to a pair of crystals. For continuous detectors whose bin size is variable, the number of LORs mashed is determined by the actual bin size divided by the Detector Element Size (0054,1203), Value 2. The value of Axial Mash (0054,1201) is the same regardless of whether the mashing was done during acquisition or reconstruction.

Note: As an example on a discrete crystal scanner, if a ring difference of -2,0,+2 are binned as an odd slice and a ring difference of -1,+1 are binned as an even slice, then the Axial Mash (0054,1201) is equal to 3\2 .

C.8.9.1.1.9 Transverse Mash

Transverse Mash (0054,1202) is defined as the number of unique transverse Lines of Response (LOR) that were mashed together. For discrete crystal scanners, each unique LOR corresponds to a pair of crystals. For continuous detectors whose bin size is variable, the number of LORs mashed is determined by the actual bin size divided by the Detector Element Size (0054,1203), Value 1. The value of Transverse Mash (0054,1202) is the same regardless of whether the mashing was done during acquisition or reconstruction.

C.8.9.1.1.10 Energy Window Range Sequence

Multiple energy windows are allowed in order to allow coincidence events based on additional Energy Windows (e.g. Compton events scattered in the detector). All energy windows are assumed to contribute to all images in the PET Series.

C.8.9.1.1.11 Temporal Relationships of Images in PET Series

The following diagram shows the temporal relationships of images within a PET Series.

[pic]

C.8.9.2 PET Isotope Module

Table C.8-61 contains IOD Attributes that describe a PET Isotope.

Table C.8-61 - PET ISOTOPE MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Radiopharmaceutical Information Sequence (0054,0016) 2 Sequence of Items that describe isotope information. Zero or more Items shall be included in this sequence.
>Radionuclide Code Sequence (0054,0300) 2 Sequence that identifies the radionuclide. Zero or one item shall be included in this sequence.
>>Include ‘Code Sequence Macro’ Table 8.8-1 Baseline CID 4020 .
>Radiopharmaceutical Route (0018,1070) 3 Route of administration.
>Administration Route Code Sequence (0054,0302) 3 Sequence that identifies the administration route of the radiopharmaceutical. Only a single Item is permitted in this sequence.
>>Include ‘Code Sequence Macro’ Table 8.8-1 Baseline CID 11.
>Radiopharmaceutical Volume (0018,1071) 3 Volume of administered radiopharmaceutical in cubic cm.
>Radiopharmaceutical Start Time (0018,1072) 3 Time of start of administration. The actual time of radiopharmaceutical administration to the patient for imaging purposes, using the same time base as Series Time (0008,0031). The use of this Attribute is deprecated in favor of Radiopharmaceutical Start DateTime (0018,1078). Note: The use of a time alone can cause confusion when the procedure spans midnight.
>Radiopharmaceutical Start DateTime (0018,1078) 3 Date and time of start of administration. The actual date and time of radiopharmaceutical administration to the patient for imaging purposes, using the same time base as Series Time (0008,0031).
>Radiopharmaceutical Stop Time (0018,1073) 3 Time of end of administration. The actual ending time of radiopharmaceutical administration to the patient for imaging purposes, using the same time base as Series Time (0008,0031). The use of this Attribute is deprecated in favor of Radiopharmaceutical Stop DateTime (0018,1079). Note: The use of a time alone can cause confusion when the procedure spans midnight.
>Radiopharmaceutical Stop DateTime (0018,1079) 3 Date and time of end of administration. The actual ending date and time of radiopharmaceutical administration to the patient for imaging purposes, using the same time base as Series Time (0008,0031).
>Radionuclide Total Dose (0018,1074) 3 The radiopharmaceutical dose administered to the patient measured in Becquerels (Bq) at the Radiopharmaceutical Start Time (0018,1072). Note: In other IODs, such as the NM IOD, this same attribute is specified in MegaBecquerels (MBq).
>Radionuclide Half Life (0018,1075) 3 The radionuclide half life, in seconds, that was used in the correction of this image.
>Radionuclide Positron Fraction (0018,1076) 3 The radionuclide positron fraction (fraction of decays that are by positron emission) that was used in the correction of this image.
>Radiopharmaceutical Specific Activity (0018,1077) 3 The activity per unit mass of the radiopharmaceutical, in Bq/micromole, at the Radiopharmaceutical Start Time (0018,1072).
>Radiopharmaceutical (0018,0031) 3 Name of the radiopharmaceutical.
>Radiopharmaceutical Code Sequence (0054,0304) 3 Sequence that identifies the radiopharmaceutical. Only a single Item is permitted in this sequence.
>>Include ‘Code Sequence Macro’ Table 8.8-1 Baseline CID 4021 .
Intervention Drug Information Sequence (0018,0026) 3 Sequence of Items that describes the intervention drugs used. One or more items are permitted in this sequence.
>Intervention Drug Name (0018,0034) 3 Name of the intervention drug.
>Intervention Drug Code Sequence (0018,0029) 3 Sequence that identifies the intervention drug name. Only a single Item is permitted in this Sequence.
>>Include ‘Code Sequence Macro’ Table 8.8-1 Baseline CID 10.
>Intervention Drug Start Time (0018,0035) 3 Time of administration of the intervention drug, using the same time base as for the Series Time (0008,0031).
>Intervention Drug Stop Time (0018,0027) 3 Time of completion of administration of the intervention drug, using the same time base as for the Series Time (0008,0031).
>Intervention Drug Dose (0018,0028) 3 Intervention drug dose, in mg.

C.8.9.3 PET Multi-gated Acquisition Module

Table C.8-62 contains IOD Attributes that describe a PET Multi-gated Acquisition.

Table C.8-62 - PET MULTI-GATED ACQUISITION MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Beat Rejection Flag (0018,1080) 2 Heart beat duration sorting has been applied. Enumerated values: Y = yes N = no
Trigger Source or Type (0018,1061) 3 Text indicating trigger source. Defined terms: EKG
PVC Rejection (0018,1085) 3 Description of the type of PVC rejection criteria used.
Skip Beats (0018,1086) 3 Number of beats skipped after a detected arrhythmia.
Heart Rate (0018,1088) 3 Average number of heart beats per minute for the collection period for this image. This shall include all accepted beats as well as rejected beats.
Cardiac Framing Type (0018,1064) 3 Description of type of framing performed. See C.7.6.18.1.1.1 for description and Defined Terms.

C.8.9.4 PET Image Module

Table C.8-63 contains IOD Attributes that describe PET images.

Table C.8-63 - PET IMAGE MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Image Type (0008,0008) 1 Image identification characteristics. See C.8.9.4.1.1 for specialization.
Samples per Pixel (0028,0002) 1 Number of samples (planes) in this image. This value shall be 1.
Photometric Interpretation (0028,0004) 1 Specifies the intended interpretation of the pixel data. See C.8.9.4.1.2 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. Enumerated values: 16.
Bits Stored (0028,0101) 1 Number of bits stored for each pixel sample. Each sample shall have the same number of bits stored. The value shall be the same as the value in Bits Allocated (0028,0100).
High Bit (0028,0102) 1 Most significant bit for pixel sample data. Each sample shall have the same high bit. Shall be one less than the value in Bits Stored (0028,0101).
Rescale Intercept (0028,1052) 1 The value b in relationship between stored values (SV) and pixel value units (U) defined in Units (0054,1001): U = m*SV+b. The Rescale Intercept is always zero for PET images.
Rescale Slope (0028,1053) 1 m in the equation specified in Rescale Intercept (0028,1052).
Frame Reference Time (0054,1300) 1 The time that the pixel values in the image occurred. Frame Reference Time is the offset, in msec, from the Series reference time. See explanation in C.8.9.4.1.5.
Trigger Time (0018,1060) 1C Time interval, in msec, from the start of the trigger to the beginning of data acquisition for this image. Required if Series Type (0054,1000), Value 1 is GATED.
Frame Time (0018,1063) 1C Nominal duration per individual frame, in msec. Required if Series Type (0054,1000), Value 1 is GATED. See C.8.9.4.1.3 for explanation.
Low R-R Value (0018,1081) 1C R-R interval lower limit for beat rejection, in msec. Required if Series Type (0054,1000), Value 1 is GATED and Beat Rejection Flag (0018,1080) is Y.
High R-R Value (0018,1082) 1C R-R interval upper limit for beat rejection, in msec. Required if Series Type (0054,1000), Value 1 is GATED and Beat Rejection Flag (0018,1080) is Y.
Lossy Image Compression (0028,2110) 1C Specifies whether an Image has undergone lossy compression. Enumerated values: 00 = Image has NOT been subjected to lossy compression. 01 = Image has been subjected to lossy compression. See C.7.6.1.1.5. Required if Lossy Compression has been performed on the image.
Image Index (0054,1330) 1 An index identifying the position of this image within a PET Series. See C.8.9.4.1.9 for explanation.
Acquisition Date (0008,0022) 2 The date the acquisition of data that resulted in this image started. See C.8.9.4.1.4 for specialization.
Acquisition Time (0008,0032) 2 The time the acquisition of data that resulted in this image started. See C.8.9.4.1.4 for specialization.
Actual Frame Duration (0018,1242) 2 Elapsed time of the data acquisition for this image, in msec. See C.8.9.4.1.6 for explanation.
Nominal Interval (0018,1062) 3 Average duration of accepted beats, in msec, of the R-R interval.
Intervals Acquired (0018,1083) 3 Number of heartbeats that fall within Low R-R Value (0018,1081) and High R-R Value (0018,1082), and were therefore accepted and contribute coincidence events to this R-R Interval.
Intervals Rejected (0018,1084) 3 Number of heartbeats that fall outside Low R-R Value (0018,1081) and High R-R Value (0018,1082), and do not contribute coincidence events to this R-R Interval. However, they may contribute coincidence events to other R-R Intervals.
Primary (Prompts) Counts Accumulated (0054,1310) 3 The sum of events that occur in the primary event channel. The counts include Trues +Scatter+ Randoms if Randoms Correction Method (0054,1100) is NONE; otherwise the counts are Trues +Scatter.
Secondary Counts Accumulated (0054,1311) 3 Sum of counts accumulated in secondary channels. See C.8.9.4.1.7 for explanation.
Slice Sensitivity Factor (0054,1320) 3 The slice-to-slice sensitivity correction factor that was used to correct this image. The value shall be one if no slice sensitivity correction was applied.
Decay Factor (0054,1321) 1C The decay factor that was used to scale this image. Required if Decay Correction (0054,1102) is other than NONE. If decay correction is applied, all images in the Series shall be decay corrected to the same time.
Dose Calibration Factor (0054,1322) 3 Factor that was used to scale this image from counts/sec to Bq/ml using a dose calibrator. The value shall be one if no dose calibration was applied. See C.8.9.4.1.8 for explanation.
Scatter Fraction Factor (0054,1323) 3 An estimate of the fraction of acquired counts that were due to scatter and were corrected in this image. The value shall be zero if no scatter correction was applied.
Dead Time Factor (0054,1324) 3 The average dead time correction factor that was applied to this image. The value shall be one if no dead time correction was applied.
Include 'General Anatomy Optional Macro' Table 10-7 No Context ID for the Anatomic Region Sequence is defined.
Slice Progression Direction (0054,0500) 3 Describes the anatomical direction that slices are progressing as the slices are considered in order (as defined by the Slice Index. See section C.8.9.4.1.9 for a definition of Slice Index). Meaningful only for cardiac images. When View Code Sequence (0054,0220) indicates a short axis view, then Enumerated Values are: APEX_TO_BASE BASE_TO_APEX
View Code Sequence (0054,0220) 3 Sequence that describes the projection of the anatomic region of interest. Only a single Item is permitted in this sequence.
>Include ‘Code Sequence Macro’ Table 8.8-1 Baseline CID 26.
>View Modifier Code Sequence (0054,0222) 2C View Modifier. Required if needed to fully specify the View. Zero or one Item shall be included in this sequence.
>>Include ‘Code Sequence Macro’ Table 8.8-1 Baseline CID 23.

Note: Referenced Overlay Sequence (0008,1130) and Referenced Curve Sequence (0008,1145) were previously included in this Module as optional Attributes but have been retired. See PS 3.3 2004.

C.8.9.4.1 PET Image Module Attribute Descriptions

C.8.9.4.1.1 Image Type

For PET Images, Image Type (0008,0008) is specified to be Type 1.

Note: For PET images, Image Type (0008,0008) Value 1 will be ORIGINAL for reconstructed images. DERIVED may be appropriate for some other results images. For PET images, Image Type (0008,0008) Value 2 will be PRIMARY.

C.8.9.4.1.2 Photometric Interpretation

For PET images, Photometric Interpretation (0028,0004) shall have one of the following Enumerated Values:

MONOCHROME2

See C.7.6.3.1.2 for definition of this term.

C.8.9.4.1.3 Frame Time

The Frame Time (0018,1063) is the explicit duration of the gated frame when Cardiac Framing Type (0018,1064) is equal to FORW or BACK. Frame Time (0018,1063) is the nominal duration of the gated frame when Cardiac Framing Type (0018,1064) is equal to PCNT.

C.8.9.4.1.4 Acquisition Date, Acquisition Time

For PET Images, Acquisition Date (0008,0022) and Acquisition Time (0008,0032) are specified to be Type 2. The Acquisition Date (0008,0022) and Acquisition Time (0008,0032) use the same time base as Series Time (0008,0031).

For Series Type (0054,1000) Value 1 equal to STATIC, WHOLE BODY, or DYNAMIC, the Acquisition Time (0008,0032) is the real-world beginning of the accumulation of events into this Image. For STATIC, WHOLE BODY, or DYNAMIC Series, the Acquisition Time (0008,0032) may vary from Image to Image within a PET Series.

For Series Type (0054,1000) Value 1 equal to GATED, the Acquisition Time (0008,0032) is the real-world beginning of the capability of accumulating events into this Image. (The actual accumulation of events has only occurred during an R-R Interval.) For GATED Series, the Acquisition Time (0008,0032) shall not vary from Image to Image within a PET Series.

C.8.9.4.1.5 Frame Reference Time

Frame Reference Time (0054,1300) is the time that the pixel values in the Image occurred. Frame Reference Time is defined as the time offset, in msec, from the Series Reference Time, where the Series Reference Time is defined by the combination of Series Date (0008,0021) and Series Time (0008,0031).

Note: Frame Reference Time (0054,1300) is implementation dependent and may or may not be tied to any real-world event. To illustrate the meaning of Frame Reference Time (0054,1300), the following are some examples of possible implementations:

Example 1: For a long-lived radionuclide and a non-time-varying radiopharmaceutical distribution, an implementation sets the Frame Reference Time (0054,1300) to the midpoint of the Actual Frame Duration (0018,1242).

Example 2: For a short-lived radionuclide and a non-time-varying radiopharmaceutical distribution, an implementation sets the Frame Reference Time (0054,1300) to the time at which the average activity occurs for a decaying radionuclide, Tave . If image acquisition started at the Series Reference Time and the image has not been decay corrected, then Tave will be:

where: lambda = decay constant = (ln 2)/T1/2 T1/2 = Radionuclide Half Life (0018,1075) T = Actual Frame Duration (0018,1242)Note that Tave will be sooner than the midpoint of the Actual Frame Duration (0018,1242).

Example 3: For a short-lived radionuclide and a time-varying radiopharmaceutical distribution, an implementation with supplementary data (e.g. scanner count rates or blood sample data) sets the Frame Reference Time (0054,1300) to a derived time determined to be its best estimate of the time that the pixel values occurred.

C.8.9.4.1.6 Actual Frame Duration

The accumulation of counts for a PET Image shall occur entirely between:

(1) the acquisition starting time (as specified by Acquisition Date (0008,0022) and Acquisition Time (0008,0032)), and

(2) the acquisition ending time, which is equal to the acquisition starting time in (1) plus the Actual Frame Duration (0018,1242).

If the Series Type (0054,1000), Value 1 is GATED, then the actual accumulation of counts has only occurred during an R-R Interval.

C.8.9.4.1.7 Secondary Counts Accumulated

Secondary Counts Accumulated (0054,1311) is multi-valued and, if supplied, has Values corresponding to the Secondary Counts Type (0054,1220). The number and order of the Values in Secondary Counts Accumulated (0054,1311) shall be the same as Secondary Counts Type (0054,1220).

C.8.9.4.1.8 Dose Calibration Factor

The Dose Calibration Factor (0054,1322) is the factor that was used to scale this image from counts/sec to Bq/ml using an external dose calibrator. The value shall be one if no dose calibration was applied. The application of a dose calibration correction is specified by Corrected Image (0028,0051) equal to DCAL.

Note: Dose Calibration Factor (0054,1322) is not equal to the inverse of the sensitivity (kcps/Bq/ml) of the scanner, which is usually measured for a given radiopharmaceutical distribution and excluding the effects of attenuation.

C.8.9.4.1.9 Image Index

Image Index (0054,1330) is an index identifying the position of this image within a PET Series.

Note: The scheme for encoding Image Index (0054,1330) is as follows. Images within a PET Series can be viewed as a multi-dimensional array whose possible dimensions include R-R Intervals, Time Slots, Time Slices, and Slices. The dimensions of the array are defined by the Series Type (0054,1000) Value 1. Each dimension of the array has an index that identifies the position of this image in the array. The indices are: R-R Interval Index, Time Slot Index, Time Slice Index, Slice Index. The indices are calculated as follows:

Index Range of Index Order of Images along that Dimension
R-R Interval Index 1 to Number of R-R Intervals (0054,0061) Increasing Low R-R Value (0018,1081)
Time Slot Index 1 to Number of Time Slots (0054,0071) Increasing Trigger Time (0018,1060)
Time Slice Index 1 to Number of Time Slices (0054,0101) Increasing Frame Reference Time (0054,1300)
Slice Index 1 to Number of Slices (0054,0081) If Series Type (0054,1000) Value 2 is IMAGE: Order is in increasing position along the normal, where the normal is determined by the cross product of the direction cosines of the row and column of the image. See Image Orientation (0020,0037) in the Image Plane Module. If Series Type (0054,1000) Value 2 is REPROJECTION: Order is in increasing or decreasing angle of the normal, where the normal is determined by the cross product of the direction cosines of the row and column of the image. See Image Orientation (0020,0037) in the Image Plane Module. (Note that reprojection images rotate about only a single axis as described in C.8.9.1.1.1. Therefore, all normals are co-planar and make a single angle with respect to each other.)

Using these index values the position of this image within the multi-dimensional array (the Image Index (0054,1330)) is calculated as follows:

Series Type (0054,1000), Value 1 Dimensions of Array (Last dimension is most rapidly changing) Encoding of Image Index (0054,1330)
STATIC Slice Slice Index
WHOLE BODY Slice Slice Index
DYNAMIC Time Slice \ Slice ( ( Time Slice Index - 1 ) * ( Number of Slices (0054,0081) ) ) + Slice Index
GATED R-R Interval \ Time Slot \ Slice ( ( R-R Interval Index - 1 ) * ( Number of Time Slots (0054,0071) ) * ( Number of Slices (0054,0081) ) ) + ( ( Time Slot Index - 1 ) * ( Number of Slices (0054,0081) ) ) + Slice Index

C.8.9.5 PET Curve Module

Retired. See PS 3.3 2004.

C.8.10 Hardcopy Modules

Retired. See PS 3.3 2004.

C.8.11 DX Modules

C.8.11.1 DX Series Module

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

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

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

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

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

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

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

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

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

Table C.8-68DX SERIES MODULE ATTRIBUTES

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

C.8.11.1.1 DX Series Attribute Descriptions

C.8.11.1.1.1 Presentation Intent Type

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[pic]

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

C.8.11.2 DX Anatomy Imaged Module

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

Table C.8-69DX ANATOMY IMAGED MODULE ATTRIBUTES

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

C.8.11.2.1 DX Anatomy Imaged Attribute Descriptions

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

C.8.11.3 DX Image Module

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

Table C.8-70DX IMAGE MODULE ATTRIBUTES

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

C.8.11.3.1 DX Image Attribute Descriptions

C.8.11.3.1.1 Image Type

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

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

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

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

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

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

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

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

C.8.11.3.1.2 Pixel Intensity Relationship and Grayscale Transformations

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

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

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

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

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

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

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

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

C.8.11.3.1.3 Acquisition Device Processing Description

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

C.8.11.3.1.4 Derivation Description

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

C.8.11.3.1.5 VOI Attributes

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

C.8.11.4 DX Detector Module

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

Table C.8-71DX DETECTOR MODULE ATTRIBUTES

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

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

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

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

C.8.11.4.1 DX Detector Attribute Descriptions

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

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

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

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

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

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

- Field of View Shape (0018,1147),

- Field of View Dimensions (0018,1149),

- Imager Pixel Spacing (0018,1164),

- Rows (0028,0010),

- Columns (0028,0011)

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

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

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

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

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

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

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

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

- Field of View Origin (0018,7030),

- Field of View Rotation (0018,7032),

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

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

- Detector Active Shape (0018,7024),

- Detector Active Dimensions (0018,7026),

- Detector Element Physical Size (0018,7020),

- Detector Element Spacing (0018,7022).

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

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

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

- Detector Active Origin (0018,7028).

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

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

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

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

[pic]

Figure C.8-14 Explanation of Digital Detector Attributes

[pic]

[pic]

Figure C.8-15Explanation of Digital Detector Attributes

C.8.11.5 DX Positioning Module

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

Table C.8-72DX POSITIONING MODULE ATTRIBUTES

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

C.8.11.5.1 DX Positioning Attribute Descriptions

C.8.11.5.1.1 View Code Sequence

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

C.8.11.5.1.2 Patient Orientation Code Sequence

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

C.8.11.6 Mammography Series Module

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

Table C.8-73MAMMOGRAPHY SERIES MODULE ATTRIBUTES

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

C.8.11.7 Mammography Image Module

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

Table C.8-74MAMMOGRAPHY IMAGE MODULE ATTRIBUTES

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

C.8.11.7.1 Mammography Image Attribute Descriptions

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

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

[pic]

Figure C.8-8

C.8.11.7.1.2 Detector Primary and Secondary Angles

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

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

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

C.8.11.7.1.3 Partial View Code Sequence

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

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

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

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

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

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

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

C.8.11.7.1.4 Image Type

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

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

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

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

Table C.8-74a

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

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

C.8.11.8 Intra-oral Series Module

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

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

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

C.8.11.9 Intra-oral Image Module

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

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

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

C.8.11.9.1 Intra-oral Image Attribute Descriptions

C.8.11.9.1.1 Primary Anatomic Structure Sequence

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

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

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

C.8.11.10 Enhanced Mammography Series Module

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

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

Table C.8-76bENHANCED MAMMOGRAPHY SERIES MODULE ATTRIBUTES

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

C.8.12 VL Modules and Functional Group Macros

C.8.12.1 VL Image Module

Table C.8-77 specifies the Attributes that describe a VL Image produced by Endoscopy (ES), General Microscopy (GM), Automated-Stage Microscopy (SM), External-camera Photography (XC), or other VL imaging Modalities.

Table C.8-77VL IMAGE MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Image Type (0008,0008) 1 Image identification characteristics. See C.8.12.1.1.6 for specialization.
Photometric Interpretation (0028,0004) 1 Specifies the intended interpretation of the pixel data. See C.8.12.1.1.1 for specialization of this Attribute.
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.8.12.1.1.2 for specialization of this Attribute. See PS 3.5 for further explanation.
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.8.12.1.1.2 for specialization of this Attribute. See PS 3.5 for further explanation.
High Bit (0028,0102) 1 Most significant bit for pixel sample data. Each sample shall have the same high bit. See C.8.12.1.1.2 for specialization of this Attribute. See PS 3.5 for further explanation.
Pixel Representation (0028,0103) 1 Data representation of the pixel samples. Each sample shall have the same pixel representation. See Section C.8.12.1.1.3 for specialization of this Attribute.
Samples per Pixel (0028,0002) 1 Number of samples (planes) per image. See C.8.12.1.1.4 for specialization of this Attribute.
Planar Configuration (0028,0006) 1C Indicates whether the pixel data are sent color-by-plane or color-by-pixel. Required if Samples per Pixel (0028,0002) has a value greater than 1. See C.8.12.1.1.5 for specialization of this Attribute.
Content Time (0008,0033) 1C The time the image pixel data creation started. Required if the Image is part of a series in which the images are temporally related. Note: This Attribute was formerly known as Image Time.
Lossy Image Compression (0028,2110) 2 Specifies whether an Image has undergone lossy compression. Enumerated Values: 00 = Image has NOT been subjected to lossy compression. 01 = Image has been subjected to lossy compression. See C.7.6.1.1.5
Referenced Image Sequence (0008,1140) 1C A Sequence that references other images significantly related to this image. One or more items are permitted in this sequence. Required if Image Type (0008,0008) Value 3 is present and has a value of "STEREO L" or "STEREO R". May also be present otherwise. See Section C.8.12.1.1.7.
>Include ‘Image SOP Instance Reference Macro’ Table 10-3
>Purpose of Reference Code Sequence (0040,A170) 2 Describes the purpose for which the reference is made. Zero or one item shall be included in this sequence.
>>Include Code Sequence Macro Table 8.8-1 Defined Context ID 7201
Window Center (0028,1050) 3 Window Center for display. See C.11.2.1.2 for further explanation. Meaningful only if Photometric Interpretation (0028,0004) is MONOCHROME2.
Window Width (0028,1051) 1C Window Width for display. See C.11.2.1.2 for further explanation. Required if Window Center (0028,1050) is present.
Anatomic Region Sequence (0008,2218) 1C Sequence that identifies the anatomic region of interest in this image (i.e. external anatomy, surface anatomy, or general region of the body). Only a single Item shall be included in this sequence. Required if Number of Frames (0028,0008) is present and Specimen Description Sequence (0040,0560) is absent. May be present otherwise.
>Include ‘Code Sequence Macro’ Table 8.8-1 Defined CID 4040 is defined for the Video Endoscopic IOD. For other IODs, no Context ID is defined.
>Anatomic Region Modifier Sequence (0008,2220) 3 Sequence of Items that modifies the anatomic region of interest of this image One or more Items are permitted in this Sequence.
>>Include ‘Code Sequence Macro’ Table 8.8-1 Baseline CID 2.
Include ‘Primary Anatomic Structure Macro’ Table 10.4-8 No Context ID is defined. These Type 3 Attributes are not appropriate when Specimen Description Sequence (0040,0560) is present, as it includes the Primary Anatomic Structure Macro for each specimen in the image.
Channel Description Code Sequence (0022,001A) 3 Describes the light color used for each channel to generate the image. If Photometric Interpretation (0028,0004) has one of the YBR values, the meaning is for pixel data in an equivalent RGB encoding. Note: Interpretation and representation of RGB images rely on the assumption that the red channel really contains the red wavelength range of illumination light, the blue channel the blue wavelength range, etc. Some modalities use the RGB Photometric Interpretation as a container representing 3 channels of any illumination wavelength. Shall have the same number of items as the value of Samples per Pixel (0028,0002). The channels shall be described in the order in which the channels are encoded.
>Include ‘Code Sequence Macro’ Table 8.8-1 Baseline CID 4206.
Pixel Spacing (0028,0030) 3 Physical distance in the imaging target (patient or specimen) between the center of each pixel, specified as a numeric pair – adjacent row spacing \ adjacent column spacing, in mm. See 10.7.1.3.

C.8.12.1.1 VL Image Module Attribute Descriptions

C.8.12.1.1.1 Photometric Interpretation

The Enumerated Values of Photometric Interpretation (0028,0004) shall be:

MONOCHROME2

RGB

YBR_FULL_422

YBR_PARTIAL_420

YBR_RCT

YBR_ICT

Note: There is no formal color space defined, hence “false” color applications that encode near-visible light images may be encoded, for example, as RGB.

C.8.12.1.1.2 Bits Allocated, Bits Stored, and High Bit

The Enumerated Value of Bits Allocated (0028,0100) shall be 8; the Enumerated Value of Bits Stored (0028,0101) shall be 8; and the Enumerated Value of High Bit (0028,0102) shall be 7.

C.8.12.1.1.3 Pixel Representation

The Enumerated Value of Pixel Representation (0028,0103) shall be 0.

C.8.12.1.1.4 Samples per Pixel

The Enumerated Values of Samples per Pixel (0028,0002) shall be as follows: If the value of Photometric Interpretation (0028,0004) is MONOCHROME2, then the Enumerated Value of Samples per Pixel (0028,0002) shall be one (1). If the value of Photometric Interpretation (0028,0004) is RGB or YBR_FULL_422 or YBR_PARTIAL_420 or YBR_RCT or YBR_ICT, then the Enumerated Value of Samples per Pixel (0028,0002) shall be three (3).

C.8.12.1.1.5 Planar Configuration

If present, the Enumerated Value of Planar Configuration (0028,0006) shall be 0. This value shall be present if Samples per Pixel (0028,0002) has a value greater than 1.

C.8.12.1.1.6 Image Type

The Image Type attribute identifies important image characteristics in a multiple valued data element. For Visible Light, Image Type is specialized as follows:

a. Value 1 shall identify the Pixel Data Characteristics in accordance with Section C.7.6.1.1.2; Enumerated Values are: ORIGINAL and DERIVED;

b. Value 2 shall identify the Patient Examination Characteristics in accordance with Section C.7.6.1.1.2; Enumerated Values are: PRIMARY and SECONDARY.

c. Value 3 may be absent, but if present shall identify the members of a stereo pair, in which case Referenced Image Sequence (0008,1140) is used to identify the other member of the pair. If present, the Enumerated Values are:

STEREO L Image is the left image (relative to the observer's left) of a stereo pair acquisition;
STEREO R Image is the right image (relative to the observer's right) of a stereo pair acquisition.

d. Other Values are implementation specific (optional).

C.8.12.1.1.7 Referenced Image Sequence

When Image Type (0008,0008) Value 3 is STEREO L or STEREO R, Referenced Image Sequence (0008,1140) shall be used to identify the corresponding SOP Instance of the Stereoscopic acquisition. In this case, either:

C.8.12.2 Slide Coordinates Module

The table in this Section contains Attributes that describe Slide Coordinates. Slide Coordinates provide a means to locate an image within a given Frame of Reference.

Notes: 1. A Frame of Reference (identified by a Frame of Reference UID) typically only applies to a single mounting of a slide on a particular microscope stage; there is no guarantee that a subsequent mounting of the slide, even on the same equipment, will allow reproducible positioning to the exact same location. These attributes allow consistent location of multiple images within the Series of a single Frame of Reference.

2. There is no a priori correspondence of pixels to Slide Coordinates. Therefore, the geometrical symmetry point through the pixel plane of the digital microscope may not correspond to the center of a pixel. The geometrical symmetry point could be between pixels.

3. This module formerly included a Type 3 attribute Pixel Spacing Sequence (0040,08D8), and subsidiary attributes; see PS 3.3-2009. Pixel spacing is an attribute of the image acquisition, not the slide coordinates, and is inappropriate for this Module. It is now conveyed by Pixel Spacing (0028,0030) in the VL Image Module or the Pixel Measures Functional Group.

Table C.8-78Slide Coordinates Module Attributes

Attribute Name Tag Type Attribute Description
Image Center Point Coordinates Sequence (0040,071A) 2 The coordinates of the center point of the Image in the Slide Coordinate System Frame of Reference. Zero or one item shall be included in this sequence. See Section C.8.12.2.1.1 for further explanation.
>X Offset in Slide Coordinate System (0040,072A) 1 The X offset in millimeters from the Origin of the Slide Coordinate System. See Figure C.8-16.
>Y Offset in Slide Coordinate System (0040,073A) 1 The Y offset in millimeters from the Origin of the Slide Coordinate System. See Figure C.8-16.
>Z Offset in Slide Coordinate System (0040,074A) 2 The Z offset in microns from the image substrate reference plane (i.e. utilized surface of a glass slide).

C.8.12.2.1 Slide Coordinates Attribute Descriptions

C.8.12.2.1.1 Image Center Point Coordinates Sequence

This Section defines the Slide Coordinate System and specifies the Attributes that shall be used to describe the location of the center point of the Image pixel plane (as captured through a microscope) in the Slide Coordinate System Frame of Reference.

Note: In Slide Microscopy (SM), the Microscope is equipped with a moveable Stage and position sensors that enable storage of the location of the center point of the displayed image with respect to the examined Specimen.

The Stage is the part of the Microscope to which the Slide is attached for viewing. The Objective Lens is the lens that is closest to the Specimen. The Top Surface of the Slide is the surface of the Slide on which the Specimen is mounted. The Bottom Surface of the Slide is the opposite surface. This Specification presumes that: 1) the Slide is rectangular; 2) the Top Surface of the Slide is oriented toward the Objective Lens of the Microscope; and 3) the Bottom Surface of the Slide is in perfect contact with the Microscope Stage when the Slide is attached to the Stage for viewing.

Notes: 1. The Label of the Slide is presumed to be mounted-on or written-on the Top Surface of the Slide.

2. Specification of the mechanical form, function, or tolerances of the Microscope are outside the scope of this Standard.

Figure C.8-16 depicts the Top Surface of the Slide on the Microscope Stage from the perspective of the Objective Lens. This is Reference Slide Orientation. The X, Y, and Z axes of the Slide Coordinate System in Reference Slide Orientation are defined as follows. The Y-axis is a line that nominally represents the Left Edge of the Slide. The X-axis is a line that is orthogonal to the Y-axis and nominally represents the Specimen Edge of the Slide. The Z-axis is a line that passes through the intersection of the X-axis and Y-axis and is orthogonal to the Microscope Stage. The Origin (0,0,0) of the Slide Coordinate System is the point of intersection of the X, Y, and Z axes.

[pic]

Figure C.8-16 REFERENCE SLIDE ORIENTATION

Notes: 1. An improperly-placed coverslip or Specimen that overlaps an Edge of a Slide is not considered part of the Edge a Slide for purposes of defining the Slide Coordinate System. However, such objects may cause inaccurate positioning of the Slide on the Stage.

2. If the Left Edge and Specimen Edge of the Slide are not orthogonal (e.g. the Slide is damaged or defective or the Specimen Edge is curvilinear), then the lower left-hand corner of the Slide may not be located at the Origin.

3. The definitions of X, Y, and Z axes are the same for inverted microscopes, with the Top Surface of the slide (i.e. Specimen side of the Slide) still being closest to the Objective Lens.

4. The origin of a Frame of Reference is arbitrary (see C.7.4.1), but its nominal location for consistency of slide coordinates is defined in this section.

Figure C.8-17 depicts the Z-axis center point location. The X-axis value of Image Center Point Location (0040,073A) shall increase from the Origin toward the Right Edge in Reference Slide Orientation. The Y-axis value of Image Center Point Location (0040,073A) shall increase from the Origin toward the Label Edge in Reference Slide Orientation. The Z-axis value of Image Center Point Location (0040,073A) shall be nominally referenced as zero at the image substrate reference plane (i.e. the top surface of a glass slide) and shall increase in a positive fashion coincident with increased distance from the substrate surface.

[pic]Figure C.8-17 Z-AXIS CENTER POINT LOCATION, VIEW FROM RIGHT EDGE OF SLIDE

C.8.12.3 VL Whole Slide Microscopy Series Module

Table C.8.12.3-1 specifies attributes for the VL Whole Slide Microscopy Series Module, including specialization of attributes in the General Series Module for use in the VL Whole Slide Microscopy Series Module.

Table C.8.12.3-1VL WHOLE SLIDE MICROSCOPY SERIES MODULE ATTRIBUTES

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

C.8.12.4 VL Whole Slide Microscopy Image Module

Table C.8.12.4-1 specifies the Attributes that describe the VL Whole Slide Microscopy Image Module.

Table C.8.12.4-1VL WHOLE SLIDE MICROSCOPY IMAGE MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Image Type (0008,0008) 1 Image identification characteristics. See C.8.12.4.1.1 for specialization.
Imaged Volume Width (0048,0001) 1 Width of total imaged volume (distance in the direction of rows in each frame) in mm. See C.8.12.4.1.2
Imaged Volume Height (0048,0002) 1 Height of total imaged volume (distance in the direction of columns in each frame) in mm. See C.8.12.4.1.2
Imaged Volume Depth (0048,0003) 1 Depth of total imaged volume (distance in the Z direction of focal planes) in μm. See C.8.12.4.1.2
Total Pixel Matrix Columns (0048,0006) 1 Total number of columns in pixel matrix; i.e., width of total imaged volume in pixels. See C.8.12.4.1.3
Total Pixel Matrix Rows (0048,0007) 1 Total number of rows in pixel matrix; i.e., height of total imaged volume in pixels. See C.8.12.4.1.3
Total Pixel Matrix Origin Sequence (0048,0008) 1 Location of pixel 1\1 of the total pixel matrix in the Slide Coordinate System Frame of Reference. Only a single Item shall be included in this sequence. See C.8.12.4.1.4 and C.8.12.2.1.1 for further explanation
>X Offset in Slide Coordinate System (0040,072A) 1 The X offset in millimeters from the Origin of the Slide Coordinate System.
>Y Offset in Slide Coordinate System (0040,073A) 1 The Y offset in millimeters from the Origin of the Slide Coordinate System.
Image Orientation (Slide) (0048,0102) 1 The direction cosines of the first row and the first column of the total pixel matrix with respect to the Slide Coordinate System Frame of Reference. See C.8.12.4.1.4
Samples Per Pixel (0028,0002) 1 Number of samples (color planes) per frame in this image. Enumerated values: 1 or 3. See C.8.12.4.1.5 for further explanation.
Photometric Interpretation (0028,0004) 1 Specifies the intended interpretation of the pixel data. See section C.8.12.4.1.5 for Enumerated Values.
Planar Configuration (0028,0006) 1C Indicates whether the pixel data are sent color-by-plane or color-by-pixel. Required if Samples per Pixel (0028,0002) has a value greater than 1. Enumerated Value: 0 = color-by-pixel
Number of Frames (0028,0008) 1 Number of frames in a multi-frame image. If Image Type (0008,0008) Value 3 is LOCALIZER or LABEL, Enumerated Value is 1.
Bits Allocated (0028,0100) 1 Number of bits allocated for each pixel sample. Enumerated Values: 8, 16
Bits Stored (0028,0101) 1 Number of bits stored for each pixel sample. Enumerated Values: 8, 16
High Bit (0028,0102) 1 Most significant bit for pixel sample data. Enumerated Values: 7, 15
Pixel Representation (0028,0103) 1 Data representation of pixel samples. Enumerated Value: 0 = unsigned integer
Acquisition Datetime (0008,002A) 1 The date and time that the acquisition of data that resulted in this image started.
Acquisition Duration (0018,9073) 1 Duration of the image acquisition in ms.
Lossy Image Compression (0028,2110) 1 Specifies whether an Image has undergone lossy compression. Enumerated Values: 00 - Image has NOT been subjected to lossy compression. 01 - Image has been subjected to lossy compression. See C.7.6.1.1.5
Lossy Image Compression Ratio (0028,2112) 1C See C.7.6.1.1.5 for further explanation. Required if Lossy Image Compression (0028,2110) equals 01.
Lossy Image Compression Method (0028,2114) 1C A label for the lossy compression method(s) that have been applied to this image. See C.7.6.1.1.5 for further explanation. May be multi valued if successive lossy compression steps have been applied; the value order shall correspond to the values of Lossy Image Compression Ratio (0028,2112). Required if Lossy Image Compression (0028,2110) equals 01.
Presentation LUT Shape (2050,0020) 1C Specifies an identity transformation for the Presentation LUT, such that the output of all grayscale transformations defined in the IOD containing this Module are defined to be P-Values. Enumerated Values: IDENTITY - output is in P-Values. Required if Photometric Interpretation (0028,0004) is MONOCHROME2.
Rescale Intercept (0028,1052) 1C The value b in relationship between stored values (SV) and the output units. Output units = m*SV + b. Enumerated value 0 Required if Photometric Interpretation (0028,0004) is MONOCHROME2.
Rescale Slope (0028,1053) 1C m in the equation specified by Rescale Intercept (0028,1052). Enumerated value 1 Required if Photometric Interpretation (0028,0004) is MONOCHROME2.
Volumetric Properties (0008,9206) 1 Indication if geometric manipulations are possible with frames in the SOP Instance. See C.8.16.2.1.2. Enumerated Value: VOLUME - pixels represent the volume specified for the image, and may be geometrically manipulated
Specimen Label in Image (0048,0010) 1 Indicates whether the specimen label is captured in the image. Enumerated Values: YES, NO
Burned In Annotation (0028,0301) 1 Indicates whether or not image contains sufficient burned in annotation to identify the patient. Enumerated Values: YES NO Note: If Specimen Label in Image (0048,0010) value is YES, Burned In Annotation (0028,0301) might be NO if the label includes only a specimen identifier and not patient identifying data.
Focus Method (0048,0011) 1 Method of focusing image Enumerated Values: AUTO – autofocus MANUAL – includes any human adjustment or verification of autofocus
Extended Depth of Field (0048,0012) 1 Image pixels were created through combining of image acquisition at multiple focal planes (focus stacking). Enumerated Values: YES, NO
Number of Focal Planes (0048,0013) 1C Number acquisition focal planes used for extended depth of field. Required if Extended Depth of Field (0048,0012) value is YES
Distance Between Focal Planes (0048,0014) 1C Distance between acquisition focal planes used for extended depth of field, in μm. Required if Extended Depth of Field (0048,0012) value is YES
Acquisition Device Processing Description (0018,1400) 3 Description of visual processing performed on the image prior to exchange. Examples of this processing are: edge enhanced, gamma corrected, convolved (spatially filtered)
Convolution Kernel (0018,1210) 3 Label for convolution kernel used in acquisition device visual processing
Recommended Absent Pixel CIELab Value (0048,0015) 3 A color value with which it is recommended to display the pixels of the Total Pixel Matrix that are not encoded. The units are specified in PCS-Values, and the value is encoded as CIELab. See C.10.7.1.1.

C.8.12.4.1 VL Whole Slide Microscopy Image Attribute Descriptions

C.8.12.4.1.1 Image Type

Image Type (0008,0008) is specified to be Type 1 with the following constraints:

Value 1 shall have a value of ORIGINAL or DERIVED

Value 2 shall have a value of PRIMARY

Value 3 (Image Flavor) shall have the Defined Terms in Table C.8.12.4-2

Table C.8.12.4-2VL WHOLE SLIDE MICROSCOPY IMAGE FLAVORS

LOCALIZER Collected for the purpose of planning or navigating other images.
VOLUME Set of frames that define a regularly sampled volume
LABEL Purpose of image is to capture the slide label; any non-label area captured is incidental to that purpose.

Value 4 (Derived Pixel) shall have the Defined Terms specified in Table C.8.12.4-3.

Table C.8.12.4-3VL WHOLE SLIDE MICROSCOPY DERIVED PIXELS

NONE No derivation of pixels (original)
RESAMPLED Pixels were derived by down sampling a higher resolution image

No additional values shall be present.

C.8.12.4.1.2 Imaged Volume Width, Height, Depth

The full physical extent of the whole slide image target volume is described in the attributes Imaged Volume Width (0048,0001), Imaged Volume Height (0048,0002), and Imaged Volume Depth (0048,0003). These values reflect the maximum extent in these dimensions. There is no requirement that this entire extent is actually encoded in frames of the Image SOP Instance.

The value of Imaged Volume Depth (0048,0003) shall not be 0. If only a single focal plane is imaged, the Imaged Volume Depth may be the optical depth of field as encoded in the Slice Thickness (0018,0050) attribute of the Pixel Measures Functional Group (see C.7.6.16.2.1.1).

C.8.12.4.1.3 Total Pixel Matrix Columns, Rows

Total Pixel Matrix Columns (0048,0006) and Total Pixel Matrix Rows (0048,0007) describe the size of the entire imaged volume as a single extent across all frames (tiles).

The extent would be as described in these attributes if the whole volume would be imaged and encoded as a non-sparse pixel matrix with the pixel spacing as specified in the Pixel Spacing (0028,0030) attribute of the Pixel Measures Functional Group (see C.7.6.16.2.1.1).

C.8.12.4.1.4 Total Pixel Matrix Origin Sequence and Image Orientation (Slide)

Total Pixel Matrix Origin Sequence (0048,0008) specifies the location of the top leftmost pixel of the pixel matrix, and Image Orientation (Slide) (0048,0102) specifies the direction cosines of the first row and the first column of the pixel matrix, both with respect to the Slide Coordinate System Frame of Reference (see C.8.12.2). Although the image acquisition may vary the true row and column orientation at the pixel scale to account for local variation in the physical specimen, this attribute describes the orientation as if the Pixel Matrix were flat.

Note: Typically, the Image Orientation (Slide) attribute will describe only a planar rotation, as the image plane is usually nominally parallel to the slide surface.

C.8.12.4.1.5 Photometric Interpretation and Samples per Pixel

Photometric Interpretation (0028,0004) shall be one of these Enumerated Values (see C.7.6.3.1.2):

MONOCHROME2

RGB

YBR_FULL_422

YBR_ICT

YBR_RCT

The value shall be appropriate to the compression transfer syntax used, if any, and shall be MONOCHROME2 or RGB for uncompressed or lossless compressed transfer syntaxes that do not involve color space transformations, YBR_ICT for irreversible JPEG 2000 transfer syntaxes, YBR_RCT for reversible JPEG 2000 transfer syntaxes, and YBR_FULL_422 for other lossy compressed transfer syntaxes.

Note: Future lossless and lossy transfer syntaxes may lead to the need for new definitions and choices for Photometric Interpretation. The Enumerated Values may therefore be extended with additional Photometric Interpretation values directly associated with new transfer syntaxes that are negotiated, and hence do not render existing implementations non-conformant.

Multi-spectral images may be encoded as a single wavelength band (color) in each frame using MONOCHROME2, or with up to three bands in each frame using one of the color Photometric Interpretations.

Samples per Pixel (0028,0002) shall be 1 for MONOCHROME2, and 3 otherwise.

C.8.12.5 Optical Path Module

Table C.8.12.5-1 specifies the attributes of the optical paths used in the VL imaging. Each optical path is a combination of illumination, filters, lenses, and sensors, and each combination is identified for possible reference by attributes in other modules. Additional optical path parameters may be specified in the Acquisition Context Module.

Table C.8.12.5-1OPTICAL PATH MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Optical Path Sequence (0048,0105) 1 Describes the optical paths used during the acquisition of this image. One or more Items shall be included in this sequence. See C.8.12.5.1.1
>Optical Path Identifier (0048,0106) 1 Identifier for the optical path specified in the Sequence Item. The identifier shall be unique for each Item within the Optical Path Sequence.
>Optical Path Description (0048,0107) 3 Description of the optical path specified in the Sequence Item.
>Illuminator Type Code Sequence (0048,0100) 3 Type of illuminator. Only a single Item is permitted in this sequence.
>>Include ‘Code Sequence Macro’ Table 8.8.1 Context ID may be defined in the IOD constraints.
>Illumination Wave Length (0022,0055) 1C Nominal wavelength of the illuminator in nm. Required if Illumination Color Code Sequence (0048,ee08) is not present. May be present otherwise.
>Illumination Color Code Sequence (0048,0108) 1C Color of the illuminator. Only a single Item shall be included in this sequence. Required if Illumination Wave Length (0022,0055) is not present. May be present otherwise.
>>Include ‘Code Sequence Macro’ Table 8.8.1 Context ID may be defined in the IOD constraints.
>Illumination Type Code Sequence (0022,0016) 1 Coded value for illumination method. See C.8.12.5.1.2. One or more Items shall be included in this sequence.
>>Include ‘Code Sequence Macro’ Table 8.8.1 Context ID may be defined in the IOD constraints.
>Light Path Filter Type Stack Code Sequence (0022,0017) 3 Filters used in the light source (excitation) path. One or more Items are permitted in this sequence. See C.8.12.5.1.3.
>>Include ‘Code Sequence Macro’ Table 8.8.1 Context ID may be defined in the IOD constraints.
>Light Path Filter Pass-Through Wavelength (0022,0001) 3 Nominal pass-through wavelength of light path filter(s) in nm
>Light Path Filter Pass Band (0022,0002) 3 Pass band of light path filter(s) in nm. This Attribute has two Values. The first is the shorter and the second the longer wavelength relative to the peak. The values are for the – 3dB nominal (1/2 of peak) pass through intensity. One of the two Values may be zero length, in which case it is a cutoff filter.
>Image Path Filter Type Stack Code Sequence (0022,0018) 3 Describes stack of filters used in image (emission) path between the imaging target and the optical sensor. One or more items are permitted in this sequence. See C.8.12.5.1.3.
>>Include ‘Code Sequence Macro’ Table 8.8.1 Context ID may be defined in the IOD constraints.
>Image Path Filter Pass-Through Wavelength (0022,0003) 3 Nominal pass-through wavelength of image path filter(s) in nm
>Image Path Filter Pass Band (0022,0004) 3 Pass band of image path filter(s) in nm. This Attribute has two Values. The first is the shorter and the second the longer wavelength relative to the peak. The values are for the – 3dB nominal (1/2 of peak) pass through intensity. One of the two Values may be zero length, in which case it is a cutoff filter
>Lenses Code Sequence (0022,0019) 3 Lenses that were used in this optical path. One or more items are permitted in this sequence.
>>Include ‘Code Sequence Macro’ Table 8.8-1 Context ID may be defined in the IOD constraints.
>Condenser Lens Power (0048,0111) 3 Nominal power of the condenser lens
>Objective Lens Power (0048,0112) 3 Nominal power of the objective lens. If a single lens is used as both condenser and objective, its power is specified in this attribute.
>Objective Lens Numerical Aperture (0048,0113) 3 Nominal numerical aperture of the objective lens.
>Channel Description Code Sequence (0022,001A) 1C Describes the light color sensed for each channel to generate the image. Required if this differs from the natural interpretation. Notes: 1. For MONOCHROME2, the natural interpretation is the full visible light spectrum. A full spectrum sensor may be presented with light of only a single color based on illumination and filters. 2. Equipment may use a color Photometric Interpretation (RGB, YBR) as a container representing up to 3 channels of any detected wavelength. Shall have the same number of Items as the value of Samples per Pixel Used (0028,0003) if present, or otherwise the value of Samples per Pixel (0028,0002). The channels shall be described in the order in which the channels are encoded.
>>Include ‘Code Sequence Macro’ Table 8.8.1 Context ID may be defined in the IOD constraints.
>Palette Color Lookup Table Sequence (0048,0120) 3 For MONOCHROME2 images, provides a transform of the pixel values with this optical path into an RGB color representation. The LUT provides a mapping to an appropriate color or pseudo-color for display purposes. Only a single Item is permitted in this sequence.
>>Include ‘Palette Color Lookup Macro’ Table C.7-22a
>ICC Profile (0028,2000) 1C An ICC Profile encoding the transformation of device-dependent stored pixel values into PCS-Values. See C.8.12.5.1.4 Required if Photometric Interpretation (0028,0004) is not MONOCHROME2, or if Palette Color Lookup Table Sequence (0048,0120) is present.

C.8.12.5.1 Optical Path Attribute Descriptions

C.8.12.5.1.1 Optical Path Sequence and Optical Path Identifier

The Optical Path Sequence (0048,0105) shall include an Item for every optical path used in the acquisition of the current image.

For single frame images that do not include the Multi-frame Functional Groups Module, this Sequence shall include only one Item.

For images that use the Multi-frame Functional Groups Module, the optical path associated with each frame is identified by reference to the Optical Path Identifier (0048,0106) of this Sequence (see Optical Path Identification Sequence (0048,0207) in Section C.8.12.6.2). The Optical Path Sequence may include Items for defined optical paths that are not referenced by any frame.

For Whole Slide Microscopy Image LOCALIZER images (see C.8.12.4.1.1 and C.8.12.7), all the optical paths associated with referenced images shall be described in Items of this Optical Path Sequence. The optical path associated with each referenced frame is identified in the Referenced Image Navigation Sequence (0048,0200) by reference to an Optical Path Identifier (0048,0106) of this Sequence. The Optical Path Identifiers used in the LOCALIZER image do not have to be identical to those used in the referenced images.

Notes: 1. For example, each of four referenced images may use a different optical path (color), and within each of those image SOP Instances the single Optical Path Sequence Item is identified as “1”, although the meaning of optical path “1” is different for each image. The LOCALIZER, however, must include all four optical paths with distinct identifiers “1”, “2”, “3”, and “4”.

2. The Optical Path Identifier is not necessarily numeric; it is a string of up to 16 characters (VR SH).

C.8.12.5.1.2 Illumination Type Code Sequence

Illumination Type Code Sequence (0022,0016) specifies the type of illumination of the imaging target. This attribute may include multiple Items, as some techniques may involve multiple methods, or some method identifiers may not be completely descriptive.

Note: For example, this attribute might include two items, (111741, DCM, “Transmission illumination”) and (111748, DCM, “Differential interference contrast”) to indicate “Transmission DIC”.

The type of illumination often prescribes the set of optical path components such as filters and prisms, and their arrangement in the optical path.

Note: For instance, phase contrast illumination will utilize a condenser annulus and a phase contrast plate; this may be indicated by an item (111747, DCM, “Phase contrast illumination”) in this attribute, but with no further specification in the filters and lenses identification attributes.

C.8.12.5.1.3 Light Path and Image Path Filter Type Stack Code Sequences

In some optical imaging methods, e.g., epifluorescence, there may be a single light path with its associated imaging components that is used in both illumination/excitation of the imaging target and in the transmitted/emitted path to the imaging sensor. In this case, the optical components are to be specified in the Image Path Filter Type Stack Code Sequence (0022,0018).

C.8.12.5.1.4 ICC Profile

ICC Profile (0028,2000) provides the transform for mapping stored color pixel values into ICC standard color Profile Connection Space (PCS). For MONOCHROME2 pixels that have a preferred color rendering through the Palette Color Lookup Table Sequence (0048,0120), this attribute provides a mapping of that preferred RGB color rendering into PCS. The ICC Profile shall follow the requirements specified in Section C.11.15.1.1.

C.8.12.6 Whole Slide Microscopy Functional Group Macros

The following sections contain Functional Group macros specific to the VL Whole Slide Microscopy Image IOD.

Note: The attribute descriptions in the Functional Group Macros are written as if they were applicable to a single frame (i.e., the macro is part of the Per-frame Functional Groups Sequence). If an attribute is applicable to all frames (i.e. the macro is part of the Shared Functional Groups Sequence) the phrase “this frame” in the attribute description shall be interpreted to mean “for all frames”.

C.8.12.6.1 Plane Position (Slide) Macro

Table C.8.12.6.1-1 specifies the attributes of the Plane Position (Slide) Functional Group macro.

Table C.8.12.6.1-1PLANE POSITION (SLIDE) MACRO ATTRIBUTES

Attribute Name Tag Type Attribute Description
Plane Position (Slide) Sequence (0048,021A) 1 Describes position of frame in the Total Pixel Matrix and in the Slide Coordinate System Frame of Reference. Only a single Item shall be included in this Sequence.
>Column Position In Total Pixel Matrix (0048,021E) 1 The column position of the top left hand pixel of the frame in the Total Pixel Matrix (see C.8.12.4.1.1). The column position of the top left pixel of the Total Pixel Matrix is 1.
>Row Position In Total Pixel Matrix (0048,021F) 1 The row position of the top left hand pixel of the frame in the Total Pixel Matrix (see C.8.12.4.1.1). The row position of the top left pixel of the Total Pixel Matrix is 1.
>X Offset in Slide Coordinate System (0040,072A) 1 The X offset in mm from the Origin of the Slide Coordinate System. See Figure C.8-16.
>Y Offset in Slide Coordinate System (0040,073A) 1 The Y offset in mm from the Origin of the Slide Coordinate System. See Figure C.8-16.
>Z Offset in Slide Coordinate System (0040,074A) 1 The Z offset in μm from the Origin of the Slide Coordinate System, nominally the surface of the glass slide substrate. See Figure C.8-17 Note: Required even if only a single focal plane was acquired.

C.8.12.6.2 Optical Path Identification Macro

Table C.8.12.6.2-1 specifies the attributes of the Optical Path Identification Functional Group macro.

Table C.8.12.6.2-1OPTICAL PATH IDENTIFICATION MACRO ATTRIBUTES

Attribute Name Tag Type Attribute Description
Optical Path Identification Sequence (0048,0207) 1 Identifies the optical path characteristics of this frame. Only a single Item shall be included in this sequence.
>Optical Path Identifier (0048,0106) 1 Uniquely identifies the path described in the Optical Path Sequence (0048,0105) by reference to an Item with the same Optical Path Identifier (0048,0106) value. See C.8.12.5.

C.8.12.6.3 Specimen Reference Macro

Table C.8.12.6.3-1 specifies the attributes of the Specimen Reference Functional Group macro. This allows association of the frame with specific specimens imaged on the same slide (e.g., tissue micro-arrays).

Table C.8.12.6.3-1SPECIMEN REFERENCE MACRO ATTRIBUTES

Attribute Name Tag Type Attribute Description
Specimen Reference Sequence (0048,0110) 2 Identifies specimens that may be visible in this frame, and which are fully identified in the Specimen Description Sequence (0040,0560). Zero or more Items shall be included in this sequence.
>Specimen UID (0040,0554) 1 Unique Identifier for Specimen. See Section C.7.6.22.1.2.

C.8.12.7 Multi-Resolution Navigation Module

Table C.8.12.7-1 specifies the Attributes that describe the Multi-Resolution Navigation Module, used in Whole Slide Microscopy LOCALIZER images.

Table C.8.12.7-1MULTI-RESOLUTION NAVIGATION MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Referenced Image Navigation Sequence (0048,0200) 1 Identification of correspondence between areas of the Pixel Data (07FE,0010) and frames of higher resolution images. One or more Items shall be included in this sequence.
>Include ‘SOP Instance Reference Macro’ Table 10-11 Referenced Image Instance
>Referenced Frame Number (0008,1160) 1 Referenced Frame Number within Referenced Image.
>Top Left Hand Corner of Localizer Area (0048,0201) 1 Top Left Hand Corner of Localizer image pixel area corresponding to referenced frame, specified as column\row. Column is the horizontal offset and row is the vertical offset.
>Bottom Right Hand Corner of Localizer Area (0048,0202) 1 Bottom Right Hand Corner of Localizer image pixel area corresponding to referenced frame, specified as column\row. Column is the horizontal offset and row is the vertical offset.
>Pixel Spacing (0028,0030) 1 Pixel Spacing in Referenced Image, specified as a numeric pair – adjacent row spacing \ adjacent column spacing, in mm.
>Z Offset in Slide Coordinate System (0040,074A) 1 The Z offset of the referenced frame from the Slide Coordinates System reference plane, in microns
>Samples per Pixel (0028,0002) 1 The number of samples (color planes) containing information in the referenced image.
>Optical Path Identifier (0048,0106) 1 Identifies the optical path used in acquiring the referenced Frame by reference to an Item in the Optical Path Sequence (0048,0105) of the current SOP Instance. See C.8.12.5.

C.8.12.8 Slide Label Module

Table C.8.12.8-1 specifies the Attributes that describe the interpretation of a scanned Slide Label.

Table C.8.12.8-1SLIDE LABEL MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Barcode Value (2200,0005) 2 Barcode interpreted from the scanned slide label. Note: This may be the same as the Container Identifier (0040,0512).
Label Text (2200,0002) 2 Label text interpreted from the scanned slide label, e.g., by optical character recognition.

C.8.13 Enhanced MR Image

This section describes the specific modules for the Enhanced MR Image IOD.

C.8.13.1 Enhanced MR Image Module

This section describes the Enhanced MR Image Module.

Table C.8-79 specifies the attributes of the Enhanced MR Image module.

Table C.8-79ENHANCED MR IMAGE MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Include ' MR Image and Spectroscopy Instance Macro' Table C.8-81
Image Type (0008,0008) 1 Image characteristics. See C.8.16.1 and C.8.13.1.1.1.
Include Common CT/MR Image Description Macro' Table C.8-131
Include 'MR Image Description Macro' Table C.8.82
Samples per Pixel (0028,0002) 1 Number of samples (planes) in this image. For Enumerated Values see C.8.13.1.1.2.
Photometric Interpretation (0028,0004) 1 Specifies the intended interpretation of the pixel data. Enumerated Values are specified in the IOD that invokes this Module. See C.7.6.3.1.2 for definition of this term.
Bits Allocated (0028,0100) 1 Number of bits allocated for each pixel sample. Each sample shall have the same number of bits allocated. For Enumerated Values see C.8.13.1.1.2.
Bits Stored (0028,0101) 1 Number of bits stored for each pixel sample. Each sample shall have the same number of bits stored. For Enumerated Values see C.8.13.1.1.2.
High Bit (0028,0102) 1 Most significant bit for pixel sample data. Each sample shall have the same high bit. Shall be one less than the value in Bits Stored (0028,0101).
Pixel Representation (0028,0103) 1 Data representation of the pixel samples. Each sample shall have the same pixel representation. For Enumerated Values see C.8.13.1.1.2
Planar Configuration (0028,0006) 1C Indicates whether the pixel data are sent color-by-plane or color-by-pixel. Required if Samples per Pixel (0028,0002) has a value greater than 1. See C.7.6.3.1.3 and C.8.13.1.1.2 for further explanation.
Spacing between Slices (0018,0088) 3 Value of the prescribed spacing to be applied between the slices in a volume that is to be acquired. The spacing in mm is defined as the center-to-center distance of adjacent slices.
Burned In Annotation (0028,0301) 1 Indicates whether or not the image contains sufficient burned in annotation to identify the patient and date the image was acquired. Enumerated Values: NO This means that images that contain this Module shall not contain such burned in annotations.
Recognizable Visual Features (0028,0302) 3 Indicates whether or not the image contains sufficiently recognizable visual features to allow the image or a reconstruction from a set of images to identify the patient. Enumerated Values: YES NO If this Attribute is absent, then the image may or may not contain recognizable visual features.
Lossy Image Compression (0028,2110) 1 Specifies whether an Image has undergone lossy compression. Enumerated Values: 00 = Image has NOT been subjected to lossy compression. 01 = Image has been subjected to lossy compression. See C.7.6.1.1.5 for further explanation.
Lossy Image Compression Ratio (0028,2112) 1C Describes the approximate lossy compression ratio(s) that have been applied to this image. See C.7.6.1.1.5 for further explanation. May be multivalued if successive lossy compression steps have been applied. Note: For example, a compression ratio of 30:1 would be described in this Attribute with a single value of 30. Required if Lossy Images Compression (0028,2110) is “01”.
Lossy Image Compression Method (0028,2114) 1C A label for the lossy compression method(s) that have been applied to this image. See C.7.6.1.1.5 for further explanation. May be multivalued if successive lossy compression steps have been applied; the value order shall correspond to the values of Lossy Image Compression Ratio (0028,2112). Required if Lossy Image Compression (0028,2110) is “01”.
Presentation LUT Shape (2050,0020) 1C Specifies an identity transformation for the Presentation LUT, such that the output of all grayscale transformations defined in the IOD containing this Module are defined to be P-Values. Enumerated Values: IDENTITY - output is in P-Values. Required if Photometric Interpretation (0028,0004) is MONOCHROME2.
Icon Image Sequence (0088,0200) 3 This icon image is representative of the Image. Only a single Item is permitted in this Sequence.
>Include ‘Image Pixel Macro’ Table C.7-11b See Section F.7.

C.8.13.1.1 Enhanced MR Image Module Attribute Description

C.8.13.1.1.1 Image Type and Frame Type

The Image Type (0008,0008) and Frame Type (0008,9007) are not included in this Macro but one or the other is always included in the Module or Macro that invokes this Macro, and they are therefore described here.

In addition to the requirements specified in C.8.16.1 Image Type and Frame Type, the following additional requirements and Defined Terms are specified.

C.8.13.1.1.1.1 Pixel Data Characteristics

Value 1 of Image Type (0008,0008) and Frame Type (0008,9007) is discussed in C.8.16.1.1. No additional requirements or Defined Terms.

C.8.13.1.1.1.2 Patient Examination Characteristics

Value 2 of Image Type (0008,0008) and Frame Type (0008,9007) is discussed in C.8.16.1.2. No additional requirements or Defined Terms.

C.8.13.1.1.1.3 Image Flavor

Table C.8-80 specifies the Defined Terms for MR additional to those defined in C.8.16.1.3 for Value 3 for Image Type (0008,0008) and Frame Type (0008,9007).

Table C.8-80MR-SPECIFIC IMAGE TYPE AND FRAME TYPE VALUE 3

Defined Term Name Defined Term Description
ANGIO_TIME Angio time acquisition (peripheral vascular/carotid)
ASL Arterial Spin Labeling
CINE Cardiac CINE
DIFFUSION Collected to show diffusion effects.
FLOW_ENCODED Flow Encoded
FLUID_ATTENUATED Fluid Attenuated T2 weighted
FMRI Collected for functional imaging calculations.
MAX_IP Maximum Intensity Projection
MIN_IP Minimum Intensity Projection
M_MODE Image line over time
METABOLITE_MAP Metabolite Maps from spectroscopy data
MULTIECHO Multiple echoes with different contrast weighting (e.g. proton density and T2 weighted)
PROTON_DENSITY Proton density weighted
REALTIME Real-time collection of single slices
STIR Short Tau Inversion Recovery
TAGGING Images with superposition of thin saturation bands
TEMPERATURE Images record temperature
T1 T1 weighted
T2 T2 weighted
T2_STAR T2* weighted
TOF Time Of Flight weighted
VELOCITY Velocity encoded

C.8.13.1.1.1.4 Derived Pixel Contrast

Table C.8-81 specifies the Defined Terms for MR additional to those defined in C.8.16.1.4 for Value 4 for Image Type (0008,0008) and Frame Type (0008,9007).

Table C.8-81MR-SPECIFIC IMAGE TYPE AND FRAME TYPE VALUE 4

Defined Term Name Defined Term Description
ADC Apparent Diffusion Coefficient
DIFFUSION Diffusion weighted
DIFFUSION_ANISO Diffusion Anisotropy
DIFFUSION_ATTNTD Diffusion Attenuated. Derived by removing the T2 contributions from a Diffusion Weighted image.
DIFFUSION_ISO Isotropic images derived from Directional Diffusion images
METABOLITE_MAP Metabolite Maps from spectroscopy data
NEI Created through Negative Enhancement Integral operation
PERFUSION_ASL Perfusion from an ASL series obtained by subtraction of control and label data
R_COEFFICIENT R-Coefficient Map (fMRI)
RHO Proton Density map
SCM Signal Change Map
SNR_MAP Signal to Noise Map
T1_MAP T1 Map
T2_STAR_MAP T2* Map
T2_MAP T2 Map
TCS Time Course of Signal
TEMPERATURE Temperature encoded
VELOCITY Velocity encoded

C.8.13.1.1.2 Photometric Interpretation, Pixel Representation, Samples per Pixel, Planar Configuration, Bits Allocated and Bits Stored

Table C.8-82 specifies the Enumerated Values and allowed combinations of Samples per Pixel (0028,0002), Planar Configuration (0028,0006), Pixel Representation (0028,0103), Bits Allocated (0028,0100) and Bits Stored (0028,0101) for each allowable Photometric Interpretation allowed by the IOD that invokes this Module.

Table C.8-82ALLOWED COMBINATIONS OF ATTRIBUTE VALUES FOR PHOTOMETRIC INTERPRETATION, SAMPLES PER PIXEL, PLANAR CONFIGURATION, PIXEL REPRESENTATION, BITS ALLOCATED AND BITS STORED

Photometric Interpretation Samples per Pixel Planar Configuration Pixel Representation Bits Allocated Bits Stored
MONOCHROME2 1 - 0 or 1 8 8
MONOCHROME2 1 - 0 or 1 16 12, 16
RGB 3 0 0 8 8
YBR_ICT 3 0 0 8 8
YBR_RCT 3 0 0 8 8
YBR_PARTIAL_420 3 0 0 8 8
YBR_FULL_422 3 0 0 8 8

C.8.13.1.1.3 Pixel Presentation

See C.8.16.2.1.1. No additional requirements or Defined Terms.

C.8.13.1.1.3.1 Supplemental Palette Color LUTs

See C.8.16.2.1.1.1.

C.8.13.1.1.4 Volumetric Properties

See C.8.16.2.1.2. No additional requirements or Defined Terms.

C.8.13.1.1.5 Volume Based Calculation Technique

See C.8.16.2.1.3. No additional requirements or Defined Terms.

C.8.13.2 MR Image and Spectroscopy Instance Macro

Table C.8-83 specifies the common attributes Enhanced MR Image Module and MR Spectroscopy Module.

Table C.8-83MR IMAGE AND SPECTROSCOPY INSTANCE MACRO

Attribute Name Tag Type Attribute Description
Acquisition Number (0020,0012) 3 A number identifying the single continuous gathering of data over a period of time that resulted in this image. Note: This number is not required to be unique across SOP Instances in a series. See also the description of the Referenced Raw Data Sequence (0008,9121).
Acquisition DateTime (0008,002A) 1C The date and time that the acquisition of data started. Note: The synchronization of this time with an external clock is specified in the synchronization Module in Acquisition Time synchronized (0018,1800). Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise.
Acquisition Duration (0018,9073) 1C The time in seconds needed to run the prescribed pulse sequence. See C.7.6.16.2.2.1 for further explanation. Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise.
Referenced Raw Data Sequence (0008,9121) 3 The Raw data that was used to derive this Image. One or more Items are permitted in this Sequence. Note: The items of in this sequence may identify raw data that has not been stored or encoded as a DICOM object. This allows recognition that images and spectra in different instances have been reconstructed from the same raw data.
>Include '’Hierarchical SOP Instance Reference Macro' Table C.17-3
Referenced Waveform Sequence (0008,113A) 3 References to waveforms acquired in conjunction with this image. These Waveforms may or may not be temporally synchronized with this image. One or more Items are permitted in this Sequence.
>Include '’Hierarchical SOP Instance Reference Macro' Table C.17-3
Referenced Image Evidence Sequence (0008,9092) 1C Full set of Composite SOP Instances referred to inside the Referenced Image Sequences of this Enhanced MR Image SOP Instance. See C.8.13.2.1.2 for further explanation. One or more Items shall be included in this sequence. Required if the Referenced Image Sequence (0008,1140) is present.
>Include '’Hierarchical SOP Instance Reference Macro' Table C.17-3
Source Image Evidence Sequence (0008,9154) 1C Full set of Composite SOP Instances referred to inside the Source Image Sequences of this Enhanced MR Image SOP Instance. See C.8.13.2.1.2 for further explanation. One or more Items shall be included in this sequence. Required if the Source Image Sequence (0008,2112) is present.
>Include '’Hierarchical SOP Instance Reference Macro' Table C.17-3
Referenced Presentation State Sequence (0008,9237) 1C References to Presentation State instances acquired in conjunction with this instance. Note: May only be used to reference Presentation States belonging to the acquired data and not to reference Presentation States generated subsequently such as during interpretation. One or more Items shall be included in this sequence. Required if Presentation State is generated during acquisition, shall not be present otherwise.
>Include '’Hierarchical SOP Instance Reference Macro' Table C.17-3
Content Qualification (0018,9004) 1 Content Qualification Indicator Enumerated Values: PRODUCT RESEARCH SERVICE See C.8.13.2.1.1 for further explanation.
Resonant Nucleus (0018,9100) 1C Nucleus that is resonant at the transmitter frequency. Defined Terms: 1H 3HE 7LI 13C 19F 23NA 31P 129XE Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise.
k-space Filtering (0018,9064) 1C Describes k-space filtering applied. Shall be NONE if no k-space filter. Defined Terms: COSINE COSINE_SQUARED FERMI GAUSSIAN HAMMING HANNING LORENTZIAN LRNTZ_GSS_TRNSFM RIESZ TUKEY NONE Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise.
Magnetic Field Strength (0018,0087) 1C Nominal field strength of the MR Magnet, in Tesla. Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise.
Applicable Safety Standard Agency (0018,9174) 1 Agency that established MR safety standard applicable to the acquisition of this Instance. Defined Terms: IEC FDA MHW
Applicable Safety Standard Description (0018,9175) 3 Name and Version of the applicable standard.
Image Comments (0020,4000) 3 User-defined comments about the image.

C.8.13.2.1 MR Image and Spectroscopy Instance Macro Attribute Description

C.8.13.2.1.1 Content Qualification

Content Qualification (0018,9004) shall have the value PRODUCT if the content (image or Spectroscopy data) was produced with approved hardware and software. It shall have the value RESEARCH or SERVICE if there is any doubt as to whether the content was produced with approved hardware and software.

If data with Content Qualification (0018,9004) of RESEARCH or SERVICE is used to derive other content then it is expected that this derived content will also have Content Qualification (0018,9004) set to RESEARCH or SERVICE.

The intent of this element is to allow annotation of an advisory message that indicates that this content may not be suitable for clinical interpretation.

C.8.13.2.1.2 Evidence Sequence Attributes

The intent of the Referenced Image Evidence Sequence (0008,9092) and Source Image Evidence Sequence (0008,9154) is to provide a list of all unique SOP Instances listed in the Referenced Image Sequence (0008,1140) and Source Image Sequence (0008,2112) attributes respectively.

C.8.13.3 MR Image Description Macro

This section describes the MR Image Description Macro.

Table C.8-84 specifies the attributes of the MR Image Description Macro.

Table C.8-84MR IMAGE DESCRIPTION MACRO ATTRIBUTES

Attribute Name Tag Type Attribute Description
Complex Image Component (0008,9208) 1 Representation of complex data of frames in the SOP Instance. See C.8.13.3.1.1 for a description and Defined Terms.
Acquisition Contrast (0008,9209) 1 Indication of acquisition contrast used with frames in the SOP Instance. See C.8.13.3.1.2 for a description and Defined Terms.

C.8.13.3.1 MR Image Description Attribute Description

C.8.13.3.1.1 Complex Image Component

The value of the Complex Image Component attribute (0008,9208) shall be used to indicate which component of the complex representation of the signal is represented in the pixel data.

Table C.8-85 specifies the Defined Terms for Complex Image Component attribute (0008,9208).

Table C.8-85COMPLEX IMAGE COMPONENT ATTRIBUTE VALUES

Defined Term Name Defined Term Description
MAGNITUDE The magnitude component of the complex image data.
PHASE The phase component of the complex image data.
REAL The real component of the complex image data.
IMAGINARY The imaginary component of the complex image data.
MIXED Used only as a value in Complex Image Component (0008,9208) in the Enhanced MR Image Module if frames within the image SOP Instance contain different values for the Complex Image Component attribute in the MR Frame Type Functional Group.

C.8.13.3.1.2 Acquisition Contrast

Table C.8-86 specifies the Defined Terms for Acquisition Contrast attribute (0008,9209).

Table C.8-86ACQUISITION CONTRAST VALUES

Defined Term Name Defined Term Description
DIFFUSION Diffusion weighted contrast
FLOW_ENCODED Flow Encoded contrast
FLUID_ATTENUATED Fluid Attenuated T2 weighted contrast
PERFUSION Perfusion weighted contrast
PROTON_DENSITY Proton Density weighted contrast
STIR Short Tau Inversion Recovery
TAGGING Superposition of thin saturation bands onto image
T1 T1 weighted contrast
T2 T2 weighted contrast
T2_STAR T2* weighted contrast
TOF Time Of Flight weighted contrast
UNKNOWN Value should be UNKNOWN if acquisition contrasts were combined resulting in an unknown contrast. Also this value should be used when the contrast is not known.
MIXED Used only as a value in Acquisition Contrast (0008,9209) attribute in the Enhanced MR Image Type Module if frames within the image SOP Instance contain different values for the Acquisition Contrast attribute in the MR Frame Type Functional Group.

C.8.13.4 MR Pulse Sequence Module

The primary purpose of this module is to identify the pulse sequence and variations on that, which was used in creation of the image. Terminology is intended to be neutral, and allow equivalent sequences provided by different vendors to be classified the same.

Table C.8-87 specifies the attributes of the MR Pulse Sequence Module.

Table C.8-87MR PULSE SEQUENCE MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Pulse Sequence Name (0018,9005) 1C Name of the pulse sequence for annotation purposes. Potentially vendor-specific name. Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise.
MR Acquisition Type (0018,0023) 1C Identification of spatial data encoding scheme. Defined Terms: 1D 2D 3D Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise.
Echo Pulse Sequence (0018,9008) 1C Echo category of pulse sequences. Enumerated Values: SPIN GRADIENT BOTH Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise.
Multiple Spin Echo (0018,9011) 1C Multiple Spin Echo category of pulse sequence used to collect different lines in k-space for a single frame. Enumerated Values: YES NO Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED and Echo Pulse Sequence (0018,9008) equals SPIN or BOTH. Otherwise may be present if Image Type (0008,0008) Value 1 is DERIVED and Echo Pulse sequence (0018,9008) equals SPIN or BOTH.
Multi-planar Excitation (0018,9012) 1C Technique that simultaneously excites several volumes. Enumerated Values: YES NO Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise.
Phase Contrast (0018,9014) 1C Phase Contrast Pulse sequence is a pulse sequence in which the flowing spins are velocity encoded in phase. Enumerated Values: YES NO Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise.
Velocity Encoding Acquisition Sequence (0018,9092) 1C Velocity encoding directions used for acquisition. Required if Phase Contrast (0018,9014) equals YES. One or more Items shall be included in this sequence.
>Velocity Encoding Direction (0018,9090) 1 The direction cosines of the velocity encoding vector with respect to the patient. See C.7.6.2.1.1 for further explanation.
Time of Flight Contrast (0018,9015) 1C Time of Flight contrast is created by the inflow of blood in the saturated plane. Enumerated Values: YES NO Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise.
Arterial Spin Labeling Contrast (0018,9250) 1C Arterial Spin Labeling contrast technique. Enumerated Values: CONTINUOUS = a single long low powered RF pulse PSEUDOCONTINUOUS = multiple short low powered RF pulses PULSED = a single short high powered RF pulse Required if Image Type (0008,0008) Value 3 is ASL. May be present otherwise.
Steady State Pulse Sequence (0018,9017) 1C Steady State Sequence. Defined Terms: FREE_PRECESSION TRANSVERSE TIME_REVERSED LONGITUDINAL NONE Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise.
Echo Planar Pulse Sequence (0018,9018) 1C Echo Planar category of Pulse Sequences. Enumerated Values: YES NO Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise.
Saturation Recovery (0018,9024) 1C Saturation recovery pulse sequence. Enumerated Values: YES NO Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise.
Spectrally Selected Suppression (0018,9025) 1C Spectrally Selected Suppression. Defined Terms: FAT WATER FAT_AND_WATER SILICON_GEL NONE Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise.
Oversampling Phase (0018,9029) 1C Oversampling Phase. Enumerated Values: 2D = phase direction 3D = out of plane direction 2D_3D = both NONE Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise.
Geometry of k-Space Traversal (0018,9032) 1C Geometry category of k-Space traversal. Defined Terms: RECTILINEAR RADIAL SPIRAL Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise.
Rectilinear Phase Encode Reordering (0018,9034) 1C Rectilinear phase encode reordering. Defined Terms: LINEAR CENTRIC SEGMENTED REVERSE_LINEAR REVERSE_CENTRIC Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED and Geometry of k-Space Traversal (0018,9032) equals RECTILINEAR. Otherwise may be present if Image Type (0008,0008) Value 1 is DERIVED and Geometry of k-Space Traversal (0018,9032) equals RECTILINEAR.
Segmented k-Space Traversal (0018,9033) 1C Segmented k-Space traversal. If Geometry of k-Space Traversal is rectilinear, multiple lines can be acquired at one time. If Geometry of k-Space Traversal is spiral or radial, paths can be interleaved and acquired at one time. Enumerated Values: SINGLE = successive single echo coverage PARTIAL = segmented coverage FULL = single shot full coverage Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise.
Coverage of k-Space (0018,9094) 1C Coverage of k-Space in the ky-kz plane. Defined Terms: FULL CYLINDRICAL ELLIPSOIDAL WEIGHTED Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED and MR Acquisition Type (0018,0023) equals 3D. Otherwise may be present if Image Type (0008,0008) Value 1 is DERIVED and MR Acquisition Type (0018,0023) equals 3D.
Number of k-Space Trajectories (0018,9093) 1C Number of interleaves or shots. Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise.

C.8.13.5 Enhanced MR Image Functional Group Macros

The following sections contain Functional Group macros specific to the Enhanced MR Image IOD.

Note: The attribute descriptions in the Functional Group Macros are written as if they were applicable to a single frame (i.e., the macro is part of the Per-frame Functional Groups Sequence). If an attribute is applicable to all frames (i.e. the macro is part of the Shared Functional Groups Sequence) the phrase "this frame" in the attribute description shall be interpreted to mean " for all frames".".

C.8.13.5.1 MR Image Frame Type Macro

Table C.8-88 specifies the attributes of the MR Image Frame Type Functional Group macro.

Table C.8-88MR IMAGE FRAME TYPE MACRO ATTRIBUTES

Attribute Name Tag Type Attribute Description
MR Image Frame Type Sequence (0018,9226) 1 Identifies the characteristics of this frame. Only a single Item shall be included in this sequence.
>Frame Type (0008,9007) 1 Type of Frame. A multi-valued attribute analogous to the Image Type (0008,0008). Enumerated Values and Defined Terms are the same as those for the four values of the Image Type (0008,0008) attribute, except that the value MIXED is not allowed. See C.8.16.1 and C.8.13.1.1.1.
>Include Common CT/MR Image Description Macro' Table C.8-131
>Include 'MR Image Description Macro' Table C.8-82

C.8.13.5.2 MR Timing and Related Parameters Macro

Table C.8-89 specifies the attributes of the MR Timing and Related Parameters Functional Group macro.

Table C.8-89MR TIMING AND RELATED PARAMETERS MACRO ATTRIBUTES

Attribute Name Tag Type Attribute Description
MR Timing and Related Parameters Sequence (0018,9112) 1 Identifies the timing and safety information of this frame. Only a single Item shall be included in this sequence.
>Repetition Time (0018,0080) 1C The time in ms between two successive excitations of the same volume. Shall be 0 (zero) if there is a single excitation per volume. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise.
>Flip Angle (0018,1314) 1C Steady state angle in degrees to which the magnetic vector is flipped from the magnetic vector of the primary field. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise.
>Echo Train Length (0018,0091) 1C Number of lines in k-space acquired per excitation of the same volume regardless of the type of echo or the number of frames derived from them. See section C.8.12.5.2.1. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise.
>RF Echo Train Length (0018,9240) 1C Number of RF echoes collected per RF shot (or excitation) per frame. A value of zero shall correspond to a pure gradient echo frame. Note that this value corresponds to the current frame. Several frames may be derived from the same shot. See section C.8.13.5.2.1. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise.
>Gradient Echo Train Length (0018,9241) 1C Number of gradient echoes collected per RF echo per shot (or excitation) per frame. A value of zero shall correspond to a pure RF echo frame. If RF Echo Train Length (0018,9240) is non zero and Gradient Echo Train Length is as well then only the central echo will be an RF Spin Echo, all others will be gradient echoes. See section C.8.13.5.2.1. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise.
>Specific Absorption Rate Sequence (0018,9239) 1C Sequence containing the methods of SAR calculation and the corresponding values. One or more Items shall be included in this sequence. Required if the system is capable of calculating Specific Absorption Rate (0018,9181).
>>Specific Absorption Rate Definition (0018,9179) 1 Specification of the method of SAR calculation as defined in Applicable Safety Standard Description (0018,9174). Defined Terms: IEC_WHOLE_BODY IEC_PARTIAL_BODY IEC_HEAD IEC_LOCAL
>>Specific Absorption Rate Value (0018,9181) 1 Specific Absorption Rate in W/kg.
>Gradient Output Type (0018,9180) 1C Definition of gradient output unit, for which the value is stored in Gradient Output (0018,9182). Defined Terms: DB_DT = in T/s ELECTRIC_FIELD = in V/m PER_NERVE_STIM = percentage of peripheral nerve stimulation Required if the system is capable of calculating Gradient Output (0018,9182).
>Gradient Output (0018,9182) 1C Unit is defined by Gradient Output Type (0018,9180). Required if the system is capable of calculating Gradient Output (0018,9182).
>Operating Mode Sequence (0018,9176) 1C Sequence of operating mode information relating to the frame/SOP instance as required to adhere to the Applicable Safety Standard Agency (0018,9174) regulations. One or more Items shall be included in this sequence. Required if required by law or regulations. May be present otherwise.
>>Operating Mode Type (0018,9177) 1 Defined Terms: STATIC FIELD RF GRADIENT
>>Operating Mode (0018,9178) 1 Operating mode applicable for the defined by the applicable standard. Defined Terms: IEC_NORMAL IEC_FIRST_LEVEL IEC_SECOND_LEVEL

C.8.13.5.2.1 RF Echo Train Length and Gradient Echo Train Length Attributes Usage

The three Echo Train Length attributes all specify information related to the pulse sequence, one or more frames, and the echo type. The following examples illustrate their usage.

For a sequence with each excitation/shot producing 2 spin echoes that produce a line of k-Space for 2 different frames, the following values would be used for each frame:

Echo Train Length 2
Gradient Echo Train Length 0
RF Echo Train Length 1

For a sequence with each excitation/shot producing 2 gradient echoes that produce a line of k-Space for 2 different frames, the following values would be used:

Echo Train Length 2
Gradient Echo Train Length 1
RF Echo Train Length 0

For a sequence with each excitation/shot producing 8 spin echoes that produce 8 lines of k-Space for 1 frame, the following values would be used:

Echo Train Length 8
Gradient Echo Train Length 0
RF Echo Train Length 8

C.8.13.5.3 MR FOV/Geometry Macro

Table C.8-90 specifies the attributes of the MR FOV/Geometry Functional Group macro.

Table C.8-90MR FOV/GEOMETRY MACRO ATTRIBUTES

Attribute Name Tag Type Attribute Description
MR FOV/Geometry Sequence (0018,9125) 1 Identifies the geometry parameters of this frame. Only a single Item shall be included in this sequence.
>In-plane Phase Encoding Direction (0018,1312) 1C The axes of the in-plane phase encoding with respect to the frame. Enumerated Values: COLUMN ROW OTHER Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise.
>MR Acquisition Frequency Encoding Steps (0018,9058) 1C Number of Frequency Encoding steps (kx) acquired Required if Frame Type (0008,9007) Value 1 is ORIGINAL. May be present otherwise.
>MR Acquisition Phase Encoding Steps in-plane (0018,9231) 1C Number of In-Plane Phase Encoding steps (ky) acquired Required if Frame Type (0008,9007) Value 1 is ORIGINAL. May be present otherwise.
>MR Acquisition Phase Encoding Steps out-of-plane (0018,9232) 1C Number of Out-of-Plane Phase Encoding steps (kz) acquired Required if MR Acquisition Type (0018,0023) equals 3D and Frame Type (0008,9007) Value 1 is ORIGINAL. May be present otherwise.
>Percent Sampling (0018,0093) 1C Fraction of acquisition matrix lines acquired, expressed as a percent. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise.
>Percent Phase Field of View (0018,0094) 1C Ratio of field of view dimension in phase direction to field of view dimension in frequency direction, expressed as a percent. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise.

C.8.13.5.4 MR Echo Macro

Table C.8-91 specifies the attributes of the MR Echo Functional Group macro.

Table C.8-91MR ECHO MACRO ATTRIBUTES

Attribute Name Tag Type Attribute Description
MR Echo Sequence (0018,9114) 1 Identifies echo timing of this frame. Only a single Item shall be included in this sequence.
>Effective Echo Time (0018,9082) 1C The time in ms between the middle of the excitation pulse and the peak of the echo produced for kx=0. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise.

C.8.13.5.5 MR Modifier Macro

Table C.8-92 specifies the attributes of the MR Modifier Functional Group macro.

Table C.8-92MR MODIFIER MACRO ATTRIBUTES

Attribute Name Tag Type Attribute Description
MR Modifier Sequence (0018,9115) 1 Identifies general acquisition parameters of this frame. Only a single Item shall be included in this sequence.
>Inversion Recovery (0018,9009) 1C Inversion Recovery preparatory sequence. Enumerated Values: YES NO Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise.
>Inversion Times (0018,9079) 1C Times in ms after the middle of inverting RF pulse to middle of excitation pulse to detect the amount of longitudinal magnetization. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL and Inversion Recovery (0018,9009) equals YES. Otherwise may be present if Frame Type (0008,9007) Value 1 is DERIVED and Inversion Recovery (0018,9009) equals YES.
>Flow Compensation (0018,9010) 1C Flow Compensation. Defined Terms: ACCELERATION VELOCITY OTHER NONE Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise.
>Flow Compensation Direction (0018,9183) 1C Flow Compensation Direction. Enumerated Values: PHASE FREQUENCY SLICE_SELECT SLICE_AND_FREQ SLICE_FREQ_PHASE PHASE_AND_FREQ SLICE_AND_PHASE OTHER Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL and Flow Compensation (0018,9010) equals other than NONE. Otherwise may be present if Frame Type (0008,9007) Value 1 is DERIVED and Flow Compensation (0018,9010) equals other than NONE.
>Spoiling (0018,9016) 1C Spoiling. Enumerated Values: RF = RF spoiled GRADIENT = gradient spoiled RF_AND_GRADIENT NONE Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL and Echo Pulse Sequence (0018,9008) equals GRADIENT or BOTH. Otherwise may be present if Frame Type (0008,9007) Value 1 is DERIVED and Echo Pulse Sequence (0018,9008) equals GRADIENT or BOTH.
>T2 Preparation (0018,9021) 1C T2 prepared Pulse Sequence. Enumerated Values: YES NO Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise.
>Spectrally Selected Excitation (0018,9026) 1C Spectrally Selected Excitation. Enumerated Values: WATER = water excitation FAT = fat excitation NONE Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise.
>Spatial Pre-saturation (0018,9027) 1C Spatial Pre-saturation. Defined Terms: SLAB NONE Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise.
>Partial Fourier (0018,9081) 1C Partial Fourier. Enumerated Values: YES NO Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise.
>Partial Fourier Direction (0018,9036) 1C Direction of Partial Fourier. Enumerated Values: PHASE FREQUENCY SLICE_SELECT COMBINATION Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL and Partial Fourier (0018,9081) equals YES. Otherwise may be present if Frame Type (0008,9007) Value 1 is DERIVED and Partial Fourier (0018,9081) equals YES.
>Parallel Acquisition (0018,9077) 1C Parallel acquisition has been used to reduce measurement time. Enumerated Values: YES NO Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise.
>Parallel Acquisition Technique (0018,9078) 1C Parallel acquisition characteristics. Defined Terms: PILS SENSE SMASH OTHER Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL and Parallel Acquisition (0018,9077) equals YES. Otherwise may be present if Frame Type (0008,9007) Value 1 is DERIVED and Parallel Acquisition (0018,9077) equals YES.
>Parallel Reduction Factor In-plane (0018,9069) 1C Measurement time reduction factor expressed as ratio of original and reduced measurement time for the in-plane direction. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL and Parallel Acquisition (0018,9077) equals YES. Otherwise may be present if Frame Type (0008,9007) Value 1 is DERIVED and Parallel Acquisition (0018,9077) equals YES.
>Parallel Reduction Factor out-of-plane (0018,9155) 1C Measurement time reduction factor expressed as ratio of original and reduced measurement time for the out-of-plane direction Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL and Parallel Acquisition (0018,9077) equals YES. Otherwise may be present if Frame Type (0008,9007) Value 1 is DERIVED and Parallel Acquisition (0018,9077) equals YES.
>Parallel Reduction Factor Second In-plane (0018,9168) 1C Measurement time reduction factor expressed as ratio of original and reduced measurement time for the second in-plane direction. Only required for MR Spectroscopy SOP Instances. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL and Parallel Acquisition (0018,9077) equals YES. Otherwise may be present if Frame Type (0008,9007) Value 1 is DERIVED and Parallel Acquisition (0018,9077) equals YES.

C.8.13.5.6 MR Imaging Modifier Macro

Table C.8-93 specifies the attributes of the MR Imaging Modifier Functional Group macro.

Table C.8-93MR IMAGING MODIFIER MACRO ATTRIBUTES

Attribute Name Tag Type Attribute Description
MR Imaging Modifier Sequence (0018,9006) 1 Identifies sequence containing MR modifier Sequence Attributes. Only a single item shall be included in this sequence.
>Magnetization Transfer (0018,9020) 1C Magnetization Transfer pulse sequence. Enumerated Values: ON_RESONANCE OFF_RESONANCE NONE Required if Frame Type (0008,9007) Value 1 is ORIGINAL. May be present otherwise.
>Blood Signal Nulling (0018,9022) 1C Blood Signal Nulling (“Black Blood”) preparatory pulse sequence. Enumerated Values: YES NO Required if Frame Type (0008,9007) Value 1 is ORIGINAL. May be present otherwise.
>Tagging (0018,9028) 1C Tagging. Defined Terms: GRID LINE NONE Required if Frame Type (0008,9007) Value 1 is ORIGINAL. May be present otherwise.
>Tag Spacing First Dimension (0018,9030) 1C Space between lines in mm. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL and Tagging (0018,9028) is GRID or LINE. Otherwise may be present if Frame Type (0008,9007) Value 1 is DERIVED and Tagging (0018,9028) is GRID or LINE.
>Tag Spacing Second Dimension (0018,9218) 1C Space between the lines in mm in the other direction. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL and Tagging (0018,9028) is GRID. Otherwise may be present if Frame Type (0008,9007) Value 1 is DERIVED and Tagging (0018,9028) is GRID.
>Tag Angle First Axis (0018,9019) 1C Angle of the tag lines relative to the rows axis (left to right) of the image, with a range of 0-180 degrees. The angle is increasing in clockwise direction. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL and Tagging (0018,9028) is GRID or LINE. Otherwise may be present if Frame Type (0008,9007) Value 1 is DERIVED and Tagging (0018,9028) is GRID or LINE.
>Tag Angle Second Axis (0018,9219) 1C Angle of the tag lines relative to the rows axis (left to right) of the image, with a range of 0-180 degrees. The angle is increasing in clockwise direction. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL and Tagging (0018,9028) is GRID. Otherwise may be present if Frame Type (0008,9007) Value 1 is DERIVED and Tagging (0018,9028) is GRID.
>Tag Thickness (0018,9035) 1C Thickness of the line in mm. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL and Tagging (0018,9028) is GRID or LINE. Otherwise may be present if Frame Type (0008,9007) Value 1 is DERIVED and Tagging (0018,9028) is GRID or LINE.
>Tagging Delay (0018,9184) 3 Delay time in ms of the beginning of the application of the tagging pattern relative to the last R-peak.
>Transmitter Frequency (0018,9098) 1C Center transmitter frequency in MHz. Required if Frame Type (0008,9007) Value 1 is ORIGINAL. May be present otherwise.
>Pixel Bandwidth (0018,0095) 1C Reciprocal of the effective sampling period, in hertz per pixel. Required if Frame Type (0008,9007) Value 1 is ORIGINAL. May be present otherwise.

C.8.13.5.7 MR Receive Coil Macro

Table C.8-94 specifies the attributes of the MR Receive Coil Functional Group macro.

Table C.8-94MR RECEIVE COIL MACRO ATTRIBUTES

Attribute Name Tag Type Attribute Description
MR Receive Coil Sequence (0018,9042) 1 A sequence that provides information about each receive coil used. Only a single Item shall be included in this sequence.
>Receive Coil Name (0018,1250) 1C Name of receive coil used. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise.
>Receive Coil Manufacturer Name (0018,9041) 2C Name of manufacturer of receive coil. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise.
>Receive Coil Type (0018,9043) 1C Type of receive coil used. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise. Defined Terms: BODY VOLUME = head, extremity, etc. SURFACE MULTICOIL
>Quadrature Receive Coil (0018,9044) 1C Indicates whether the receive coil is quadrature. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise. Enumerated Values: YES = quadrature or circularly polarized NO = linear
>Multi-Coil Definition Sequence (0018,9045) 1C A sequence that provides information regarding each element of a multi-coil. It should include attributes for all elements, whether used in the current acquisition or not. One or more Items shall be included in this sequence. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL and Receive Coil Type (0018,9043) equals MULTICOIL. May be present otherwise only if Receive Coil Type (0018,9043) equals MULTICOIL.
>>Multi-Coil Element Name (0018,9047) 1 Name of element of multi-coil.
>>Multi-Coil Element Used (0018,9048) 1 Indicates whether the multi-coil element was used in the current acquisition. Enumerated Values: YES NO
>Multi-Coil Configuration (0018,9046) 3 A textual description of the configuration of multi-coil elements which was used in the current acquisition.

C.8.13.5.8 MR Transmit Coil Macro

Table C.8-95 specifies the attributes of the MR Transmit Coil Functional Group macro.

Table C.8-95MR TRANSMIT COIL MACRO ATTRIBUTES

Attribute Name Tag Type Attribute Description
MR Transmit Coil Sequence (0018,9049) 1 A sequence that provides information about the transmit coil used. Only a single Item shall be included in this sequence.
>Transmit Coil Name (0018,1251) 1C Name of transmit coil used. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise.
>Transmit Coil Manufacturer Name (0018,9050) 2C Name of manufacturer of transmit coil. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise.
>Transmit Coil Type (0018,9051) 1C Type of transmit coil used. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise. Defined Terms: BODY VOLUME = head, extremity, etc. SURFACE

C.8.13.5.9 MR Diffusion Macro

Table C.8-96 specifies the attributes of the MR Diffusion Functional Group macro.

Table C.8-96MR DIFFUSION MACRO ATTRIBUTES

Attribute Name Tag Type Attribute Description
MR Diffusion Sequence (0018,9117) 1 Identifies the diffusion parameters of this frame. Only a single Item shall be included in this sequence.
>Diffusion b-value (0018,9087) 1C Diffusion sensitization factor in sec/mm2. This is the actual b-value for original frames and those derived from frames with the same b-value, or the most representative b-value when derived from images with different b-values. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise.
>Diffusion Directionality (0018,9075) 1C Specifies whether diffusion conditions for the frame are directional, or isotropic with respect to direction. Defined Terms: DIRECTIONAL BMATRIX ISOTROPIC NONE = to be used when Frame Type (0008,9007) value 4 equals DIFFUSION_ANISO or Diffusion b-value (0018,9087) is 0 (zero). Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise.
>Diffusion Gradient Direction Sequence (0018,9076) 1C Sequence containing orientations of all diffusion sensitization gradients that were applied during the acquisition of this frame. Only a single Item shall be included in this sequence. Required if Diffusion Directionality (0018,9075) equals DIRECTIONAL May be present if Diffusion Directionality (0018,9075) equals BMATRIX.
>>Diffusion Gradient Orientation (0018,9089) 1C The direction cosines of the diffusion gradient vector with respect to the patient Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise.
>Diffusion b-matrix Sequence (0018,9601) 1C The directional diffusion sensitization expressed as a 3x3 matrix with diagonal symmetry (with six unique elements from which the other elements can be derived). The rows and columns of the matrix are the X (right to left), Y (anterior to posterior) and Z (foot to head) patient-relative orthogonal axes as defined in C.7.6.2.1.1. The values are in units of ms/mm2. Only a single Item shall be included in this sequence. Required if Diffusion Directionality (0018,9075) equals BMATRIX.
>>Diffusion b-value XX (0018,9602) 1 The value of b[X,X].
>>Diffusion b-value XY (0018,9603) 1 The value of b[X,Y].
>>Diffusion b-value XZ (0018,9604) 1 The value of b[X,Z].
>>Diffusion b-value YY (0018,9605) 1 The value of b[Y,Y].
>>Diffusion b-value YZ (0018,9606) 1 The value of b[Y,Z].
>>Diffusion b-value ZZ (0018,9607) 1 The value of b[Z,Z].
>Diffusion Anisotropy Type (0018,9147) 1C Class of diffusion anisotropy calculation. Defined Terms: FRACTIONAL RELATIVE VOLUME_RATIO Required if Frame Type (0008,9007) value 4 equals DIFFUSION_ANISO.

C.8.13.5.10 MR Averages Macro

Table C.8-97 specifies the attributes of the MR Averages Functional Group macro.

Table C.8-97MR AVERAGES MACRO ATTRIBUTES

Attribute Name Tag Type Attribute Description
MR Averages Sequence (0018,9119) 1 Identifies the averaging parameters of this frame. Only a single Item shall be included in this sequence.
>Number of Averages (0018,0083) 1C Maximum number of times any point in k-space is acquired. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise.

C.8.13.5.11 MR Spatial Saturation Macro

Table C.8-98 specifies the attributes of the MR Spatial Saturation Functional Group macro.

Table C.8-98MR SPATIAL SATURATION MACRO ATTRIBUTES

Attribute Name Tag Type Attribute Description
MR Spatial Saturation Sequence (0018,9107) 2 A sequence that provides the position of spatial saturation bands deposited as part of the pulse sequence. Zero or more Items shall be included in this sequence.
>Slab Thickness (0018,9104) 1 Thickness of slab in mm.
>Slab Orientation (0018,9105) 1 The direction cosines of a normal vector perpendicular to the saturation plane with respect to the patient. See C.7.6.2.1.1 for further explanation.
>Mid Slab Position (0018,9106) 1 The x, y, and z coordinates of the midpoint of the slab plane in mm with respect to the patient. See C.7.6.2.1.1 for further explanation.

C.8.13.5.12 MR Metabolite Map Macro

Table C.8-99 specifies the attributes of the MR Metabolite Map Functional Group macro.

TABLE C.8-99MR METABOLITE MAP MACRO ATTRIBUTES

Attribute Name Tag Type Attribute Description
MR Metabolite Map Sequence (0018,9152) 1 Describes the chemical shift parameters used to measure the resonant peaks from which the MR metabolite map represented by this frame was derived. Only a single Item shall be included in this sequence.
>Metabolite Map Description (0018,9080) 1C Text describing the Metabolite Map. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise.
>Metabolite Map Code Sequence (0018,9083) 3 When the measured peaks or their ratios can be related to metabolite substances, this sequence may be used to describe the metabolite substance whose resonant peaks are mapped in the Metabolite Map, or the ratio of substance resonant peaks that is mapped. Only a single Item shall be included in this sequence.
>>Include 'Code Sequence Macro' Table 8.8-1. Defined Context ID = 4032
>Chemical Shift Sequence (0018,9084) 3 The list of frequencies that were used to create the Metabolite Map. One or more Items are permitted in this sequence.
>>Chemical Shift Minimum Integration Limit in ppm (0018,9295) 1 Minimal value of Chemical Shift Frequency in ppm.
>>Chemical Shift Maximum Integration Limit in ppm (0018,9296) 1 Maximum value of Chemical Shift Frequency in ppm.

C.8.13.5.13 MR Velocity Encoding Macro

Table C.8-100 specifies the attributes of the MR Velocity Encoding Functional Group macro. This Functional Group contains the velocity encoding values as valid for the reconstructed Images, rather than for their acquisition. The velocity encoding directions for acquisition are described in the Velocity Encoding Acquisition Sequence (0018,9092) defined in the MR Pulse Sequence Module Section C.8.13.4.

Table C.8-100MR VELOCITY ENCODING MACRO ATTRIBUTES

Attribute Name Tag Type Attribute Description
MR Velocity Encoding Sequence (0018,9197) 1 Identifies the velocity encoding of this frame. One or more Items shall be included in this sequence.
>Velocity Encoding Direction (0018,9090) 1C The direction cosines of the velocity encoding vector with respect to the patient. See C.7.6.2.1.1 and C.8.13.5.13.1 for further explanation. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise.
>Velocity Encoding Minimum Value (0018,9091) 1C Minimum velocity in cm/s. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise.
>Velocity Encoding Maximum Value (0018,9217) 1C Maximum velocity in cm/s. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise.

C.8.13.5.13.1 Velocity Encoding Direction

The direction of the flow in a flow image is defined by the direction of the relevant flow vector in the MR Velocity Encoding Sequence (0018, 9197).

The actual flow value (as specified in the Real World Value Mapping Sequence (0040,9096)) has a positive sign when the flow direction coincides with the Velocity Encoding Direction (0018,9090) vector.

C.8.13.5.14 MR Arterial Spin Labeling Macro

Table C.8-100b specifies the attributes of the MR Arterial Spin Labeling Functional Group macro.

Table C.8-100bMR ARTERIAL SPIN LABELING MACRO ATTRIBUTES

Attribute Name Tag Type Attribute Description
MR Arterial Spin Labeling Sequence (0018,9251) 1 A sequence that provides the position of Arterial Spin Labeling regions deposited as part of the pulse sequence. One or more items shall be included in this sequence.
>ASL Technique Description (0018,9252) 2 Text describing the used labeling technique in more detail.
>ASL Context (0018,9257) 1C The purpose of the Arterial Spin Labeling. Enumerated Values: LABEL CONTROL M_ZERO_SCAN Required if Frame Type (0008,9007) is ORIGINAL. May be present otherwise. See C.8.13.5.14.1 for further explanation.
>ASL Slab Sequence (0018,9260) 1C Sequence describing the ASL Slab geometry and anatomical region. One or more Items shall be included in this sequence. Required if ASL Context (0018,9257) is CONTROL or LABEL. May be present otherwise.
>>ASL Slab Number (0018,9253) 1 Consecutive number identifying the different slabs used for labeling, starting with 1.
>>Include ‘General Anatomy Optional Macro’ Table 10-7 The anatomical region where the slab is positioned. Defined Context ID for the Anatomic Region Sequence (0008,2218) is CID 4030. Defined Context ID for Anatomic Region Modifier Sequence (0008,2220) and Primary Anatomic Structure Modifier Sequence (0008,2230) is CID 2.
>>ASL Slab Thickness (0018,9254) 1 Thickness of slab in mm.
>>ASL Slab Orientation (0018,9255) 1 The direction cosines of a normal vector perpendicular to the ASL slab with respect to the patient. See C.7.6.2.1.1 for further explanation.
>>ASL Mid Slab Position (0018,9256) 1 The x, y, and z coordinates of the midpoint of the slab in mm with respect to the patient. See C.7.6.2.1.1 for further explanation.
>>ASL Pulse Train Duration (0018,9258) 1 Duration (in milliseconds) of the Label or Control pulse. See C.8.13.5.14.3 for further explanation.
>ASL Crusher Flag (0018,9259) 1 Indicates if an ASL Crusher Method has been used. Enumerated Values: YES NO See C.8.13.5.14.2 for further explanation.
>ASL Crusher Flow Limit (0018,925A) 1C Maximum Flow Limit (in cm/s). Required if ASL Crusher Flag (0018,9259) is YES.
>ASL Crusher Description (0018,925B) 1C Description of the ASL Crusher Method. Required if ASL Crusher Flag (0018,9259) is YES.
>ASL Bolus Cut-off Flag (0018,925C) 1 Indicates if a Bolus Cut-off technique is used. Enumerated Values: YES NO
>ASL Bolus Cut-off Timing Sequence (0018,925D) 1C Sequence that specifies the timing of the Bolus Cut-off technique and possibly its (scientific) description. Only a single Item shall be included in this sequence. Required if ASL Bolus Cut-off Flag (0018,925C) is YES.
>>ASL Bolus Cut-off Delay Time (0018,925F) 1 Bolus Cut-off pulse delay time (in ms). See C.8.13.5.14.3 for further explanation.
>>ASL Bolus Cut-off Technique (0018,925E) 2 Text describing the cut-off technique.

C.8.13.5.14.1 ASL Context

The attribute ASL Context (0018,9257) categorize the Original ASL images according to three contexts.  This categorization allows post processing applications to select the correct type of image.

LABEL: Images are acquired with magnetically labeled arterial blood supply.

CONTROL: Images are acquired with a 'control' pulse in the proximal vessels.

M_ZERO_SCAN: Images are acquired with no label or control pulse in the proximal vessels.

C.8.13.5.14.2 ASL Crusher Flag

In order to quantify the perfusion accurately, it may be necessary to suppress signals within the macroscopic blood vessels (crushing). This can be used to separate the arterial input function from the brain parenchymal signal. The ASL Crusher Flag (0018,9259) indicates the application of an ASL crushing technique.

Note: Frames with and without crushing may be present in one SOP Instance.

C.8.13.5.14.3 Relationship of ASL Timing Attributes

The general description of the ASL Acquisition technique requires a number of time related attributes that are depicted in Figure C.8.13.5.14-1.

[pic]

Figure C.8.13.5.14-1 Attributes for Quantitative ASL

C.8.13.6 MR Series Module

The MR IODs use the General Series module described in section C.7.3.1, specialized by the MR Series Module, to describe the DICOM Series Entity described in A.1.2.3, and to define what constitutes a Series for the context of MR device.

Table C.8-101 specifies the Attributes that identify and describe general information about the MR Series.

Table C.8-101MR SERIES MODULE ATTRIBUTES

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

C.8.14 MR Spectroscopy Modules

This section describes the MR Spectroscopy Modules.

Note: Many attributes have names and descriptions that include the terms “pixel” and “image”. Although MR spectroscopy is not pixel based, some of these “pixel” and “image” attributes encode concepts that are still relevant for this technique. Where such attributes appear in the MR Spectroscopy IOD, it may be helpful to consider the term “pixel” to be equivalent to a spectroscopy “voxel”, and the term “image” to be equivalent to “MR Spectroscopy SOP Instance”.

C.8.14.1 MR Spectroscopy Module

Table C.8-102 specifies the attributes of the MR Spectroscopy Module.

Table C.8-102 MR SPECTROSCOPY MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Include ' MR Image and Spectroscopy Instance Macro' Table C.8-81
Image Type