Annex C INFORMATION MODULE DEFINITIONS(NORMATIVE)

C.1 ELEMENTS OF A MODULE DEFINITION

A Module Definition is composed of the following Sections

a. Module Description

b. Module Definition

c. Attribute Description (Optional)

Sections C.1.1 through C.1.3 define the requirements of a. through c. above.

C.1.1 Module Description

This Section briefly describes the Module and references the Module Definition.

C.1.2 Module Definition

This Section contains a table that enumerates each Attribute contained in the Module. For each Attribute in the table the following information is given:

a. Attribute Name (see C.1.2.1)

b. Data Element Tag (see C.1.2.2)

c. Type Designation (see C.1.2.3)

d. Attribute Definition (see C.1.2.4)

C.1.2.1 Attribute Name

This name shall be used whenever referencing the Attribute. This name shall also identify the Attribute in PS 3.6.

C.1.2.2 Attribute Tag

Each Attribute has a tag that uniquely identifies the Attribute (also used for encoding into a Data Set - see PS 3.5). This tag also serves as an index into the Data Dictionary of PS 3.6.

C.1.2.3 Type Designation

Each Attribute contained in a Module referenced by a Composite IOD defines a Type designation that indicates if a specific Attribute is required for all DIMSE operations/notifications associated with a SOP Class using this Module. PS 3.5 defines a choice of generic Type designations available for DICOM Attributes.

Note: The Type designation specified is generally determined by the value most appropriate for the C-STORE DIMSE Service.

The Type designation given in a Module is a default value and as such may be overridden by an IOD referencing the Module. Some Attributes may also be contained in more than one Module for the IOD. In that case, the Type designation applicable for the Attribute of the specific IOD is the lowest Type value (e.g. if type 2 is specified in one Module and type 3 in another, then type 2 shall apply), unless explicitly stated by the Attribute description.

The Type designation given in a Module (and/or IOD) may also be overridden by Service Class Definitions referencing the IOD containing the Module. PS 3.4 specifies the Service Class Definitions.

Modules referenced only by Normalized IODs do not contain Type designations. Modules referenced by both Normalized IODs and Composite IODs will contain a Type designation that only applies to Composite IODs and any specific conditions for Conditional Types (type 1C and 2C) also only apply to Composite IODs.

C.1.2.4 Attribute Definition

A brief definition will be provided for each attribute in the Module definition table. The description shall provide a context for the use of the Attribute and provide general elucidation. Defined Terms and Enumerated Values applicable to the Attribute may also be listed in the Attribute Description.

C.1.3 Attribute Descriptions

Additional information may be provided if necessary for selected Attributes. Such information shall be placed following the Module definition table. Dependencies between Attributes may be specified in this Section.

C.2 Patient Modules

The following Sections specify Modules used for patient management.

C.2.1 Patient Relationship Module

Table C.2-1 defines the Attributes that reference SOP Instances related to this SOP Class.

Table C.2-1PATIENT RELATIONSHIP MODULE ATTRIBUTES

Attribute Name Tag Attribute Description
Referenced Study Sequence (0008,1110) Uniquely identifies the Study SOP Instances associated with the Patient SOP Instance. One or more Items shall be included in this Sequence.
>Include ‘SOP Instance Reference Macro' Table 10-11
Referenced Visit Sequence (0008,1125) Uniquely identifies the Visit SOP Instances associated with this Patient SOP Instance. One or more Items shall be included in this Sequence.
>Include ‘SOP Instance Reference Macro' Table 10-11
Referenced Patient Alias Sequence (0038,0004) Uniquely identifies any Patient SOP Instances that also describe this patient. These SOP Instances are aliases. Zero or more Items shall be included in this Sequence.
>Include ‘SOP Instance Reference Macro' Table 10-11

C.2.2 Patient Identification Module

Table C.2-2 defines the Attributes relevant to identifying a patient.

Table C.2-2PATIENT IDENTIFICATION MODULE ATTRIBUTES

Attribute Name Tag Attribute Description
Patient's Name (0010,0010) Patient's full name
Patient ID (0010,0020) Primary hospital identification number or code for the patient.
Include Issuer of Patient ID Macro Table 10-18
Other Patient IDs (0010,1000) Other identification numbers or codes used to identify the patient.
Other Patient IDs Sequence (0010,1002) A sequence of identification numbers or codes used to identify the patient, which may or may not be human readable, and may or may not have been obtained from an implanted or attached device such as an RFID or barcode.
>Patient ID (0010,0020) An identification number or code used to identify the patient
>Include Issuer of Patient ID Macro Table 10-18
>Type of Patient ID (0010,0022) The type of identifier in this item. Defined Terms: TEXT RFID BARCODE Note: The identifier is coded as a string regardless of the type, not as a binary value.
Other Patient Names (0010,1001) Other names used to identify the patient.
Patient's Birth Name (0010,1005) Patient's birth name.
Patient's Mother's Birth Name (0010,1060) Birth name of patient's mother.
Medical Record Locator (0010,1090) An identifier used to find the patient's existing medical record (e.g. film jacket).

C.2.3 Patient Demographic Module

Table C.2-3 defines the Attributes relevant to generally describing a patient at a specific point in time, e.g., at the time of admission.

Table C.2-3PATIENT DEMOGRAPHIC MODULE ATTRIBUTES

Attribute Name Tag Attribute Description
Patient's Age (0010,1010) Age of the Patient.
Occupation (0010,2180) Occupation of the Patient.
Confidentiality Constraint on Patient Data Description (0040,3001) Special indication to the modality operator about confidentiality of patient information (e.g., that he should not use the patients name where other patients are present).
Patient’s Birth Date (0010,0030) Date of birth of the named patient
Patient’s Birth Time (0010,0032) Time of birth of the named patient
Patient's Sex (0010,0040) Sex of the named patient. Enumerated Values: M = male F = female O = other
Patient's Insurance Plan Code Sequence (0010,0050) A sequence that conveys the patient's insurance plan. Zero or more Items shall be included in this Sequence.
>Include ‘Code Sequence Macro’ Table 8.8-1 No Baseline Context ID is defined.
Patient’s Primary Language Code Sequence (0010,0101) The languages that can be used to communicate with the patient. Zero or more Items shall be included in this sequence. The sequence items are ordered by preference (most preferred language to least preferred language).
>Include Code Sequence Macro Table 8.8-1 Baseline CID 5000 - Languages.
>Patient’s Primary Language Modifier Code Sequence (0010,0102) A modifer for a Patient’s Primary Language. Can be used to specify a national language variant. Only a single Item shall be included in this sequence.
>>Include Code Sequence Macro Table 8.8-1 Baseline CID 5001 - Countries.
Patient's Size (0010,1020) Patient's height or length in meters
Patient's Weight (0010,1030) Weight of the patient in kilograms
Patient's Size Code Sequence (0010,1021) Patient's size category code One or more Items are permitted in this sequence.
> Include Code Sequence Macro Table 8.8-1 Baseline Context ID is CID 7040 for pediatric patients
Patient’s Address (0010,1040) Legal address of the named patient
Military Rank (0010,1080) Military rank of patient
Branch of Service (0010,1081) Branch of the military. The country allegiance may also be included (e.g. U.S. Army).
Country of Residence (0010,2150) Country in which patient currently resides
Region of Residence (0010,2152) Region within patient's country of residence
Patient’s Telephone Numbers (0010,2154) Telephone numbers at which the patient can be reached
Ethnic Group (0010,2160) Ethnic group or race of patient
Patient's Religious Preference (0010,21F0) The religious preference of the patient
Patient Comments (0010,4000) User-defined comments about the patient
Responsible Person (0010,2297) Name of person with medical decision making authority for the patient.
Responsible Person Role (0010,2298) Relationship of Responsible Person to the patient. See Section C.7.1.1.1.2 for Defined Terms.
Responsible Organization (0010,2299) Name of organization with medical decision making authority for the patient.
Patient Species Description (0010,2201) The species of the patient.
Patient Species Code Sequence (0010,2202) The species of the patient.
>Include ‘Code Sequence Macro’ Table 8.8-1 Defined CID 7454.
Patient Breed Description (0010,2292) The breed of the patient. See C.7.1.1.1.1.
Patient Breed Code Sequence (0010,2293) The breed of the patient. See C.7.1.1.1.1.
>Include ‘Code Sequence Macro’ Table 8.8-1 Defined CID 7480.
Breed Registration Sequence (0010,2294) Information identifying an animal within a breed registry.
>Breed Registration Number (0010,2295) Identification number of a veterinary patient within the registry.
>Breed Registry Code Sequence (0010,2296) Identification of the organization with which an animal is registered.
>>Include ‘Code Sequence Macro’ Table 8.8-1 Defined CID 7481.

Note: The language codes specified in CID 5000, used in Patient’s Primary Language Code Sequence (0010,0101), optionally allow the encoding of the country of language in the code value for the language. Encoding of the country of language in a subsidiary Patient’s Primary Language Modifier Code Sequence (0010,0102) is allowed for backward compatibility with previous editions of the Standard.

C.2.4 Patient Medical Module

Table C.2-4 defines the Attributes relevant to a patient's medical state or history.

Table C.2-4PATIENT MEDICAL MODULE ATTRIBUTES

Attribute Name Tag Attribute Description
Medical Alerts (0010,2000) Conditions to which medical staff should be alerted (e.g. contagious condition, drug allergies, etc.)
Allergies (0010,2110) Description of prior reaction to contrast agents, or other patient allergies or adverse reactions.
Smoking Status (0010,21A0) Indicates whether patient smokes. Enumerated Values: YES NO UNKNOWN
Additional Patient History (0010,21B0) Additional information about the patient's medical history
Pregnancy Status (0010,21C0) Describes pregnancy state of patient. Enumerated Values: 0001 = not pregnant 0002 = possibly pregnant 0003 = definitely pregnant 0004 = unknown
Last Menstrual Date (0010,21D0) Date of onset of last menstrual period
Patient’s Sex Neutered (0010,2203) Whether or not a procedure has been performed in an effort to render the patient sterile. Enumerated value: ALTERED = Altered/Neutered UNALTERED = Unaltered/intact
Special Needs (0038,0050) Medical and social needs (e.g. wheelchair, oxygen, translator, etc.)
Patient State (0038,0500) Description of patient state (comatose, disoriented, vision impaired, etc.)
Pertinent Documents Sequence (0038,0100) List of Documents (e.g., SR, or CDA) that contain information considered pertinent for the patient medical condition. Zero or more Items shall be included in this sequence.
>Include SOP Instance Reference Macro Table 10-11
>Purpose of Reference Code Sequence (0040,A170) Describes the purpose for which the document reference is made. Zero or more Items shall be included in this sequence.
>>Include ‘Code Sequence Macro’ Table 8.8-1 No Baseline Context Group ID defined
>Document Title (0042,0010) Title of the referenced document.
Patient Clinical Trial Participation Sequence (0038,0502) Sequence of identifiers for clinical trials in which the patient participates. Zero or more Items shall be included in this sequence.
>Clinical Trial Sponsor Name (0012,0010) The name of the clinical trial sponsor, responsible for conducting the clinical trial and for defining the Clinical Trial Protocol.
>Clinical Trial Protocol ID (0012,0020) Identifier for the noted protocol, used by the Clinical Trial Sponsor to uniquely identify the investigational protocol.
>Clinical Trial Protocol Name (0012,0021) The name or title of the clinical trial protocol.
>Clinical Trial Site ID (0012,0030) The identifier, issued by the Clinical Trial Sponsor, of the site responsible for submitting clinical trial data.
>Clinical Trial Site Name (0012,0031) Name of the site responsible for submitting clinical trial data.
>Clinical Trial Subject ID (0012,0040) The assigned identifier for the patient as a clinical trial subject.
>Clinical Trial Subject Reading ID (0012,0042) Identifies the patient as a clinical trial subject for blinded evaluations.

Note: The Patient Clinical Trial Participation Sequence (0038,0502) identifies potentially multiple trials in which the patient is enrolled. Application behavior in the presence of multiple items is outside the scope of the standard.

C.3 Visit Modules

The following Sections specify Modules relevant to a real world patient visit.

C.3.1 Visit Relationship Module

Table C.3-1 defines the Attributes that reference SOP Instances related to this SOP Class.

Table C.3-1VISIT RELATIONSHIP MODULE ATTRIBUTES

Attribute Name Tag Attribute Description
Referenced Study Sequence (0008,1110) Uniquely identifies the Study SOP Instances associated with the Visit SOP Instance. One or more Items shall be included in this Sequence.
>Include ‘SOP Instance Reference Macro' Table 10-11
Referenced Patient Sequence (0008,1120) Uniquely identifies the Patient SOP Instance that relates to the Visit SOP Instance. Only a single Item shall be included in this Sequence.
>Include ‘SOP Instance Reference Macro' Table 10-11

C.3.2 Visit Identification Module

Table C.3-2 defines the Attributes relevant to identifying a visit.

Table C.3-2VISIT IDENTIFICATION MODULE ATTRIBUTES

Attribute Name Tag Attribute Description
Institution Name (0008,0080) Institution where the equipment is located
Institution Address (0008,0081) Mailing Address of the institution where the equipment is located
Institution Code Sequence (0008,0082) A sequence that conveys the healthcare facility identification. Only a single Item shall be included in this Sequence.
>Include ‘Code Sequence Macro’ Table 8.8-1 No Baseline Context ID is defined.
Admission ID (0038,0010) Identification number of the visit as assigned by the healthcare provider
Issuer of Admission ID Sequence (0038,0014) Identifier of the Assigning Authority that issued the Admission ID. Only a single Item shall be included in this sequence.
>Include HL7v2 Hierarchic Designator Macro Table 10-17
Service Episode ID (0038,0060) Identifier of the Service Episode as assigned by the healthcare provider
Issuer of Service Episode ID Sequence (0038,0064) Identifier of the Assigning Authority that issued the Service Episode ID. Only a single Item shall be included in this sequence.
>Include HL7v2 Hierarchic Designator Macro Table 10-17
Service Episode Description (0038,0062) Description of the type of service episode.

C.3.3 Visit Status Module

Table C.3-3 defines the Attributes relevant to the patient's stay with the healthcare provider.

Table C.3-3VISIT STATUS MODULE ATTRIBUTES

Attribute Name Tag Attribute Description
Visit Status ID (0038,0008) Identifies the state of the visit. Defined Terms: CREATED = Created but not yet scheduled SCHEDULED = Scheduled but not yet admitted ADMITTED = Patient admitted to institution DISCHARGED = Patient Discharged
Current Patient Location (0038,0300) Describes the current known location of the patient
Patient’s Institution Residence (0038,0400) Primary location where patient resides (ward, floor, room, etc. or outpatient)
Visit Comments (0038,4000) User-defined comments about the visit

C.3.4 Visit Admission Module

Table C.3-4 defines the Attributes relevant to admitting a patient during a visit.

Table C.3-4VISIT ADMISSION MODULE ATTRIBUTES

Attribute Name Tag Attribute Description
Referring Physician's Name (0008,0090) Patient's primary referring physician for this visit
Referring Physician's Address (0008,0092) Referring physician's address
Referring Physician's Telephone Numbers (0008,0094) Referring physician's telephone numbers
Referring Physician Identification Sequence (0008,0096) Identification of the patient's referring physician. Only a single item shall be included in this sequence.
>Include ‘Person Identification Macro’ Table 10-1
Admitting Diagnoses Description (0008,1080) Description of admitting diagnosis (diagnoses).
Admitting Diagnoses Code Sequence (0008,1084) A sequence that conveys the admitting diagnosis (diagnoses). One or more Items shall be included in this Sequence.
>Include ‘Code Sequence Macro’ Table 8.8-1 No Baseline Context ID is defined.
Route of Admissions (0038,0016) Mode of admission: emergency, normal
Admitting Date (0038,0020) Date patient visit began
Admitting Time (0038,0021) Time patient visit began

C.3.5 Visit Discharge Module

Retired. See PS 3.3 2004.

C.3.6 Visit Scheduling Module

Retired. See PS 3.3 2004.

C.4 Study Modules

The following Sections specify Modules relevant to a real world diagnostic imaging study performed on a patient.

C.4.1 Study Relationship Module

Retired. See PS 3.3 2004.

C.4.2 Study Identification Module

Retired. See PS 3.3 2004.

C.4.3 Study Classification Module

Retired. See PS 3.3 2004.

C.4.4 Study Scheduling Module

Retired. See PS 3.3 2004.

C.4.5 Study Acquisition Module

Retired. See PS 3.3 2004.

C.4.6 Study Read Module

Retired. See PS 3.3 2004.

C.4.7 Study Component Module

Retired. See PS 3.3 2004.

C.4.8 Study Component Relationship Module

Retired. See PS 3.3 2004.

C.4.9 Study Component Acquisition Module

Retired. See PS 3.3 2004.

C.4.10 Scheduled Procedure Step Module

Table C.4-10SCHEDULED PROCEDURE STEP MODULE ATTRIBUTES

Attribute Name Tag Attribute Description
Scheduled Procedure Step Sequence (0040,0100) One or more Scheduled Procedure Steps for one Requested Procedure.
>Scheduled Station AE Title (0040,0001) The AE title of the modality on which the Scheduled Procedure Step is scheduled to be performed.
>Scheduled Station Name (0040,0010) An institution defined name for the modality on which the Scheduled Procedure Step is scheduled to be performed.
>Scheduled Procedure Step Location (0040,0011) The location at which the Procedure Step is scheduled to be performed.
>Scheduled Procedure Step Start Date (0040,0002) Date on which the Scheduled Procedure Step is scheduled to start.
>Scheduled Procedure Step Start Time (0040,0003) Time at which the Scheduled Procedure Step is scheduled to start.
>Scheduled Procedure Step End Date (0040,0004) Date on which the Scheduled Procedure Step is scheduled to end.
>Scheduled Procedure Step End Time (0040,0005) Time at which the Scheduled Procedure Step is scheduled to end.
>Scheduled Performing Physician's Name (0040,0006) Name of the physician scheduled to administer the Scheduled Procedure Step.
>Scheduled Performing Physician Identification Sequence (0040,000B) Identification of the physician scheduled to administer the Scheduled Procedure Step. Only a single item shall be included in this sequence.
>>Include ‘Person Identification Macro’ Table 10-1
>Scheduled Procedure Step Description (0040,0007) Institution-generated description or classification of the Scheduled Procedure Step to be performed. Note: The purpose of this attribute is to store a description or classification that is used at a local level (e.g., a hospital or a managed care network), and this description need not comply to an accepted standard.
>Scheduled Protocol Code Sequence (0040,0008) Sequence describing the Scheduled Protocol following a specified coding scheme. One or more Items shall be included in this sequence.
>>Include ‘Code Sequence Macro’ Table 8.8-1 No Baseline Context ID is defined.
>>Protocol Context Sequence (0040,0440) Sequence that specifies the context for the Scheduled Protocol Code Sequence Item. One or more items shall be included in this sequence. See Section C.4.10.1.
>>>Include ‘Content Item Macro’ Table 10-2 No Baseline Template is defined.
>>>Content Item Modifier Sequence (0040,0441) Sequence that specifies modifiers for a Protocol Context Content Item. One or more items shall be included in this sequence. See Section C.4.10.1.
>>>>Include ‘Content Item Macro’ Table 10-2 No Baseline Template is defined.
>Scheduled Procedure Step ID (0040,0009) Identifier that identifies the Scheduled Procedure Step.
>Scheduled Procedure Step Status (0040,0020) A real world condition that may affect the selection of of the Scheduled Procedure Step. Defined Terms: SCHEDULED - Procedure Step scheduled ARRIVED - patient is available for the Scheduled Procedure Step READY - all patient and other necessary preparation for this step has been completed STARTED - at least one Performed Procedure Step has been created that references this Scheduled Procedure Step DEPARTED - patient is no longer available for the Scheduled Procedure Step
>Comments on the Scheduled Procedure Step (0040,0400) User-defined comments on the Scheduled Procedure Step. Note: The Comments attribute is intended to transmit non-structured information, which can be displayed to the operator of the Modality.
>Modality (0008,0060) Source equipment for the image. See Section C.7.3.1.1.1 for Defined Terms.
>Requested Contrast Agent (0032,1070) Contrast agent requested for use in the Scheduled Procedure Step.
>Pre-Medication (0040,0012) Medication to be administered at the beginning of the Scheduled Procedure Step, e.g. Nuclear Medicine radiopharmaceutical.
>Anatomical Orientation Type (0010,2210) The anatomical orientation type appropriate for this patient. Enumerated Values: BIPED QUADRUPED
Scheduled Specimen Sequence (0040,0500) Sequence of Items identifying specimens to be imaged in the identified Scheduled Procedure Step(s), with their characteristics.
>Include ‘Specimen Macro’ Table C.7.6.22-2

C.4.10.1 Protocol Context Sequence

The Protocol Context Sequence (0040,0440) allows the specification of parameters that further qualify the scheduled protocol, provided through a set of generic name/value pairs of context Content Items.

Note: This allows the specification of clinical, acquisition, or procedural qualifiers for the scheduled protocol, such as a specific body part, imaging technique, or parameters of a preparatory event (e.g., radionuclide injection). Specific uses of this Sequence may be documented in a Template defined in accordance with PS3.16.

C.4.11 Requested Procedure Module

Table C.4-11REQUESTED PROCEDURE MODULE ATTRIBUTES

Attribute Name Tag Attribute Description
Requested Procedure ID (0040,1001) Identifier that identifies the Requested Procedure in the Imaging Service Request.
Reason for the Requested Procedure (0040,1002) Reason for requesting this imaging procedure.
Requested Procedure Comments (0040,1400) User-defined comments on the Requested Procedure.
Reason for Requested Procedure Code Sequence (0040,100A) Coded Reason for requesting this procedure. One or more Items shall be included in this sequence.
>Include ‘Code Sequence Macro’ Table 8.8-1 No Baseline Context ID is defined.
Requested Procedure Code Sequence (0032,1064) A sequence that conveys the Requested Procedure of one Procedure Type.
>Include ‘Code Sequence Macro’ Table 8.8-1 No Baseline Context ID is defined.
Study Instance UID (0020,000D) Unique identifier to be used to identify the Study
Study Date (0008,0020) Date the Study started, if any previous procedure steps within the same study have already been performed.
Study Time (0008,0030) Time the Study started, if any previous procedure steps within the same study have already been performed.
Referenced Study Sequence (0008,1110) Uniquely identifies the Study SOP Instances associated with this SOP Instance. One or more Items shall be included in this sequence.
>Include ‘SOP Instance Reference Macro' Table 10-11
Requested Procedure Description (0032,1060) Institution-generated administrative description or classification of Requested Procedure
Requested Procedure Priority (0040,1003) Requested Procedure Type Urgency. Defined Terms: STAT, HIGH, ROUTINE, MEDIUM, LOW
Patient Transport Arrangements (0040,1004) Mode of transportation of the patient to the location of examination.
Requested Procedure Location (0040,1005) Physical location at which the Requested Procedure is to be performed.
Confidentiality Code (0040,1008) Confidentiality Constraints on the Requested Procedure by the party filling the order.
Reporting Priority (0040,1009) Requested Reporting Priority. Defined Terms: HIGH, ROUTINE, MEDIUM, LOW
Names of Intended Recipients of Results (0040,1010) Names of the physicians, who are intended recipients of results.
Intended Recipients of Results Identification Sequence (0040,1011) Identification of the physicians who are intended recipients of results. One or more items shall be included in this sequence. If more than one Item, the number and order shall correspond to the value of Names of Intended Recipients of Results (0040,1010), if present.
>>Include ‘Person Identification Macro’ Table 10-1

Note: Attributes (0040,1006) Placer Order Number/Procedure and (0040,1007) Filler Order Number/Procedure were previously defined in DICOM. They are now retired (See PS3.3 1998).

C.4.12 Imaging Service Request Module

Table C.4-12IMAGING SERVICE REQUEST MODULE ATTRIBUTES

Attribute Name Tag Attribute Description
Imaging Service Request Comments (0040,2400) User-defined comments on the Imaging Service Request. Note: The Comments attribute is intended to transmit non-structured information, which can be displayed to the operator of the equipment (e.g. Modality).
Requesting Physician (0032,1032) Name of the physician who requested the Imaging Service Request.
Requesting Physician Identification Sequence (0032,1031) Identification of the physician who requested the Imaging Service Request. Only a single item shall be included in this sequence.
>Include ‘Person Identification Macro’ Table 10-1
Referring Physician's Name (0008,0090) Name of the patient's referring physician for this Imaging Service Request.
Referring Physician Identification Sequence (0008,0096) Identification of the patient's referring physician. Only a single item shall be included in this sequence.
>Include ‘Person Identification Macro’ Table 10-1
Requesting Service (0032,1033) Institutional department where the request initiated.
Requesting Service Code Sequence (0032,1034) Institutional department where the request initiated. Equivalent to HL7 v2.x ORC-17. Only a single item shall be included in this sequence. See Note 3.
>Include ‘Code Sequence Macro’ Table 8.8-1 Defined CID 7030.
Accession Number (0008,0050) A departmental IS generated number that identifies the order for the Imaging Service Request.
Issuer of Accession Number Sequence (0008,0051) Identifier of the Assigning Authority that issued the Accession Number. Only a single Item shall be included in this sequence.
>Include HL7v2 Hierarchic Designator Macro Table 10-17
Issue Date of Imaging Service Request (0040,2004) Date on which the Imaging Service Request was issued by the requester.
Issue Time of Imaging Service Request (0040,2005) Time at which the Imaging Service Request was issued by the requester.
Placer Order Number / Imaging Service Request (0040,2016) The order number assigned to the Imaging Service Request by the party placing the order.
Order Placer Identifier Sequence (0040,0026) Identifier of the Assigning Authority that issued the Placer Order Number. Only a single Item shall be included in this sequence.
>Include HL7v2 Hierarchic Designator Macro Table 10-17
Filler Order Number / Imaging Service Request (0040,2017) The order number assigned to the Imaging Service Request by the party filling the order.
Order Filler Identifier Sequence (0040,0027) Identifier of the Assigning Authority that issued the Filler Order Number. Only a single Item shall be included in this sequence.
>Include HL7v2 Hierarchic Designator Macro Table 10-17
Order entered by ... (0040,2008) The person who entered the Imaging Service Request into an Information System.
Order Enterer’s Location (0040,2009) The location at which the Imaging Service Request was entered.
Order Callback Phone Number (0040,2010) Telephone Number at which additional information can be retrieved.
Admission ID (0038,0010) Identification number of the visit as assigned by the healthcare provider
Issuer of Admission ID Sequence (0038,0014) Identifier of the Assigning Authority that issued the Admission ID. Only a single Item shall be included in this sequence.
>Include HL7v2 Hierarchic Designator Macro Table 10-17

Notes: 1. Attributes (0040,2016) and (0040,2017) Placer Order Number and Filler Order Number/Imaging Service Request are intended to convey the corresponding order numbers as defined in HL7, in the case where interoperability with an HL7 environment is the objective.

2. Attributes (0040,2001), (0040,2006) and (0040,2007) were previously defined in DICOM. They are now retired (See PS3.3 1998).

3. Both the attribute Requesting Service (0032,1033) and Requesting Service Code Sequence (0032,1034) are defined in this table; the latter has been added and is preferred, but the former is not retired since in some uses it may be copied from an HL7 message without the ability to map it to a coded form (e.g., with only ORC-17 component 1 valued).

C.4.13 Performed Procedure Step Relationship

Table C.4-13 specifies the Attributes used to reference other SOP Classes and other Information Entities of the DICOM real-world model as defined in Section 7.3.1.6.

Table C.4-13

PERFORMED PROCEDURE STEP RELATIONSHIP MODULE ATTRIBUTES

Attribute Name Tag Attribute Description
Patient's Name (0010,0010) Patient's full legal name.
Patient ID (0010,0020) Primary hospital identification number or code for the patient.
Include Issuer of Patient ID Macro Table 10-18
Patient's Birth Date (0010,0030) Date of birth of the named patient
Patient's Sex (0010,0040) Sex of the named Patient. Enumerated Values: M = male F = female O = other
Referenced Patient Sequence (0008,1120) Uniquely identifies the Patient SOP Instance. Only a single Item shall be included in this sequence.
>Include ‘SOP Instance Reference Macro' Table 10-11
Service Episode ID (0038,0060) Identifier of the Service Episode as assigned by the healthcare provider
Issuer of Service Episode ID Sequence (0038,0064) Identifier of the Assigning Authority that issued the Service Episode ID. Only a single Item shall be included in this sequence.
>Include HL7v2 Hierarchic Designator Macro Table 10-17
Service Episode Description (0038,0062) Description of the type of service episode.
Scheduled Step Attributes Sequence (0040,0270) Sequence containing attributes that are related to the scheduling of the Procedure Step. One or more Items shall be included in this sequence.
>Study Instance UID (0020,000D) Unique identifier for the Study.
>Referenced Study Sequence (0008,1110) Uniquely identifies the Study SOP Instance associated with this Scheduled Procedure Step. Only a single Item shall be included in this sequence.
>>Include ‘SOP Instance Reference Macro' Table 10-11
>Accession Number (0008,0050) A departmental IS generated number that identifies the order for the Study.
>Issuer of Accession Number Sequence (0008,0051) Identifier of the Assigning Authority that issued the Accession Number. Only a single Item shall be included in this sequence.
>>Include HL7v2 Hierarchic Designator Macro Table 10-17
>Placer Order Number/Imaging Service Request (0040,2016) The order number assigned to the Imaging Service Request by the party placing the order.
>Order Placer Identifier Sequence (0040,0026) Identifier of the Assigning Authority that issued the Placer Order Number. Only a single Item shall be included in this sequence.
>>Include HL7v2 Hierarchic Designator Macro Table 10-17
>Filler Order Number/Imaging Service Request (0040,2017) The order number assigned to the Imaging Service Request by the party filling the order.
>Order Filler Identifier Sequence (0040,0027) Identifier of the Assigning Authority that issued the Filler Order Number. Only a single Item shall be included in this sequence.
>>Include HL7v2 Hierarchic Designator Macro Table 10-17
>Requested Procedure ID (0040,1001) Identifier of the related Requested Procedure.
>Requested Procedure Description (0032,1060) Institution-generated administrative description or classification of Requested Procedure.
>Requested Procedure Code Sequence (0032,1064) A sequence that conveys the Procedure Type of the requested procedure. Only a single Item shall be included in this sequence.
>>Include ‘Code Sequence Macro’ Table 8.8-1 No Baseline Context ID is defined.
>Scheduled Procedure Step ID (0040,0009) Identifier of the related Scheduled Procedure Step.
>Scheduled Procedure Step Description (0040,0007) Institution-generated description or classification of the Scheduled Procedure Step to be performed.
>Scheduled Protocol Code Sequence (0040,0008) Sequence describing the Scheduled Protocol following a specific coding scheme. One or more Items shall be included in this sequence.
>>Include ‘Code Sequence Macro’ Table 8.8-1 No Baseline Context ID is defined.
>>Protocol Context Sequence (0040,0440) Sequence that specifies the context for the Scheduled Protocol Code Sequence Item. One or more items shall be included in this sequence. See Section C.4.10.1.
>>>Include ‘Content Item Macro’ Table 10-2 No Baseline Template is defined.
>>>Content Item Modifier Sequence (0040,0441) Sequence that specifies modifiers for a Protocol Context Content Item. One or more items shall be included in this sequence. See Section C.4.10.1.
>>>>Include ‘Content Item Macro’ Table 10-2 No Baseline Template is defined.

Notes: 1. The patient information is included in order to relate the Modality Performed Procedure Step SOP Instance to the Study Management SOP Instance and other associated IODs in case the SCU (the modality) is unable to obtain or use the Study Instance UID created by the Information System.2. Attributes (0040,2016) and (0040,2017) Placer Order Number and Filler Order Number/Imaging Service Request are intended to convey the corresponding order numbers as defined in HL7, in the case where interoperability with an HL7 environment is the objective.

3. Attributes (0040,2006) and (0040,2007) were previously defined in DICOM. They are now retired (See PS3.3 1998).

4. Attributes (0040,1006) Placer Order Number/Procedure and (0040,1007) Filler Order Number/Procedure were previously defined in DICOM. They are now retired (See PS3.3 1998).

C.4.14 Performed Procedure Step Information

Table C.4-14 defines the general attributes that may be used by all specific Procedure Steps.

Table C.4-14

PERFORMED PROCEDURE STEP INFORMATION MODULE ATTRIBUTES

Attribute Name Tag Attribute Description
Performed Station AE Title (0040,0241) AE title of the modality on which the Performed Procedure Step was performed.
Performed Station Name (0040,0242) An institution defined name for the modality on which the Performed Procedure Step was performed.
Performed Location (0040,0243) Description of the location at which the Performed Procedure Step was performed.
Performed Procedure Step Start Date (0040,0244) Date on which the Performed Procedure Step started. Note: This value may be used to determine the earliest date to use as the Study Date (0008,0020) in composite instances and in updated Modality Scheduled Procedure Steps in order to allow Study level attributes to have consistent values if additional Procedure Steps are performed.
Performed Procedure Step Start Time (0040,0245) Time at which the Performed Procedure Step started. Note: This value may be used to determine the earliest time to use as the Study Time (0008,0030) in composite instances and in updated Modality Scheduled Procedure Steps in order to allow Study level attributes to have consistent values if additional Procedure Steps are performed.
Performed Procedure Step ID (0040,0253) User or equipment generated identifier of that part of a Procedure that has been carried out within this step.
Performed Procedure Step End Date (0040,0250) Date on which the Performed Procedure Step ended.
Performed Procedure Step End Time (0040,0251) Time at which the Performed Procedure Step ended.
Performed Procedure Step Status (0040,0252) Contains the state of the Performed Procedure Step. Enumerated Values: IN PROGRESS = Started but not complete DISCONTINUED = Canceled or unsuccessfully terminated COMPLETED = Successfully completed
Performed Procedure Step Description (0040,0254) Institution-generated description or classification of the Procedure Step that was performed.
Comments on the Performed Procedure Step (0040,0280) User-defined comments on the Performed Procedure Step.
Performed Procedure Type Description (0040,0255) A description of the type of procedure performed.
Procedure Code Sequence (0008,1032) A sequence that conveys the (single) type of procedure performed. Only a single Item shall be included in this sequence.
>Include ‘Code Sequence Macro’ Table 8.8-1 No Baseline Context ID is defined.
Reason For Performed Procedure Code Sequence (0040,1012) Coded reason(s) for performing this procedure. Note: May differ from the values in Reason for the Requested Procedure (0040,100A) in Request Attribute Sequence (0040,0275), for example if what was performed differs from what was requested. One or more Items shall be included in this Sequence.
>Include ‘Code Sequence Macro’ Table 8.8-1 No Baseline Context ID is defined.
Performed Procedure Step Discontinuation Reason Code Sequence (0040,0281) The reason the Performed Procedure Step Status (0040,0252) was set to DISCONTINUED.
>Include ‘Code Sequence Macro’ Table 8.8-1 Defined CID 9300.

C.4.15 Image Acquisition Results

Table C.4-15 specifies attributes that describe the acquisition of images during the performance of the Procedure Step and that provide references to the Series, Images and other Composite SOP Instances associated with this Modality Performed Procedure Step.

Table C.4-15

IMAGE ACQUISITION RESULTS MODULE ATTRIBUTES

Attribute Name Tag Attribute Description
Modality (0008,0060) Type of equipment that originally acquired the data used to create the images associated with this Modality Performed Procedure Step. See C.7.3.1.1.1 for Defined Terms. Note: A Modality value in the created SOP Instances may be different from the MPPS Modality value. For example, multiple series may have been created during the MPPS (images, waveforms, softcopy presentation states and/or structured reports) with SOP Instances in different series having different modality values.
Study ID (0020,0010) User or equipment generated Study Identifier.
Performed Protocol Code Sequence (0040,0260) Sequence describing the Protocol performed for this Procedure Step. Zero or more Items shall be included in this sequence .
>Include ‘Code Sequence Macro’ Table 8.8-1 No Baseline Context ID is defined.
>Protocol Context Sequence (0040,0440) Sequence that specifies the context for the Performed Protocol Code Sequence Item. One or more items shall be included in this sequence. See Section C.4.10.1.
>>Include ‘Content Item Macro’ Table 10-2 No Baseline Template is defined.
>>Content Item Modifier Sequence (0040,0441) Sequence that specifies modifiers for a Protocol Context Content Item. One or more items shall be included in this sequence. See Section C.4.10.1.
>>>Include ‘Content Item Macro’ Table 10-2 No Baseline Template is defined.
Performed Series Sequence (0040,0340) Attributes of the Series that comprise this Modality Performed Procedure Step. Zero or more Items shall be included in this sequence.
>Performing Physician's Name (0008,1050) Name of the physician(s) administering this Series.
>Performing Physician Identification Sequence (0008,1052) Identification of the physician(s) administering the Series. One or more items shall be included in this sequence. If more than one Item, the number and order shall correspond to the value of Performing Physician’s Name (0008,1050), if present.
>>Include ‘Person Identification Macro’ Table 10-1
>Operators’ Name (0008,1070) Name(s) of the operator(s) who supporting this Series.
>Operator Identification Sequence (0008,1072) Identification of the operator(s) supporting the Series. One or more items shall be included in this sequence. If more than one Item, the number and order shall correspond to the value of Operators’ Name (0008,1070), if present.
>>Include ‘Person Identification Macro’ Table 10-1
>Protocol Name (0018,1030) User-defined description of the conditions under which the Series was performed. Note: This attribute conveys series-specific protocol identification and may or may not be identical to the one presented in the Performed Protocol Code Sequence (0040,0260).
>Series Instance UID (0020,000E) Unique Identifier of the Series.
>Series Description (0008,103E) Description of the Series
>Series Description Code Sequence (0008,103F) A coded description of the Series. Only a single Item shall be permitted in this sequence.
>>Include ‘Code Sequence Macro’ Table 8.8-1 No Baseline Context ID is defined.
>Retrieve AE Title (0008,0054) Title of the DICOM Application Entity where the Images and other Composite SOP Instances in this Series may be retrieved on the network. Note: The duration for which this location remains valid is unspecified.
>Archive Requested (0040,A494) The instances in this series are expected to be archived in the long term archive. Defined Terms: NO, YES
>Referenced Image Sequence (0008,1140) A Sequence that provides reference to Composite SOP Instances created during the acquisition of the procedure step. Zero or more Items shall be included in this sequence. Note: The use of Referenced Image Sequence is historical, and in this context it allows the reference of any Composite SOP Instance.
>>Include ‘SOP Instance Reference Macro' Table 10-11
>>Container Identifier (0040,0512) The identifier for the container that contains the specimen(s) imaged.
>>Specimen Description Sequence (0040,0560) Sequence of identifiers and detailed description of the specimen(s) imaged. One or more Items shall be included in this Sequence.
>>>Specimen Identifier (0040,0551) A departmental information system identifier for the Specimen.
>>>Specimen UID (0040,0554) Unique identifier for the Specimen.
>Referenced Non-Image Composite SOP Instance Sequence (0040,0220) Uniquely identifies instances, other than images, of any SOP Class that conforms to the DICOM Composite IOD Information Model, such as Waveforms, Presentation States or Structured Reports, created during the acquisition of the procedure step, and that are not referenced in Referenced Image Sequence (0008,1140). Zero or more Items shall be included in this sequence.
>>Include ‘SOP Instance Reference Macro' Table 10-11

C.4.16 Radiation Dose

Table C.4-16 defines the Attributes that may be used to communicate information related to radiation dose values. The attributes are intended to enable the Information System to store Patient exposure to ionizing radiation for legal purposes. Though these attributes are not intended to be used to accurately calculate volume dose distribution, they may serve for some quality control purposes.

This module provides a means to communicate radiation dose values but DICOM does not define any requirements for the accuracy of these values, which may be defined in other professional, national or international standards.

The scope of the attributes contained in this module covers the entire acquisition that comprises the Modality Performed Procedure Step. Attributes that relate to single images, such as mAs or kVP, may be included in the Image IODs. It is beyond the scope of DICOM to define what attributes may be required to calculate or estimate area dose product values.

Note: The X-Ray Radiation Dose SR SOP Class provides a more comprehensive means of reporting radiation dose. Such a dose report may be referenced in the Image Acquisition Results Module.

Table C.4-16

RADIATION DOSE MODULE ATTRIBUTES

Attribute Name Tag Attribute Description
Anatomic Structure, Space or Region Sequence (0008,2229) Anatomic structure, space or region that has been exposed to ionizing radiation. Zero or one Item shall be included in this Sequence.
>Include ‘Code Sequence Macro’ Table 8.8-1 No Baseline Context ID is defined.
Total Time of Fluoroscopy (0040,0300) Total duration of X-Ray exposure during fluoroscopy in seconds (pedal time) during this Performed Procedure Step.
Total Number of Exposures (0040,0301) Total number of exposures made during this Performed Procedure Step. The number includes non-digital and digital exposures.
Distance Source to Detector (0018,1110) Distance in mm from the source to detector center. Note: This value is traditionally referred to as Source Image Receptor Distance (SID).
Distance Source to Entrance (0040,0306) Distance in mm from the source to the surface of the patient closest to the source during this Performed Procedure Step. Note: This may be an estimated value based on assumptions about the patient’s body size and habitus.
Entrance Dose (0040,0302) Average entrance dose value measured in dGy at the surface of the patient during this Performed Procedure Step. Note: This may be an estimated value based on assumptions about the patient’s body size and habitus.
Entrance Dose in mGy (0040,8302) Average entrance dose value measured in mGy at the surface of the patient during this Performed Procedure Step. Note: This may be an estimated value based on assumptions about the patient’s body size and habitus.
Exposed Area (0040,0303) Typical dimension of the exposed area at the detector plane. If Rectangular: row dimension followed by column; if Round: diameter. Measured in mm. Notes: 1. This may be an estimated value based on assumptions about the patient’s body size and habitus. 2. This attribute is used in the X-Ray Acquisition Dose Module with units in cm (see Section C 8.7.8 Table C.8-33).
Image and Fluoroscopy Area Dose Product (0018,115E) Total area-dose-product to which the patient was exposed, accumulated over the complete Performed Procedure Step and measured in dGy*cm*cm, including fluoroscopy. 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.
Comments on Radiation Dose (0040,0310) User-defined comments on any special conditions related to radiation dose encountered during this Performed Procedure Step.
Exposure Dose Sequence (0040,030E) Exposure Dose Sequence will contain Total Number of Exposures (0040,0301) items plus an item for each fluoroscopy episode not already counted as an exposure. Zero or more Items shall be included in this sequence.
>Radiation Mode (0018,115A) Specifies X-Ray radiation mode. Enumerated Values: CONTINUOUS PULSED
>KVp (0018,0060) Peak kilo voltage output of the x-ray generator used. An average in the case of fluoroscopy (continuous radiation mode).
>X-Ray Tube Current in µA (0018,8151) X-Ray Tube Current in µA. An average in the case of fluoroscopy (continuous radiation mode).
>Exposure Time (0018,1150) Time of x-ray exposure or fluoroscopy in msec.
>Filter Type (0018,1160) Type of filter(s) inserted into the X-Ray beam (e.g. wedges). See C.8.7.10 and C.8.15.3.9 (for enhanced CT) for Defined Terms.
>Filter Material (0018,7050) The X-Ray absorbing material used in the filter. May be multi-valued. See C.8.7.10 and C.8.15.3.9 (for enhanced CT) for Defined Terms.
>Comments on Radiation Dose (0040,0310) User-defined comments on any special conditions related to radiation dose encountered during during the episode described by this Exposure Dose Sequence Item.

Notes: 1. The Anatomic Region may be deduced from attribute values available within the Modality Worklist Management SOP Class, such as Reason for Service Request, Reasons for Requested Procedure, Scheduled Procedure Step Description and Scheduled Protocol Code Sequence.

2. The Image Area Dose Product should take into account collimator position and filters, and the value for the Exposed Area should also take into account collimator position. If the equipment does not provide the Entrance Dose, it may be calculated using Area Dose Product, Exposed Area, SID and an assumed body thickness.

3. The Distance Source to Detector (0018,1110) and Exposed Area (0040,0303) are only meaningful if they remain constant for all acquisitions during this Performed Procedure Step.

C.4.17 Billing and Material Management Codes

The Attributes defined in Table C.4-17 provide a means to transmit billing and material management codes from a modality to an Information System. It is beyond the scope of this Standard to define all the required coding schemes and the relevant codes.

Table C.4-17BILLING AND MATERIAL MANAGEMENT CODE MODULE ATTRIBUTES

Attribute name Tag Attribute Description
Billing Procedure Step Sequence (0040,0320) Contains billing codes for the Procedure Type performed within the Procedure Step. Zero or more Items shall be included in this sequence.
>Include ‘Code Sequence Macro’ Table 8.8-1 No Baseline Context ID is defined.
Film Consumption Sequence (0040,0321) Information about the film consumption for this Performed Procedure Step. Zero or more Items shall be included in this sequence.
>Number of Films (2100,0170) Number of films actually printed.
>Medium Type (2000,0030) Type(s) of medium on which images were printed. For Defined Terms see Table C.13-1.
>Film Size ID (2010,0050) Size(s) of film on which images were printed. For Defined Terms see Table C.13-3.
Billing Supplies and Devices Sequence (0040,0324) Chemicals, supplies and devices for billing used in the Performed Procedure Step. One or more Items shall be included in this sequence.
>Billing Item Sequence (0040,0296) Code values of chemicals, supplies or devices required for billing. Zero or one Item shall be included in this Sequence.
>>Include ‘Code Sequence Macro’ Table 8.8-1 No Baseline Context ID is defined.
>Quantity Sequence (0040,0293) Sequence containing the quantity of used chemicals or devices. Zero or one Item shall be included in this Sequence.
>>Quantity (0040,0294) Numerical quantity value.
>>Measuring Units Sequence (0040,0295) Unit of measurement. Zero or one Item shall be included in this Sequence.
>>>Include ‘Code Sequence Macro’ Table 8.8-1 Baseline CID 82.

C.4.18 General Purpose Scheduled Procedure Step Relationship Module

Table C.4-18

GENERAL PURPOSE SCHEDULED PROCEDURE STEP RELATIONSHIP MODULE ATTRIBUTES

Attribute Name Tag Attribute Description
Patient's Name (0010,0010) Patient's full legal name.
Patient ID (0010,0020) Primary hospital identification number or code for the patient.
Include Issuer of Patient ID Macro Table 10-18
Patient's Birth Date (0010,0030) Date of birth of the named patient.
Patient's Sex (0010,0040) Sex of the named Patient. Enumerated Values: M = male F = female O = other
Referenced Request Sequence (0040,A370) The list of Requested Procedures the Procedure Step shall contribute to. One or more Items shall be included in this sequence.
>Study Instance UID (0020,000D) Unique identifier for the Study.
>Referenced Study Sequence (0008,1110) Uniquely identifies the Study SOP Instance that represents the Requested Procedure. Zero or one Item shall be included in this sequence.
>>Referenced SOP Class UID (0008,1150) Uniquely identifies the SOP Class.
>>Referenced SOP Instance UID (0008,1155) Uniquely identifies the SOP Instance.
>Accession Number (0008,0050) A departmental IS generated number that identifies the Imaging Service Request.
>Issuer of Accession Number Sequence (0008,0051) Identifier of the Assigning Authority that issued the Accession Number. Only a single Item shall be included in this sequence.
>>Include HL7v2 Hierarchic Designator Macro Table 10-17
>Requested Procedure Code Sequence (0032,1064) A sequence that conveys the Procedure Type of the Requested Procedure. Zero or one Item shall be included in this sequence.
>>Include Code Sequence Macro Table 8.8-1 No Baseline Context ID is defined.
>Placer Order Number / Imaging Service Request (0040,2016) The order number assigned to the Imaging Service Request by the party placing the order.
>Order Placer Identifier Sequence (0040,0026) Identifier of the Assigning Authority that issued the Placer Order Number. Only a single Item shall be included in this sequence.
>>Include HL7v2 Hierarchic Designator Macro Table 10-17
>Filler Order Number / Imaging Service Request (0040,2017) The order number assigned to the Imaging Service Request by the party filling the order.
>Order Filler Identifier Sequence (0040,0027) Identifier of the Assigning Authority that issued the Filler Order Number. Only a single Item shall be included in this sequence.
>>Include HL7v2 Hierarchic Designator Macro Table 10-17
>Requested Procedure ID (0040,1001) Identifier that identifies the Requested Procedure in the Imaging Service Request.
>Requested Procedure Description (0032,1060) Institution-generated description or classification of the Requested Procedure.
>Reason for the Requested Procedure (0040,1002) Reason for requesting this procedure.
>Reason for Requested Procedure Code Sequence (0040,100A) Coded reason for requesting this procedure. One or more Items shall be included in this sequence.
>>Include ‘Code Sequence Macro’ Table 8.8-1 No Baseline Context ID is defined.
>Requested Procedure Comments (0040,1400) User-defined comments on the Requested Procedure.
>Confidentiality Code (0040,1008) Confidentiality Constraints on the Requested Procedure by the party filling the order.
>Names of Intended Recipients of Results (0040,1010) Names of the physicians, who are intended recipients of results.
>Imaging Service Request Comments (0040,2400) User-defined comments on the Imaging Service Request.
>Requesting Physician (0032,1032) Physician who requested the Imaging Service Request.
>Requesting Physician Identification Sequence (0032,1031) Identification of the physician who requested the Imaging Service Request. Only a single item shall be included in this sequence.
>>Include ‘Person Identification Macro’ Table 10-1
>Requesting Service (0032,1033) Institutional department where the request initiated.
>Requesting Service Code Sequence (0032,1034) Institutional department where the request initiated. Equivalent to HL7 v2.x ORC-17. Only a single item shall be included in this sequence. See Note 2.
>>Include ‘Code Sequence Macro’ Table 8.8-1 Defined CID 7030.
>Issue Date of Imaging Service Request (0040,2004) Date on which the Imaging Service Request was issued by the requester.
>Issue Time of Imaging Service Request (0040,2005) Time at which the Imaging Service Request was issued by the requester.
>Referring Physician's Name (0008,0090) Patient's primary physician for this Imaging Service Request.

Notes: 1. Attribute (0040,2001) was previously defined in DICOM. It is now retired (See PS3.3 2003).

2. Both the attribute Requesting Service (0032,1033) and Requesting Service Code Sequence (0032,1034) are defined in this table; the latter has been added and is preferred, but the former is not retired since in some uses it may be copied from an HL7 message without the ability to map it to a coded form (e.g., with only ORC-17 component 1 valued).

C.4.19 General Purpose Scheduled Procedure Step Information Module

Table C.4-19GENERAL PURPOSE SCHEDULED PROCEDURE STEP INFORMATION MODULE ATTRIBUTES

Attribute Name Tag Attribute Description
General Purpose Scheduled Procedure Step Status (0040,4001) A status that informs the operator and the worklist management system about the progress of the scheduled General Purpose procedure step. Enumerated Values are: SCHEDULED, IN PROGRESS, SUSPENDED, COMPLETED, DISCONTINUED. See PS 3.4 for a detailed description of the meaning and usage of these values.
General Purpose Scheduled Procedure Step Priority (0040,4003) Scheduled Procedure Step priority. Enumerated Values are: HIGH: used to indicate an urgent or emergent work item, equivalent to a STAT request. MEDIUM: used to indicate a work item that has a priority less than HIGH and higher than LOW. It can be used to further stratify work items. LOW: used to indicate a routine or non-urgent work item.
Scheduled Procedure Step ID (0040,0009) Identifier that identifies the Scheduled General Purpose Procedure Step.
Scheduled Procedure Step Modification Date Time (0040,4010) Date and time when the General Purpose Scheduled Procedure Step was last modified or first created (whichever is most recent). Note: This attribute should be implicitly updated by the worklist management system whenever any modification is made to attributes of a General Purpose Scheduled Procedure Step. In particular, note that creation of General Purpose Performed Procedure Steps by a performing device can modify attributes of a related General Purpose Scheduled Procedure Step (e.g. the contents of Resulting General Purpose Performed Procedure Steps Sequence (0040,4015)).
Scheduled Processing Applications Code Sequence (0040,4004) The list of processing application instances and/or application types on which the General Purpose Procedure Step is scheduled. Zero or more Items shall be included in this sequence.
>Include Code Sequence Macro Table 8.8-1 No Baseline Context ID is defined.
Scheduled Station Name Code Sequence (0040,4025) Identifying name within the enterprise of the equipment for which the General Purpose Scheduled Procedure Step is scheduled. The name conveyed in the Code Value (0008,0100) may be the same as the AE Title, but does not have to be. Zero or more Items shall be included in this sequence.
>Include Code Sequence Macro Table 8.8-1 No Baseline Context ID is defined.
Scheduled Station Class Code Sequence (0040,4026) Class of the equipment for which the General Purpose Scheduled Procedure Step is scheduled. Zero or more Items shall be included in this sequence.
>Include Code Sequence Macro Table 8.8-1 No Baseline Context ID is defined.
Scheduled Station Geographic Location Code Sequence (0040,4027) Geographic location of the equipment for which the General Purpose Scheduled Procedure Step is scheduled. Zero or more Items shall be included in this sequence.
>Include Code Sequence Macro Table 8.8-1 No Baseline Context ID is defined.
Scheduled Human Performers Sequence (0040,4034) The list of human performers that are scheduled to be involved or responsible for performing the Workitem in the General Purpose Scheduled Procedure Step. Zero or more Items shall be included in this sequence.
>Human Performer Code Sequence (0040,4009) Human performer that is involved or responsible for performing the Workitem. Only a single Item shall be included in this sequence.
>>Include Code Sequence Macro Table 8.8-1 No Baseline Context ID is defined.
>Human Performer's Name (0040,4037) Name of the human performer.
>Human Performer's Organization (0040,4036) Organization to which the human performer is accountable for the activities in the Workitem.
Scheduled Procedure Step Start Date Time (0040,4005) Date and time on which the General Purpose Scheduled Procedure Step is scheduled to start.
Expected Completion Date Time (0040,4011) Date on which the Procedure Step is expected to be completed.
Scheduled Workitem Code Sequence (0040,4018) A sequence that conveys the code for the Workitem. Only a single Item shall be included in this sequence.
>Include Code Sequence Macro Table 8.8-1 Baseline CID 9231.
Comments on the Scheduled Procedure Step (0040,0400) User-defined comments on the Scheduled Procedure Step.
Referenced Performed Procedure Step Sequence (0008,1111) List of any Modality or General Purpose Performed Procedure Steps, that may be used to perform the procedure step. This sequence may contain references to performed procedure steps resulting from previous contributions to the performance of the procedure step (e.g. an image processing procedure step interrupted, and completed later). Zero or more Items shall be included in this sequence.
>Include SOP Instance Reference Macro Table 10-11
Input Availability Flag (0040,4020) Flag that indicates the availability of Composite SOP Instances in the Attribute “Input Information Sequence” (0040,4021) of the General Purpose Scheduled Procedure Step. Enumerated values are: PARTIAL COMPLETE The value PARTIAL denotes that the list of Composite SOP Instances may not yet be complete, and additional ones may be added at a later time. The value COMPLETE denotes that all Composite SOP Instances are available and listed. Note: It may happen that the list of Composite SOP Instances is empty when the value of the Input Availability Flag is COMPLETE. In such a case a Workitem has been scheduled that does not require input information.
Input Information Sequence (0040,4021) List of Composite SOP Instances that forms the input information needed to perform the scheduled procedure step. See also Input Availability Flag (0040,4020). The same Composite SOP Instance shall not be included in both the Input Information Sequence (0040,4021) and the Relevant Information Sequence (0040,4022). Zero or more Items shall be included in this sequence.
>Include '’Hierarchical SOP Instance Reference Macro' Table C.17-3
Relevant Information Sequence (0040,4022) List of Composite SOP Instances that refers to relevant information that is considered pertinent for the performance of the scheduled procedure step. The same Composite SOP Instance shall not be included in both the Input Information Sequence (0040,4021) and the Relevant Information Sequence (0040,4022). Zero or more Items shall be included in this sequence.
>Include '’Hierarchical SOP Instance Reference Macro' Table C.17-3
Study Instance UID (0020,000D) Unique Study identification that shall be used for the created Composite SOP Instances resulting from this General Purpose Scheduled Procedure Step. Note: In most cases this will be the same Study Instance UID as for the instances in the Input Information Sequence (0040,4021).
Study Date (0008,0020) Date the Study started, if any previous procedure steps within the same study have already been performed. Note: This value should be the same as that in the instances in the Input Information Sequence (0040,4021).
Study Time (0008,0030) Time the Study started, if any previous procedure steps within the same study have already been performed. Note: This value should be the same as that in the instances in the Input Information Sequence (0040,4021).
Multiple Copies Flag (0040,4006) This flag indicates that multiple copies have to be made of a Composite SOP Instance that supports the notion of multiple copies. This includes the SR SOP Class. If set the Study Instance UIDs in the Referenced Request Sequence (0040,A370) shall be used for the created multiple copies. Enumerated Values: Y = Yes N = No
Resulting General Purpose Performed Procedure Steps Sequence (0040,4015) List of all General Purpose Performed Procedure Steps that result from the performance of the procedure step. Zero or more Items shall be included in this sequence. Note: Initially this list will be empty. New entries will be added when General Purpose Performed Procedure Steps are created by performing devices that are related to this Scheduled Procedure Step. E.g, this sequence may contain the partial results in case a General Purpose Scheduled Procedure Step is discontinued.
>Include SOP Instance Reference Macro Table 10-11
Actual Human Performers Sequence (0040,4035) The list of current human performers that are actually involved or responsible for performing the Workitem. Zero or more Items shall be included in this sequence. Note: Initially this list will be empty. A list of entries may be created at the status transition of the General Purpose Scheduled Procedure Step Status (0040,4001) to "IN PROGRESS"
>Human Performer Code Sequence (0040,4009) Human performer that is involved or responsible for performing the Workitem. Only a single Item shall be included in this sequence.
>>Include Code Sequence Macro Table 8.8-1 No Baseline Context ID is defined.
>Human Performer's Name (0040,4037) Name of the human performer.
>Human Performer's Organization (0040,4036) Organization to which the human performer is accountable for the activities in the Workitem.

C.4.20 General Purpose Performed Procedure Step Relationship Module

Table C.4.20-1 specifies the Attributes used to reference other SOP Classes and other Information Entities of the DICOM real-world model as defined in PS 3.3 Section 7.3.1.11.

Table C.4.20-1

GENERAL PURPOSE PERFORMED PROCEDURE STEP RELATIONSHIP MODULE ATTRIBUTES

Attribute Name Tag Attribute Description
Patient's Name (0010,0010) Patient's full legal name.
Patient ID (0010,0020) Primary hospital identification number or code for the patient.
Include Issuer of Patient ID Macro Table 10-18
Patient's Birth Date (0010,0030) Date of birth of the named patient.
Patient's Sex (0010,0040) Sex of the named Patient. Enumerated Values: M = male F = female O = other
Referenced Request Sequence (0040,A370) The list of Requested Procedures the Procedure Step shall contribute to. Zero or more Items shall be included in this sequence.
>Study Instance UID (0020,000D) Unique identifier for the Study.
>Referenced Study Sequence (0008,1110) Uniquely identifies the Study SOP Instance associated with this Scheduled Procedure Step. Only a single Item shall be included in this sequence.
>>Include SOP Instance Reference Macro Table 10-11
>Accession Number (0008,0050) A departmental IS generated number that identifies the order for the Study.
>Issuer of Accession Number Sequence (0008,0051) Identifier of the Assigning Authority that issued the Accession Number. Only a single Item shall be included in this sequence.
>>Include HL7v2 Hierarchic Designator Macro Table 10-17
>Requested Procedure Code Sequence (0032,1064) A sequence that conveys the Procedure Type of the Requested Procedure. Zero or one Item shall be included in this sequence.
>>Include Code Sequence Macro Table 8.8-1 No Baseline Context ID is defined.
>Placer Order Number/Imaging Service Request (0040,2016) The order number assigned to the Imaging Service Request by the party placing the order.
>Order Placer Identifier Sequence (0040,0026) Identifier of the Assigning Authority that issued the Placer Order Number. Only a single Item shall be included in this sequence.
>>Include HL7v2 Hierarchic Designator Macro Table 10-17
>Filler Order Number/Imaging Service Request (0040,2017) The order number assigned to the Imaging Service Request by the party filling the order.
>Order Filler Identifier Sequence (0040,0027) Identifier of the Assigning Authority that issued the Filler Order Number. Only a single Item shall be included in this sequence.
>>Include HL7v2 Hierarchic Designator Macro Table 10-17
>Requested Procedure ID (0040,1001) Identifier of the related Requested Procedure.
>Requested Procedure Description (0032,1060) Institution-generated administrative description or classification of Requested Procedure.
Referenced General Purpose Scheduled Procedure Step Sequence (0040,4016) Uniquely identifies the General Purpose Scheduled Procedure Step SOP Instance associated with this General Purpose Performed Procedure Step. Zero or more Items shall be included in this sequence.
>Include SOP Instance Reference Macro Table 10-11
>Referenced General Purpose Scheduled Procedure Step Transaction UID (0040,4023) Transaction UID (0008,1195) used in the N-ACTION transaction that requested the transition to the IN PROGRESS state for the referenced General Purpose Scheduled Procedure Step.
Admission ID (0038,0010) Identification number of the visit as assigned by the healthcare provider
Issuer of Admission ID Sequence (0038,0014) Identifier of the Assigning Authority that issued the Admission ID. Only a single Item shall be included in this sequence.
>Include HL7v2 Hierarchic Designator Macro Table 10-17
Service Episode ID (0038,0060) Identifier of the Service Episode as assigned by the healthcare provider
Issuer of Service Episode ID Sequence (0038,0064) Identifier of the Assigning Authority that issued the Service Episode ID. Only a single Item shall be included in this sequence.
>Include HL7v2 Hierarchic Designator Macro Table 10-17
Service Episode Description (0038,0062) Description of the type of service episode.

C.4.21 General Purpose Performed Procedure Step Information Module

Table C.4.21-1

GENERAL PURPOSE PERFORMED PROCEDURE STEP INFORMATION MODULE ATTRIBUTES

Attribute Name Tag Attribute Description
Actual Human Performers Sequence (0040,4035) The list of human performers that were actually involved in or responsible for performing this General Purpose Performed Procedure Step. Zero or more Items shall be included in this sequence.
>Human Performer Code Sequence (0040,4009) Human performer that is actually involved or responsible for performing the General Purpose Performed Procedure Step. Only a single Item shall be included in this sequence.
>>Include Code Sequence Macro Table 8.8-1 No Baseline Context ID is defined.
>Human Performer's Name (0040,4037) Name of the human performer.
>Human Performer's Organization (0040,4036) Organization to which the human performer is accountable for the activities in the General Purpose Performed Procedure Step.
Performed Station Name Code Sequence (0040,4028) Name within the enterprise of the equipment that created the General Purpose Performed Procedure Step. This name may be the same as the AE Title, but does not have to be. Zero or one Item shall be included in this sequence.
>Include Code Sequence Macro Table 8.8-1 No Baseline Context ID is defined.
Performed Station Class Code Sequence (0040,4029) Class of the equipment that created the General Purpose Performed Procedure Step. Zero or one Item shall be included in this sequence.
>Include Code Sequence Macro Table 8.8-1 No Baseline Context ID is defined.
Performed Station Geographic Location Code Sequence (0040,4030) Geographic location of the equipment that created General Purpose Performed Procedure Step. Zero or one Item shall be included in this sequence.
>Include Code Sequence Macro Table 8.8-1 No Baseline Context ID is defined.
Performed Processing Applications Code Sequence (0040,4007) The list of processing application instances and/or application types on which the General Purpose Performed Procedure Step is executed. Zero or more Items shall be included in this sequence.
>Include Code Sequence Macro Table 8.8-1 No Baseline Context ID is defined.
Performed Procedure Step Start Date (0040,0244) Date on which the General Purpose Performed Procedure Step started. Note: This value may be used to determine the earliest date to use as the Study Date (0008,0020) in composite instances and in updated General Purpose Scheduled Procedure Steps in order to allow Study level attributes to have consistent values if additional Procedure Steps are performed.
Performed Procedure Step Start Time (0040,0245) Time at which the General Purpose Performed Procedure Step started. Note: This value may be used to determine the earliest time to use as the Study Time (0008,0030) in composite instances and in updated General Purpose Scheduled Procedure Steps in order to allow Study level attributes to have consistent values if additional Procedure Steps are performed.
Performed Procedure Step ID (0040,0253) User or equipment generated identifier of that part of a Procedure that has been carried out within this procedure step.
Performed Procedure Step End Date (0040,0250) Date on which the General Purpose Performed Procedure Step ended.
Performed Procedure Step End Time (0040,0251) Time at which the General Purpose Performed Procedure Step ended.
General Purpose Performed Procedure Step Status (0040,4002) Contains the state of the Performed Procedure Step. Enumerated Values: IN PROGRESS = Started but not complete DISCONTINUED = Canceled or unsuccessfully terminated COMPLETED = Successfully completed
Performed Procedure Step Description (0040,0254) Institution-generated description or classification of the Procedure Step that was performed.
Comments on the Performed Procedure Step (0040,0280) User-defined comments on the Performed Procedure Step. This attribute shall not be used as a substitute for the code meaning in the Performed Workitem Code Sequence (0040,4019).
Performed Workitem Code Sequence (0040,4019) A sequence that conveys the (single) type of procedure performed. Only a single Item shall be included in this sequence.
>Include Code Sequence Macro Table 8.8-1 Baseline CID 9231.

C.4.22 General Purpose Results

Table C.4.22-1 specifies attributes that describe the creation of results during the performance of the General Purpose Procedure Step and that provide references to the Results and Structured Reporting SOP Instances associated with this General Purpose Performed Procedure Step.

Table C.4.22-1

GENERAL PURPOSE RESULTS MODULE ATTRIBUTES

Attribute Name Tag Attribute Description
Output Information Sequence (0040,4033) A Sequence that provides reference to one or more Composite SOP instances, that identify the Structured Reports or other results created. Zero or more Items shall be included in this sequence.
>Study Instance UID (0020,000D) Unique identifier for the Study
>Referenced Series Sequence (0008,1115) Sequence of Items where each Item includes the Attributes of a Series containing referenced Composite Object(s). One or more Items shall be included in this sequence
>>Archive Requested (0040,A494) The instances in this series are expected to be archived in the long term archive. Defined Terms: NO, YES
>>Include ‘Hierarchical Series Reference Macro’ Table C.17-3a
Requested Subsequent Workitem Code Sequence (0040,4031) A Sequence that provides suggested next Workitems, based on the produced results. Note: This Attribute may also be used in case a step has been done incorrectly and should be redone. Zero or more Items shall be included in this sequence
>Include Code Sequence Macro Table 8.8-1 Baseline CID 9231.
Non-DICOM Output Code Sequence (0040,4032) A Sequence that describes any non-DICOM output produced as results. Zero or more Items shall be included in this sequence.
>Include Code Sequence Macro Table 8.8-1 Baseline CID 9232.

C.4.23 Instance Availability Notification Module

Table C.4.23-1 specifies the Attributes used to describe which Instances are available and their relationships.

Table C.4.23-1

INSTANCE AVAILABILITY NOTIFICATION MODULE ATTRIBUTES

Attribute Name Tag Attribute Description
Referenced Performed Procedure Step Sequence (0008,1111) Uniquely identifies the Performed Procedure Step SOP Instance to which this availability notification instance is related, if any. Zero or one Item shall be included in this sequence. Notes: 1. This may refer to a different PPS than that encoded in the composite instances themselves. 2. It is typically used for notification about instances created as a consequence of some scheduled activity.
>Include SOP Instance Reference Macro Table 10-11
>Performed Workitem Code Sequence (0040,4019) A sequence that conveys the (single) type of procedure performed. Only a single Item shall be included in this sequence.
>>Include Code Sequence Macro Table 8.8-1 Baseline CID 9231.
Study Instance UID (0020,000D) Unique identifier for the Study of which all the Instances referenced in this notification are part.
Referenced Series Sequence (0008,1115) Sequence of Items where each Item includes references to Instances within the same Series. One or more Items shall be included in this Sequence.
>Series Instance UID (0020,000E) Unique identifier of the Series of which all the Instances referenced in this Item are part.
>Referenced SOP Sequence (0008,1199) Sequence of Items where each Item includes a reference to a single Instance within this Series. One or more Items shall be included in this Sequence.
>>Include SOP Instance Reference Macro Table 10-11
>>Instance Availability (0008,0056) The availability of the referenced Instance. See Section C.4.23.1.1
>>Retrieve AE Title (0008,0054) Title of the DICOM Application Entity from which the referenced Instance may or may not be retrievable, i.e. the scope for which Instance Availability (0008,0056) applies. See Section C.4.23.1.1.
>>Retrieve Location UID (0040,E011) Unique identifier of the system where the Composite Object(s) may be retrieved on the network.
>>Retrieve URI (0040,E010) Retrieval access path to the referenced SOP instance(s). Includes fully specified scheme, authority, path, and query in accordance with RFC 2396.
>>Storage Media File-Set ID (0088,0130) The user or implementation specific human readable identifier that identifies the offline storage media on which the instance resides.
>>Storage Media File-Set UID (0088,0140) Uniquely identifies the offline storage media on which the instance resides.

C.4.23.1 Instance Availability Notification Module Attribute Definitions

C.4.23.1.1 Instance Availability

The Enumerated Values for Instance Availability (0008,0056) are:

C.5 Results Modules

Retired. See PS 3.3 2004.

C.6 Interpretation Modules

Retired. See PS 3.3 2004.

C.7 Common composite image IOD modules

This Section defines the Modules that are common to all Composite Image IODs.

C.7.1 Common Patient IE Modules

The following Patient IE Module is common to all Composite Image IODs that reference the Patient IE.

C.7.1.1 Patient Module

Table C.7-1 specifies the Attributes of the Patient that describe and identify the Patient who is the subject of a diagnostic Study. This Module contains Attributes of the patient that are needed for diagnostic interpretation of the Image and are common for all studies performed on the patient. It contains Attributes that are also included in the Patient Modules in Section C.2.

Table C.7-1 PATIENT MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Patient's Name (0010,0010) 2 Patient's full name.
Patient ID (0010,0020) 2 Primary hospital identification number or code for the patient.
Include Issuer of Patient ID Macro Table 10-18
Patient's Birth Date (0010,0030) 2 Birth date of the patient.
Patient's Sex (0010,0040) 2 Sex of the named patient. Enumerated Values: M = male F = female O = other
Referenced Patient Sequence (0008,1120) 3 A sequence that provides reference to a Patient SOP Class/Instance pair. Only a single Item is permitted in this Sequence.
>Include SOP Instance Reference Macro Table 10-11
Patient's Birth Time (0010,0032) 3 Birth time of the Patient.
Other Patient IDs (0010,1000) 3 Other identification numbers or codes used to identify the patient.
Other Patient IDs Sequence (0010,1002) 3 A sequence of identification numbers or codes used to identify the patient, which may or may not be human readable, and may or may not have been obtained from an implanted or attached device such as an RFID or barcode. One or more Items are permitted in this sequence.
>Patient ID (0010,0020) 1 An identification number or code used to identify the patient.
>Include Issuer of Patient ID Macro Table 10-18
>Type of Patient ID (0010,0022) 1 The type of identifier in this item. Defined Terms: TEXT RFID BARCODE Note: The identifier is coded as a string regardless of the type, not as a binary value.
Other Patient Names (0010,1001) 3 Other names used to identify the patient.
Ethnic Group (0010,2160) 3 Ethnic group or race of the patient.
Patient Comments (0010,4000) 3 User-defined additional information about the patient.
Patient Species Description (0010,2201) 1C The species of the patient. Required if the patient is an animal and if Patient Species Code Sequence (0010,2202) is not present. May be present otherwise.
Patient Species Code Sequence (0010,2202) 1C The species of the patient. Only a single Item shall be included in this sequence. Required if the patient is an animal and if Patient Species Description (0010,2201) is not present. May be present otherwise.
>Include ‘Code Sequence Macro’ Table 8.8-1 Defined CID 7454.
Patient Breed Description (0010,2292) 2C The breed of the patient. See C.7.1.1.1.1. Required if the patient is an animal and if Patient Breed Code Sequence (0010,2293) is empty. May be present otherwise.
Patient Breed Code Sequence (0010,2293) 2C The breed of the patient. See C.7.1.1.1.1. Zero or more Items shall be included in this sequence. Required if the patient is an animal.
>Include ‘Code Sequence Macro’ Table 8.8-1 Defined CID 7480.
Breed Registration Sequence (0010,2294) 2C Information identifying an animal within a breed registry. Zero or more Items shall be included in this sequence. Required if the patient is an animal.
>Breed Registration Number (0010,2295) 1 Identification number of an animal within the registry.
>Breed Registry Code Sequence (0010,2296) 1 Identification of the organization with which an animal is registered. Only a single Item shall be permitted in this sequence.
>>Include ‘Code Sequence Macro’ Table 8.8-1 Defined CID 7481.
Responsible Person (0010,2297) 2C Name of person with medical decision making authority for the patient. Required if the patient is an animal. May be present otherwise.
Responsible Person Role (0010,2298) 1C Relationship of Responsible Person to the patient. See Section C.7.1.1.1.2 for Defined Terms. Required if Responsible Person is present and has a value.
Responsible Organization (0010,2299) 2C Name of organization with medical decision making authority for the patient. Required if patient is an animal. May be present otherwise.
Patient Identity Removed (0012,0062) 3 The true identity of the patient has been removed from the Attributes and the Pixel Data Enumerated Values: YES NO
De-identification Method (0012,0063) 1C A description or label of the mechanism or method use to remove the patient’s identity. May be multi-valued if successive de-identification steps have been performed. Notes: 1. This may be used to describe the extent or thoroughness of the de-identification, for example whether or not the de-identification is for a “Limited Data Set” (as per HIPAA Privacy Rule). 2. The characteristics of the de-identifying equipment and/or the responsible operator of that equipment may be recorded as an additional item of the Contributing Equipment Sequence (0018,A001) in the SOP Common Module. De-identifying equipment may use a Purpose of Reference of (109104,DCM,“De-identifying Equipment”). Required if Patient Identity Removed (0012,0062) is present and has a value of YES and De-identification Method Code Sequence (0012,0064) is not present. May be present otherwise.
De-identification Method Code Sequence (0012,0064) 1C A code describing the mechanism or method use to remove the patient’s identity. One or more Items shall be included in this sequence. Multiple items are used if successive de-identification steps have been performed or to describe options of a defined profile. Required if Patient Identity Removed (0012,0062) is present and has a value of YES and De-identification Method (0012,0063) is not present. May be present otherwise.
>Include Code Sequence Macro Table 8.8-1 Defined CID 7050.

C.7.1.1.1 Patient Module Attributes
C.7.1.1.1.1 Patient Breed Description and Code Sequence

The breed of an animal, if known, shall be encoded in either Patient Breed Description (0010,2292) or Patient Breed Code Sequence (0010,2293) or both.

In the case of a mixed breed, it shall be either:

  1. described in plain text in Patient Breed Description (0010,2292), e.g., “Border Collie American Bulldog mix”, or just “Mixed”, or

  2. coded as multiple specific breeds by composing the mix as multiple items of Patient Breed Code Sequence (0010,2293), e.g., (L-809A2,SRT,“Border Collie dog breed”) followed by (L-80974,SRT, “American Bulldog breed”), or

  3. encoded non-specifically with a code that means “mixed breed” of the appropriate species, as defined in CID 7482, which is included in CID 7480, e.g., (L-809DF,SRT,“Mixed breed dog”).

Note: The absence of a value for both Patient Breed Description (0010,2292) and Patient Breed Code Sequence (0010,2293) implies that the breed is unknown, not that it is mixed.

C.7.1.1.1.2 Responsible Person Role

The Defined Terms for Responsible Person Role (0010,2298) are:

OWNER

PARENT

CHILD

SPOUSE

SIBLING

RELATIVE

GUARDIAN

CUSTODIAN

AGENT

C.7.1.2 Specimen Identification Module

Retired. See PS 3.3-2008.

Note: The functionality of the Specimen Identification Module has been replaced by the Specimen Module. See C.7.6.22.

C.7.1.3 Clinical Trial Subject Module

Table C.7-2b contains attributes that identify a Patient as a clinical trial Subject.

Table C.7-2b CLINICAL TRIAL SUBJECT MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Clinical Trial Sponsor Name (0012,0010) 1 The name of the clinical trial sponsor. See C.7.1.3.1.1.
Clinical Trial Protocol ID (0012,0020) 1 Identifier for the noted protocol. See C.7.1.3.1.2.
Clinical Trial Protocol Name (0012,0021) 2 The name of the clinical trial protocol. See C.7.1.3.1.3.
Clinical Trial Site ID (0012,0030) 2 The identifier of the site responsible for submitting clinical trial data. See C.7.1.3.1.4.
Clinical Trial Site Name (0012,0031) 2 Name of the site responsible for submitting clinical trial data. See C.7.1.3.1.5
Clinical Trial Subject ID (0012,0040) 1C The assigned identifier for the clinical trial subject. See C.7.1.3.1.6. Shall be present if Clinical Trial Subject Reading ID (0012,0042) is absent. May be present otherwise.
Clinical Trial Subject Reading ID (0012,0042) 1C Identifies the subject for blinded evaluations. Shall be present if Clinical Trial Subject ID (0012,0040) is absent. May be present otherwise. See C.7.1.3.1.7.
Clinical Trial Protocol Ethics Committee Name (0012,0081) 1C Name of the Ethics Committee or Institutional Review Board (IRB) responsible for approval of the Clinical Trial. Required if Clinical Trial Protocol Ethics Committee Approval Number (0012,0082) is present.
Clinical Trial Protocol Ethics Committee Approval Number (0012,0082) 3 Approval number issued by committee described in Clinical Trial Protocol Ethics Committee Name (0012,0081).

C.7.1.3.1 Clinical Trial Subject Attribute Descriptions

Identification of subjects in clinical trials generally requires a combination of the following four attributes:

  1. Clinical Trial Sponsor Name (0012,0010),

  2. Clinical Trial Protocol ID (0012,0020),

  3. Clinical Trial Subject ID (0012,0040) (or Clinical Trial Subject Reading ID (0012,0042) for blinded evaluations), and

  4. Clinical Trial Site ID (0012,0030).

For trials in which subject identifiers are unique within the scope of the Clinical Trial Protocol (e.g., if subject identifiers are centrally assigned or contain the site identifier) the Clinical Trial Site ID (0012,0030) is not required to identify subjects.

C.7.1.3.1.1 Clinical Trial Sponsor Name

The Clinical Trial Sponsor Name (0012,0010) identifies the entity responsible for conducting the clinical trial and for defining the Clinical Trial Protocol ID (0012,0020).

C.7.1.3.1.2 Clinical Trial Protocol ID

The Clinical Trial Protocol ID (0012,0020) is the number or character sequence used by the Clinical Trial Sponsor to uniquely identify the investigational protocol in which the subject has been enrolled.

C.7.1.3.1.3 Clinical Trial Protocol Name

The Clinical Trial Protocol Name (0012,0021) contains the title of the investigational protocol in which the subject has been enrolled.

Note: It is recommended that the phase of the clinical trial be noted in the Clinical Trial Protocol Name, if applicable.

C.7.1.3.1.4 Clinical Trial Site ID

The Clinical Trial Site ID (0012,0030) is the identification number or character string (issued by the entity identified by the Clinical Trial Sponsor Name (0012,0010)) used to identify the site responsible for submitting clinical trial data.

C.7.1.3.1.5 Clinical Trial Site Name

The Clinical Trial Site Name (0012,0031) is a character string used to identify the site responsible for submitting clinical trial data.

C.7.1.3.1.6 Clinical Trial Subject ID

The Clinical Trial Subject ID (0012,0040) identifies the subject within the investigational protocol specified by Clinical Trial Protocol ID (0012,0020).

C.7.1.3.1.7 Clinical Trial Subject Reading ID

The Clinical Trial Subject Reading ID (0012,0042) identifies the subject in the context of blinded evaluations.

C.7.2 Common Study IE Modules

The following Study IE Modules are common to all Composite Image IODs that reference the Study IE. These Modules contain Attributes of the patient and study that are needed for diagnostic interpretation of the image. They contain Attributes that are also in the Patient Modules in Section C.2 and Study Modules in Section C.4.

C.7.2.1 General Study Module

Table C.7-3 specifies the Attributes that describe and identify the Study performed upon the Patient.

Table C.7-3GENERAL STUDY MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Study Instance UID (0020,000D) 1 Unique identifier for the Study.
Study Date (0008,0020) 2 Date the Study started.
Study Time (0008,0030) 2 Time the Study started.
Referring Physician's Name (0008,0090) 2 Name of the patient's referring physician
Referring Physician Identification Sequence (0008,0096) 3 Identification of the patient's referring physician. Only a single item is permitted in this sequence.
>Include ‘Person Identification Macro’ Table 10-1
Study ID (0020,0010) 2 User or equipment generated Study identifier.
Accession Number (0008,0050) 2 A RIS generated number that identifies the order for the Study.
Issuer of Accession Number Sequence (0008,0051) 3 Identifier of the Assigning Authority that issued the Accession Number. Only a single Item is permitted in this sequence.
>Include HL7v2 Hierarchic Designator Macro Table 10-17
Study Description (0008,1030) 3 Institution-generated description or classification of the Study (component) performed.
Physician(s) of Record (0008,1048) 3 Names of the physician(s) who are responsible for overall patient care at time of Study (see Section C.7.3.1 for Performing Physician)
Physician(s) of Record Identification Sequence (0008,1049) 3 Identification of the physician(s) who are responsible for overall patient care at time of Study. One or more items are permitted in this sequence.If more than one Item, the number and order shall correspond to the value of Physician(s) of Record (0008,1048), if present.
>Include ‘Person Identification Macro’ Table 10-1
Name of Physician(s) Reading Study (0008,1060) 3 Names of the physician(s) reading the Study.
Physician(s) Reading Study Identification Sequence (0008,1062) 3 Identification of the physician(s) reading the Study. One or more items are permitted in this sequence. If more than one Item, the number and order shall correspond to the value of Name of Physician(s) Reading Study (0008,1060), if present.
>Include ‘Person Identification Macro’ Table 10-1
Requesting Service Code Sequence (0032,1034) 3 Institutional department where the request initiated. Only a single item is permitted in this sequence.
>Include ‘Code Sequence Macro’ Table 8.8-1 Defined CID 7030.
Referenced Study Sequence (0008,1110) 3 A sequence that provides reference to a Study SOP Class/Instance pair. One or more Items are permitted in this Sequence.
>Include SOP Instance Reference Macro Table 10-11
Procedure Code Sequence (0008,1032) 3 A Sequence that conveys the type of procedure performed. One or more Items are permitted in this Sequence.
>Include ‘Code Sequence Macro’ Table 8.8-1 No Baseline Context ID is defined.
Reason For Performed Procedure Code Sequence (0040,1012) 3 Coded reason(s) for performing this procedure. Note: May differ from the values in Reason for the Requested Procedure (0040,100A) in Request Attribute Sequence (0040,0275), for example if what was performed differs from what was requested. One or more Items are permitted in this Sequence.
>Include ‘Code Sequence Macro’ Table 8.8-1 No Baseline Context ID is defined.

C.7.2.1.1 General Study Attribute Descriptions
C.7.2.1.1.1 Referring Physician, Physician of Record, Physician Reading Study

The model used for application of attributes related to different functions of Physicians involved in the care of a patient is shown in Figure C.7.2-1. The figure shows some of the relationships and information flows between physician roles that might be present in some healthcare business models.

[pic]

Figure C.7.2-1Functions of Physicians

There can be an overlap of functions provided by any given physician. In this case, the various attributes specifying the different roles would convey the same physician name.

C.7.2.2 Patient Study Module

Table C.7-4a defines Attributes that provide information about the Patient at the time the Study started.

Table C.7-4aPATIENT STUDY MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Admitting Diagnoses Description (0008,1080) 3 Description of the admitting diagnosis (diagnoses)
Admitting Diagnoses Code Sequence (0008,1084) 3 A sequence that conveys the admitting diagnosis (diagnoses). One or more Items are permitted in this Sequence.
>Include ‘Code Sequence Macro’ Table 8.8-1 No Baseline Context ID is defined.
Patient's Age (0010,1010) 3 Age of the Patient.
Patient's Size (0010,1020) 3 Length or size of the Patient, in meters.
Patient's Weight (0010,1030) 3 Weight of the Patient, in kilograms.
Patient's Size Code Sequence (0010,1021) 3 Patient's size category code One or more Items are permitted in this sequence.
>Include ‘Code Sequence Macro’ Table 8.8-1 Baseline Context ID is CID 7040 for pediatric patients Baseline Context ID is CID 7042 for CT calcium scoring
Occupation (0010,2180) 3 Occupation of the Patient.
Additional Patient History (0010,21B0) 3 Additional information about the Patient's medical history.
Admission ID (0038,0010) 3 Identifier of the visit as assigned by the healthcare provider
Issuer of Admission ID Sequence (0038,0014) 3 Identifier of the Assigning Authority that issued the Admission ID (0038,0010). Only a single Item is permitted in this sequence.
>Include HL7v2 Hierarchic Designator Macro Table 10-17
Service Episode ID (0038,0060) 3 Identifier of the Service Episode as assigned by the healthcare provider
Issuer of Service Episode ID Sequence (0038,0064) 3 Identifier of the Assigning Authority that issued the Service Episode ID (0038,0060). Only a single Item is permitted in this sequence.
>Include HL7v2 Hierarchic Designator Macro Table 10-17
Service Episode Description (0038,0062) 3 Description of the type of service episode.
Patient’s Sex Neutered (0010,2203) 2C Whether or not a procedure has been performed in an effort to render the patient sterile. Enumerated value: ALTERED = Altered/Neutered UNALTERED = Unaltered/intact Note: If this Attribute is present but has no value then the status is unknown. Required if patient is an animal. May be present otherwise.

C.7.2.3 Clinical Trial Study Module

Table C.7-4b contains attributes that identify a Study in the context of a clinical trial.

Table C.7-4b CLINICAL TRIAL STUDY MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Clinical Trial Time Point ID (0012,0050) 2 An identifier specifying the one or more studies that are grouped together as a clinical time point or submission in a clinical trial. See C.7.2.3.1.1.
Clinical Trial Time Point Description (0012,0051) 3 A description of a set of one or more studies that are grouped together to represent a clinical time point or submission in a clinical trial. See C.7.2.3.1.1.
Consent for Clinical Trial Use Sequence (0012,0083) 3 A Sequence that conveys information about consent for Clinical Trial use of the composite instances within this Study. One or more Items are permitted in this sequence. See C.7.2.3.1.2.
>Distribution Type (0012,0084) 1C The type of distribution for which consent to distribute has been granted. Defined Terms: NAMED_PROTOCOL RESTRICTED_REUSE PUBLIC_RELEASE See C.7.2.3.1.2. Required if Consent for Distribution Flag (0012,0085) equals YES or WITHDRAWN.
>Clinical Trial Protocol ID (0012,0020) 1C The identifier of the protocol for which consent to distribute has been granted. Required if Distribution Type (0012,0084) is NAMED_PROTOCOL and the protocol is not that which is specified in Clinical Trial Protocol ID (0012,0020) in the Clinical Trial Subject Module.
>Consent for Distribution Flag (0012,0085) 1 Whether or not consent to distribute has been granted for the purpose described in Distribution Type (0012,0084). Enumerated Values: NO YES WITHDRAWN See C.7.2.3.1.2. Note: Under some circumstances, consent may be withdrawn. The purpose of encoding this is to warn receiving systems that further distribution may not be appropriate, but no semantics are defined by the Standard for what action is appropriate under such circumstances, such as what to do with previously received images that had a value of YES.

C.7.2.3.1 Clinical Trial Study Attribute Descriptions
C.7.2.3.1.1 Clinical Trial Time Point

The Clinical Trial Time Point ID (0012,0050) attribute identifies an imaging study within the context of an investigational protocol. This attribute is used to define a set of studies that are grouped together as a clinical time point or data submission in a clinical trial. The Clinical Trial Time Point Description (0012,0051) attribute can be used to give a description of the Clinical Trial Time Point to which the set of studies belongs.

C.7.2.3.1.2 Consent for Clinical Trial Use Sequence

For applications such as clinical trials, the distribution of composite instances in Studies, whether containing identifying information or partially or completely de-identified, may need to be controlled. Permission for distribution is usually granted under the control of the patient (through informed consent), the ethics committee or institutional review board responsible for the study, and the sponsor of the study through contractual means. The Consent for Clinical Trial Use Sequence (0012,0083) is intended to encode the result of the consent process to allow appropriate subsequent handling of the instances.

The defined terms for Distribution Type (0012,0084) mean that consent has been issued to distribute for the purpose of:

NAMED_PROTOCOL - conducting the protocol named in Clinical Trial Protocol ID (0012,0020)

RESTRICTED_REUSE - re-use for restricted purposes (not specified here) other than those for which the instances were originally created

PUBLIC_RELEASE - release to the general public for re-use without restriction

Notes: 1. There is no intent to convey in this sequence further details of the often complex consent and approval process. Further information about the protocol and ethics committee may be found in the Clinical Trials modules, if present.

2. There is no identification of an individual responsible for the approval or granting consent, since in the case of a clinical trial subject granting informed consent, the presence of this information would breach de-identification requirements.

3. Multiple sequence items may be present; for example a Study may be approved for distribution for conducting multiple explicitly named protocols.

4. Whether or not the instances have been adequately de-identified for any particular purpose of distribution is not defined by the Attributes in the Consent for Clinical Trial Use Sequence (0012,0083). Other Attributes address this, such as Patient Identity Removed (0012,0062), De-identification Method (0012,0063), De-identification Method Code Sequence (0012,0064) and Burned In Annotation (0028,0301). See also PS 3.15 Application Level Confidentiality Profiles.

5. It is possible that the list of Defined Terms for Distribution Type (0012,0084) may be extended in future for other purposes, not necessarily related to the conduct of clinical trials.

C.7.3 Common Series IE Modules

The following Series IE Modules are common to all Composite Image IODs that reference the Series IE.

C.7.3.1 General Series Module

Table C.7-5a specifies the Attributes that identify and describe general information about the Series within a Study.

Table C.7-5aGENERAL 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. See C.7.3.1.1.1 for Defined Terms.
Series Instance UID (0020,000E) 1 Unique identifier of the Series.
Series Number (0020,0011) 2 A number that identifies this Series.
Laterality (0020,0060) 2C Laterality of (paired) body part examined. Required if the body part examined is a paired structure and Image Laterality (0020,0062) or Frame Laterality (0020,9072) are not sent. Enumerated Values: R = right L = left Note: Some IODs support Image Laterality (0020,0062) at the Image level or Frame Laterality(0020,9072) at the Frame level in the Frame Anatomy functional group macro or Measurement Laterality (0024,0113) at the Measurement level, which can provide a more comprehensive mechanism for specifying the laterality of the body part(s) being examined.
Series Date (0008,0021) 3 Date the Series started.
Series Time (0008,0031) 3 Time the Series started.
Performing Physicians’ Name (0008,1050) 3 Name of the physician(s) administering the Series.
Performing Physician Identification Sequence (0008,1052) 3 Identification of the physician(s) administering the Series. One or more items are permitted in this sequence. If more than one Item, the number and order shall correspond to the value of Performing Physicians’ Name (0008,1050), if present.
>Include ‘Person Identification Macro’ Table 10-1
Protocol Name (0018,1030) 3 User-defined description of the conditions under which the Series was performed. Note: This attribute conveys series-specific protocol identification and may or may not be identical to the one presented in the Performed Protocol Code Sequence (0040,0260).
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) 3 Name(s) of the operator(s) supporting the Series.
Operator Identification Sequence (0008,1072) 3 Identification of the operator(s) supporting the Series. One or more items are permitted in this sequence. If more than one Item, the number and order shall correspond to the value of Operators’ Name (0008,1070), if present.
>Include ‘Person Identification Macro’ Table 10-1
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). Only a single Item is permitted in this sequence.
>Include SOP Instance Reference Macro Table 10-11
Related Series Sequence (0008,1250) 3 Identification of Series significantly related to this Series. One or more Items are permitted in this Sequence. Notes: 1. For example, for a combined CT and PET acquisition, the CT images and PET images would be in separate series that could cross-reference each other with multiple purpose of reference codes meaning same anatomy, simultaneously acquired and same indication. 2. The related series may have different Frames of Reference and hence require some sort of registration before spatial coordinates can be directly compared. 3. This attribute is not intended for conveying localizer reference information, for which Referenced Image Sequence (0008,1140) should be used.
>Study Instance UID (0020,000D) 1 Instance UID of Study to which the related Series belongs
>Series Instance UID (0020,000E) 1 Instance UID of Related Series
>Purpose of Reference Code Sequence (0040,A170) 2 Describes the purpose for which the reference is made. Zero or more Items shall be included in this sequence. When absent, implies that the reason for the reference is unknown.
>>Include Code Sequence Macro Table 8.8-1 Defined CID 7210
Body Part Examined (0018,0015) 3 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 Note: Some IODs support the Anatomic Region Sequence (0008,2218), which can provide a more comprehensive mechanism for specifying the body part being examined.
Patient Position (0018,5100) 2C Patient position descriptor relative to the equipment. Required for images where Patient Orientation Code Sequence (0054,0410) is not present and whose SOP Class is one of the following: CT ("1.2.840.10008.5.1.4.1.1.2") or MR ("1.2.840.10008.5.1.4.1.1.4") or Enhanced CT ("1.2.840.10008.5.1.4.1.1.2.1") or Enhanced MR Image ("1.2.840.10008.5.1.4.1.1.4.1") or Enhanced Color MR Image ("1.2.840.10008.5.1.4.1.1.4.3") or MR Spectroscopy ("1.2.840.10008.5.1.4.1.1.4.2") Storage SOP Classes. May be present for other SOP Classes if Patient Orientation Code Sequence (0054,0410) is not present. See C.7.3.1.1.2 for Defined Terms and further explanation.
Smallest Pixel Value in Series (0028,0108) 3 The minimum value of all images in this Series.
Largest Pixel Value in Series (0028,0109) 3 The maximum value of all images in this Series.
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 IDs defined
Include Performed Procedure Step Summary Macro Table 10-16 No Baseline Context IDs defined
Anatomical Orientation Type (0010,2210) 1C The anatomical orientation type used in instances generated by this equipment. Enumerated Values: BIPED QUADRUPED Required if the patient is an animal and the anatomical frame of reference is not bipedal. May be present otherwise. See C.7.6.1.1.1 and C.7.6.2.1.1. Note: If this Attribute is not present, the default human standard anatomical position is used to define the patient orientation of projection images and the patient coordinate system of cross-sectional images.

Notes: 1. If the Modality or General Purpose Performed Procedure Step SOP Class is supported as an SCU by a Storage SCU, the SCU is strongly encouraged to support the attribute Referenced Performed Procedure Step Sequence (0008,1111). This attribute references the Performed Procedure Step SOP Instance, and extraction of this Attribute from a Composite Instance may allow retrieval of the Performed Procedure Step SOP Instance.

2. If the Storage SCU does not conform to the Modality or General Purpose Performed Procedure Step SOP Class, it is still advisable to include the attributes Performed Procedure Step Start Date (0040,0244), Performed Procedure Step Start Time (0040,0245) and Performed Procedure Step Description (0040,0254) into the Composite Instances.

C.7.3.1.1 General Series Attribute Descriptions
C.7.3.1.1.1 Modality

Defined Terms for the Modality (0008,0060) are:

CR = Computed Radiography CT = Computed Tomography
MR = Magnetic Resonance NM = Nuclear Medicine
US = Ultrasound OT = Other
BI = Biomagnetic imaging
DG = Diaphanography
ES = Endoscopy LS = Laser surface scan
PT = Positron emission tomography (PET) RG = Radiographic imaging (conventional film/screen)
TG = Thermography
XA = X-Ray Angiography RF = Radio Fluoroscopy
RTIMAGE = Radiotherapy Image RTDOSE = Radiotherapy Dose
RTSTRUCT = Radiotherapy Structure Set RTPLAN = Radiotherapy Plan
RTRECORD = RT Treatment Record HC = Hard Copy
DX = Digital Radiography MG = Mammography
IO = Intra-oral Radiography PX = Panoramic X-Ray
GM = General Microscopy SM = Slide Microscopy
XC = External-camera Photography PR = Presentation State
AU = Audio ECG = Electrocardiography
EPS = Cardiac Electrophysiology HD = Hemodynamic Waveform
SR = SR Document IVUS = Intravascular Ultrasound
OP = Ophthalmic Photography SMR = Stereometric Relationship
AR = Autorefraction KER = Keratometry
VA = Visual Acuity SRF = Subjective Refraction
OCT = Optical Coherence Tomography (non-Ophthalmic) LEN = Lensometry
OPV = Ophthalmic Visual Field OPM = Ophthalmic Mapping
OAM = Ophthalmic Axial Measurements RESP = Respiratory Waveform
KO = Key Object Selection SEG = Segmentation
REG = Registration OPT = Ophthalmic Tomography
BDUS = Bone Densitometry (ultrasound) BMD = Bone Densitometry (X-Ray)
DOC = Document FID = Fiducials
PLAN = Plan IOL = Intraocular Lens Data
IVOCT = Intravascular Optical Coherence Tomography

Retired Defined Terms for the Modality (0008,0060) are:

DS = Digital Subtraction Angiography CF = Cinefluorography
DF = Digital fluoroscopy VF = Videofluorography
AS = Angioscopy CS = Cystoscopy
EC = Echocardiography LP = Laparoscopy
FA = Fluorescein angiography CP = Culposcopy
DM = Digital microscopy FS = Fundoscopy
MA = Magnetic resonance angiography MS = Magnetic resonance spectroscopy
CD = Color flow Doppler DD = Duplex Doppler
ST = Single-photon emission computed tomography (SPECT) OPR = Ophthalmic Refraction

Note: 1. The XA modality incorporates the retired modality DS.

2. The RF modality incorporates the retired modalities CF, DF, VF.

3. The modality listed in the Modality Data Element (0008,0060) may not match the name of the IOD in which it appears. For example, a SOP instance from XA IOD may list the RF modality when an RF implementation produces an XA object.

4. The MR modality incorporates the retired modalities MA and MS.

5. The US modality incorporates the retired modalities EC, CD, and DD.

6. The NM modality incorporates the retired modality ST.

C.7.3.1.1.2 Patient Position

Patient Position (0018,5100) specifies the position of the patient relative to the imaging equipment space. This attribute is intended for annotation purposes only. It does not provide an exact mathematical relationship of the patient to the imaging equipment.

When facing the front of the imaging equipment, Head First is defined as the patient’s head being positioned toward the front of the imaging equipment. Feet First is defined as the patient’s feet being positioned toward the front of the imaging equipment. Prone is defined as the patient’s face being positioned in a downward (gravity) direction. Supine is defined as the patient’s face being in an upward direction. Decubitus Right is defined as the patient’s right side being in a downward direction. Decubitus Left is defined as the patient’s left side being in a downward direction.

The Defined Terms are:

HFP = Head First-Prone HFS = Head First-Supine
HFDR = Head First-Decubitus Right HFDL = Head First-Decubitus Left
FFDR = Feet First-Decubitus Right FFDL = Feet First-Decubitus Left
FFP = Feet First-Prone FFS = Feet First-Supine

The Figure C.7.3.1.1.2-1 illustrates these defined terms for imaging equipment with a table, such as in X-Ray Angiography. The orientation of the patient related to gravity is always recumbent.

[pic] [pic]
Recumbent - Head First – Supine Recumbent - Head First - Prone
[pic] [pic]
Recumbent - Head First - Decubitus Right Recumbent - Head First - Decubitus Left
[pic] [pic]
Recumbent - Feet First – Supine Recumbent - Feet First - Prone
[pic] [pic]
Recumbent - Feet First - Decubitus Right Recumbent - Feet First - Decubitus Left

Figure C.7.3.1.1.2-1Representation of the eight Different Patient Positions on the X-Ray Table

C.7.3.2 Clinical Trial Series Module

Table C.7-5b contains attributes that identify a Series in the context of a clinical trial.

Table C.7-5b CLINICAL TRIAL SERIES MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Clinical Trial Coordinating Center Name (0012,0060) 2 The name of the institution that is responsible for coordinating the medical imaging data for the clinical trial. See C.7.3.2.1.1.
Clinical Trial Series ID (0012,0071) 3 An identifier of the series in the context of a clinical trial. See C.7.3.2.1.2.
Clinical Trial Series Description (0012,0072) 3 A description of the series in the context of a clinical trial. See C.7.3.2.1.2.

C.7.3.2.1 Clinical Trial Series Attribute Descriptions
C.7.3.2.1.1 Clinical Trial Coordinating Center Name

The Clinical Trial Coordinating Center Name (0012,0060) identifies the institution responsible for coordinating the collection of images and associated data for subjects enrolled in the clinical trial.

C.7.3.2.1.2 Clinical Trial Series Identifier and Description

The Clinical Trial Series ID (0012,0071) and Clinical Trial Series Description (0012,0072) attributes can be used to identify and describe a Series within the context of a clinical trial without requiring the replacement of the values in the Series Number (0020,0011) and Series Description (0008,103E) attributes in the General Series Module, whose manufacturer or user provided values may be relevant and important to retain.

C.7.3.3 Enhanced Series Module

Table C.7-5c Table specifies the Attributes that identify and describe general information about the Series within a Study.

Note: This table contains a subset of the attributes of General Series Module (Table C.7-5a) but the Type designation is changed into Type 1. Including this module in an IOD overwrites the Type designation of the General Series Module.

Table C.7-5cENHANCED SERIES MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Series Number (0020,0011) 1 A number that identifies this Series. Notes: 1. The value of this attribute should be unique for all series in a study created on the same equipment. 2. Because series can be created on more than one equipment, it can not be guranteed that the value of Series Number (0020,0011) is unique in a study.
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.7.4 Common Frame Of Reference Information Entity Modules

C.7.4.1 Frame Of Reference Module

Table C.7-6 specifies the Attributes necessary to uniquely identify a frame of reference which insures the spatial relationship of Images within a Series. It also allows Images across multiple Series to share the same Frame Of Reference. This Frame Of Reference (or coordinate system) shall be constant for all Images related to a specific Frame Of Reference.

When a Frame of Reference is identified, it is not important how the imaging target (Patient, specimen, or phantom) is positioned relative to the imaging equipment or where the origin of the Frame Of Reference is located. It is important that the position of the imaging target and the origin are constant in relationship to a specific Frame Of Reference.

Note: Since the criteria used to group images into a Series is application specific, it is possible for imaging applications to define multiple Series within a Study that share the same imaging space. Previous versions of the DICOM Standard specified that all images within the Series must be spatially related. However, insufficient information was available to determine if multiple Series within a Study were spatially related.

Table C.7-6FRAME OF REFERENCE MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Frame of Reference UID (0020,0052) 1 Uniquely identifies the frame of reference for a Series. See C.7.4.1.1.1 for further explanation.
Position Reference Indicator (0020,1040) 2 Part of the imaging target used as a reference. See C.7.4.1.1.2 for further explanation.

C.7.4.1.1 Frame Of Reference Attribute Descriptions
C.7.4.1.1.1 Frame Of Reference UID

The Frame of Reference UID (0020,0052) shall be used to uniquely identify a frame of reference for a series. Each series shall have a single Frame of Reference UID. However, multiple Series within a Study may share a Frame of Reference UID. All images in a Series that share the same Frame of Reference UID shall be spatially related to each other.

Notes: 1. Previous versions of this Standard defined a Data Element "Location", which has been retired. Frame of Reference UID provides a completely unambiguous identification of the image location reference used to indicate position.

2. A common Frame of Reference UID may be used to spatially relate localizer images with a set of transverse images. However, in some cases (eg. multiple localizer images being related to a single set of transverse images) a common Frame of Reference UID may not be sufficient. The Referenced Image Sequence (0008,1140) provides an unambiguous method for relating localizer images.

C.7.4.1.1.2 Position Reference Indicator

The Position Reference Indicator (0020,1040) specifies the part of the imaging target that was used as a reference point associated with a specific Frame of Reference UID. The Position Reference Indicator may or may not coincide with the origin of the fixed frame of reference related to the Frame of Reference UID.

For a Patient-related Frame of Reference, this is an anatomical reference point such as the iliac crest, orbital-medial, sternal notch, symphysis pubis, xiphoid, lower coastal margin, or external auditory meatus, or a fiducial marker placed on the patient. The patient-based coordinate system is described in C.7.6.2.1.1.

For a slide-related Frame of Reference, this is the slide corner as specified in C.8.12.2.1 and shall be identified in this attribute with the value “SLIDE_CORNER”. The slide-based coordinate system is described in C.8.12.2.1.

The Position Reference Indicator shall be used only for annotation purposes and is not intended to be used as a mathematical spatial reference.

Note: The Position Reference Indicator may be sent zero length when it has no meaning, for example, when the Frame of Reference Module is required to relate mammographic images of the breast acquired without releasing breast compression, but where there is no meaningful anatomical reference point as such.

C.7.4.2 Synchronization Module

Table C.7-7 specifies the Attributes necessary to uniquely identify a frame of reference that establishes the temporal relationship of SOP Instances. A synchronized environment may be established based on a shared time of day clock, and/or on a shared trigger event or synchronization waveform channel.

Note: Within a synchronized environment, different devices may use the shared data differently. An electrical pulse, for example, may be treated as a trigger event by one device (e.g., an x-ray imaging system), but may be recorded as a synchronization waveform by another device (e.g., a hemodynamics system).

Table C.7-7 Synchronization Module Attributes

Attribute Name Tag Type Attribute Description
Synchronization Frame of Reference UID (0020,0200) 1 UID of common synchronization environment. See C.7.4.2.1.1.
Synchronization Trigger (0018,106A) 1 Data acquisition synchronization with external equipment Enumerated Values: SOURCE - this equipment provides synchronization channel or trigger to other equipment EXTERNAL - this equipment receives synchronization channel or trigger from other equipment PASSTHRU - this equipment receives synchronization channel or trigger and forwards it NO TRIGGER - data acquisition not synchronized by common channel or trigger
Trigger Source or Type (0018,1061) 3 Specifies equipment ID of trigger source and/or type of trigger
Synchronization Channel (0018,106C) 1C Identifier of waveform channel that records the synchronization channel or trigger, see C.7.4.2.1.3. Required if synchronization channel or trigger is encoded in a waveform in this SOP Instance
Acquisition Time Synchronized (0018,1800) 1 Acquisition DateTime (0008,002A) synchronized with external time reference. Enumerated Values: Y, N See C.7.4.2.1.4
Time Source (0018,1801) 3 ID of equipment or system providing time reference
Time Distribution Protocol (0018,1802) 3 Method of time distribution used to synchronize this equipment. Defined Terms: NTP - Network Time Protocol IRIG - InterRange Instrumentation Group GPS - Global Positioning System SNTP - Simple Network Time Protocol PTP - IEEE 1588 Precision Time Protocol
NTP Source Address (0018,1803) 3 IP Address of NTP, SNTP, or PTP time source. IPv4 addresses shall be in dotted decimal (e.g. 192.168.1.1). The IPv6 addresses shall be in colon separated hexadecimal (e.g. 12:34:56:78:9a:bc:de:f0). Note: Identity of this value in two instances acquired contemporaneously implies a common time base. The NTP Source Address might not persist over time.

C.7.4.2.1 Synchronization Attribute Descriptions
C.7.4.2.1.1 Synchronization Frame of Reference UID

A set of equipment may share a common acquisition synchronization environment, which is identified by a Synchronization Frame of Reference UID. All SOP Instances that share the same Synchronization Frame of Reference UID shall be temporally related to each other. If a Synchronization Frame of Reference UID is present, all SOP Instances in the Series must share the same Frame of Reference.

The UTC Synchronization UID, 1.2.840.10008.15.1.1, may be used when the equipment is synchronized to the international standard UTC. In this case the quality of synchronization may be determined by means of the Time Distribution Protocol (0018,1802) and NTP Source Address (0018,1803).

Notes: 1. The Synchronization Frame of Reference UID defines an equipment synchronization environment, and does not need to be changed for each unrelated acquisition. SOP Instances may therefore share a Synchronization Frame of Reference UID, but be clinically unrelated (e.g., apply to different patients).

2. When a synchronization environment is recalibrated, a new UID must be issued.

3. The method of distributing the Synchronization Frame of Reference UID to multiple devices is not specified.

C.7.4.2.1.2 Time Source and Time Distribution Protocol

Time may originate with a primary source (e.g., a national standards bureau) and be distributed through a chain of secondary distribution systems until reaching the imaging equipment. Time Distribution Protocol (0018,1802) specifies the immediate (last link) method used by the equipment to receive time from the immediately prior Time Source (0018,1801). It does not specify the ultimate time reference from which the Time Source may derive its synchronization.

Note: The time value distributed through the specified Time Distribution Protocol may need to be corrected to align with UTC. For example, GPS does not compensate for leap seconds.

C.7.4.2.1.3 Synchronization Channel

The Synchronization Channel (0018,106C) is specified as a pair of values (M,C), where the first value is the ordinal of the sequence item of the Waveform Sequence (5400,0100) attribute (i.e., the Multiplex Group), and the second value is the ordinal of the sequence item of the Channel Definition Sequence (003A,0200) attribute (i.e., the Waveform Channel Number) within the multiplex group.

C.7.4.2.1.4 Acquisition Time Synchronized

The Acquisition Time Synchronized (0018,1800) attribute specifies whether the Acquisition DateTime (0008,002A) attribute of the Waveform Identification Module or the General Image Module represents an accurate synchronized timestamp for the acquisition of the waveform and/or image data. For triggered multi-frame images, the Acquisition DateTime applies to the trigger for the first image frame (see attribute Image Trigger Delay (0018.1067) in the Cine Module).

Note: The degree of precision of the Acquisition DateTime and its accuracy relative to the external clock are not specified, but need to be appropriate for the clinical application.

For IODs that include the SR Document Content Module, the Acquisition Time Synchronized (0018,1800) attribute specifies whether the Observation DateTime (0040,A032) attribute of Items in the Content Sequence (0040,A730) of the SR Document Content Module represents an accurate synchronized timestamp for the Item.

C.7.5 Common Equipment IE Modules

The following Equipment IE Module is common to all Composite IODs that reference the Equipment IE.

C.7.5.1 General Equipment Module

Table C.7-8 specifies the Attributes that identify and describe the piece of equipment that produced a Series of Composite Instances.

Table C.7-8GENERAL EQUIPMENT MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Manufacturer (0008,0070) 2 Manufacturer of the equipment that produced the composite instances.
Institution Name (0008,0080) 3 Institution where the equipment that produced the composite instances is located.
Institution Address (0008,0081) 3 Mailing address of the institution where the equipment that produced the composite instances is located.
Station Name (0008,1010) 3 User defined name identifying the machine that produced the composite instances.
Institutional Department Name (0008,1040) 3 Department in the institution where the equipment that produced the composite instances is located.
Manufacturer's Model Name (0008,1090) 3 Manufacturer’s model name of the equipment that produced the composite instances.
Device Serial Number (0018,1000) 3 Manufacturer’s serial number of the equipment that produced the composite instances. Note: This identifier corresponds to the device that actually created the images, such as a CR plate reader or a CT console, and may not be sufficient to identify all of the equipment in the imaging chain, such as the generator or gantry or plate.
Software Versions (0018,1020) 3 Manufacturer’s designation of software version of the equipment that produced the composite instances. See Section C.7.5.1.1.3.
Gantry ID (0018,1008) 3 Identifier of the gantry or positioner.
Spatial Resolution (0018,1050) 3 The inherent limiting resolution in mm of the acquisition equipment for high contrast objects for the data gathering and reconstruction technique chosen. If variable across the images of the series, the value at the image center.
Date of Last Calibration (0018,1200) 3 Date when the image acquisition device calibration was last changed in any way. Multiple entries may be used for additional calibrations at other times. See C.7.5.1.1.1 for further explanation.
Time of Last Calibration (0018,1201) 3 Time when the image acquisition device calibration was last changed in any way. Multiple entries may be used. See C.7.5.1.1.1 for further explanation.
Pixel Padding Value (0028,0120) 1C Single pixel value or one limit (inclusive) of a range of pixel values used in an image to pad to rectangular format or to signal background that may be suppressed. See C.7.5.1.1.2 for further explanation. Required if Pixel Padding Range Limit (0028,0121) is present and either Pixel Data (7FE0,0010) or Pixel Data Provider URL (0028,7FE0) is present. May be present otherwise only if Pixel Data (7FE0,0010) or Pixel Data Provider URL (0028,7FE0) is present. Notes: 1. The Value Representation of this Attribute is determined by the value of Pixel Representation (0028,0103). 2. This Attribute is not used in Presentation State Instances; there is no means in a Presentation State to “override” any Pixel Padding Value specified in the referenced images. 3. This Attribute does apply to RT Dose and Segmentation instances, since they include Pixel Data.

C.7.5.1.1 General Equipment Attribute Descriptions

Note: The attributes Manufacturer (0008,0070), Manufacturer’s Model Name (0008,1090) and Device Serial Number (0018,1000) are intended to be a primary identification of the system that produces the data (e.g., modality or workstation application providing the content of the SOP Instance) and not the identification of the component that encodes the SOP Instance (e.g., a commonly used DICOM encoding toolkit).

C.7.5.1.1.1 Date Of Last Calibration, Time Of Last Calibration

Date of Last Calibration (0018,1200) and Time of Last Calibration (0018,1201) are used to convey the date and time of calibration. The Attribute Date of Last Calibration (0018,1200) may be supported alone, however, Time of Last Calibration (0018,1201) Attribute has no meaning unless Attribute Date of Last Calibration (0018,1200) is also supported. The order for each Attribute shall be from the oldest date/time to the most recent date/time. When the Attributes are both supported they shall be provided as pairs.

C.7.5.1.1.2 Pixel Padding Value and Pixel Padding Range Limit

Pixel Padding Value (0028,0120) is used to pad grayscale images (those with a Photometric Interpretation of MONOCHROME1 or MONOCHROME2) to rectangular format. The native format of some images is not rectangular. It is common for devices with this format to pad the images to the rectangular format required by the DICOM Standard with a specific pixel value that is not contained in the native image. Further, when resampling, such as after spatial registration, padding may need to be used to fill previously non-existent pixels.

Pixel Padding Value (0028,0120) and Pixel Padding Range Limit (0028,0121) are also used to identify pixels to be excluded from the normal grayscale rendering pipeline for other reasons, such as suppression of background air. Pixel Padding Range Limit (0028,0121) is defined in the Image Pixel Module.

Notes: 1. The “native image” is that which is being padded to the required rectangular format, e.g., the area within the circular reconstruction perimeter of a CT image, or the subset of the rectangular area that contains useful image information.

2. The pixel padding value is explicitly described in order to prevent display applications from taking it into account when determining the dynamic range of an image, since the Pixel Padding Value will be outside the range between the minimum and maximum values of the pixels in the native image

3. No pixels in the native image will have a value equal to Pixel Padding Value.

Pixel Padding Value (0028,0120) specifies either a single value of this padding value, or when combined with Pixel Padding Range Limit (0028,0121), a range of values (inclusive) that are padding.

The values of Pixel Padding Value (0028,0120) and Pixel Padding Range Limit (0028,0121) shall be valid values within the constraints defined by Bits Allocated (0028,0100), Bits Stored (0028,0101), and High Bit (0028,0102).

Pixel Padding Value (0028,0120) and Pixel Padding Range Limit (0028,0121) shall not be present when padding is performed but the pixel value used for padding does occur in the native image.

If Photometric Interpretation (0028,0004) is MONOCHROME2, Pixel Padding Value (0028,0120) shall be less than (closer to or equal to the minimum possible pixel value) or equal to Pixel Padding Range Limit (0028,0121). If Photometric Interpretation (0028,0004) is MONOCHROME1, Pixel Padding Value (0028,0120) shall be greater than (closer to or equal to the maximum possible pixel value) or equal to Pixel Padding Range Limit (0028,0121).

Notes: 1. When the relationship between pixel value and X-Ray Intensity is unknown, it is recommended that the following values be used to pad with black when the image is unsigned: 0 if Photometric Interpretation (0028,0004) is MONOCHROME2. 2 BitsStored - 1 if Photometric Interpretation (0028,0004) is MONOCHROME1.

and when the image is signed:

-2 BitsStored-1 if Photometric Interpretation (0028,0004) is MONOCHROME2. 2 BitsStored-1 - 1 if Photometric Interpretation (0028,0004) is MONOCHROME1.

2. For projection radiography, when the relationship between pixel value and X-Ray Intensity is known (for example as defined by Pixel Intensity Relationship (0028,1040) and Pixel Intensity relationship Sign (0028,1041)), it is recommended that a pixel value equivalent to, or rendered similarly to, air (least X-Ray absorbance) be used for padding. However, if such a value may occur in the native image, the Pixel Padding Value (0028,0120) Attribute itself should not be sent.

E.g., for an XRF image obtained with an image intensifier, if air is black then a padded perimeter, if any, should also appear black. Typically though, if unpadded, this area would be collimated with a circular collimator, in which case the pixels would appear natively as white (greatest X-Ray absorbance) and a circular shutter would be necessary to neutralize them as black. Whether collimated areas are detected and treated as padded, or neutralized with shutters is at the discretion of the application. See also the Display Shutter Module C.7.6.11.

3. The conditional requirement for the Pixel Padding Value Range Limit (0028,0121) in the Image Pixel Module means that it shall not be present unless Pixel Padding Value (0028,0120) is also present.

4. The range of values to be suppressed between Pixel Padding Value (0028,0120) and Pixel Padding Value Range Limit (0028,0121) is specified as being inclusive, that is the values themselves as well as all values between are suppressed.

5. When Pixel Padding Value Range Limit (0028,0121) is present, but not supported by a rendering application, the constraint that Pixel Padding Value (0028,0120) is closest to the “blackest” value, which is typically the most frequently occurring background pixel, will most often result in an acceptable display, permitting “backward compatibility” in the majority of cases.

When modifying equipment changes the pixel padding value in the image, it shall change the values of Pixel Padding Value (0028,0120) and Pixel Padding Range Limit (0028,0121), if present. If modifying equipment changes the pixel padding values in the image to values present in the native image, the attribute Pixel Padding Value (0028,0120) and Pixel Padding Range Limit (0028,0121) shall be removed.

Notes: 1. For example, if a CT image containing signed values from -1024 to 3191 and a Pixel Padding Value of -2000 and a Rescale Intercept of 0 is converted to an unsigned image with a Rescale Intercept of -1024 by adding 1024 to all pixels and clipping all more negative pixels to 0, then the padding pixels will be indistinguishable from some of the modified native image pixels, and hence Pixel Padding Value (0028,0120) needs to be removed.

2. If the modification involves lossy compression, which may result in changes to the pixel values, then the application of Pixel Padding Value and Pixel Padding Range Limit may result in a different appearance, and hence these attributes may need different values also.

C.7.5.1.1.3 Software Versions

Software Versions (0018,1020) is a multi-valued attribute. For equipment that is composed of several components, it may be used to identify the name and version for each of those components. This may also include the identifier and version of libraries or configuration files that significantly affect the production of the SOP Instance.

C.7.5.2 Enhanced General Equipment Module

Table C.7-8b specifies the Attributes that identify and describe the piece of equipment that produced a Series of Composite Instances.

Notes: 1. This table contains a subset of the attributes of General Equipment Module (Table C.7-8) but the Type Designation is changed into Type 1. Including this module in an IOD overwrites the Type Designation of the General Equipment Module.

2. The attributes are intended to be a primary identification of the system that produces the data (e.g., modality or workstation application providing the content of the SOP Instance) and not the identification of the component that encodes the SOP Instance (e.g., a commonly used DICOM encoding toolkit).

Table C.7-8bENHANCED GENERAL EQUIPMENT MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Manufacturer (0008,0070) 1 Manufacturer of the equipment that produced the composite instances.
Manufacturer’s Model Name (0008,1090) 1 Manufacturer’s model name of the equipment that produced the composite instances.
Device Serial Number (0018,1000) 1 Manufacturer’s serial number of the equipment that produced the composite instances.
Software Versions (0018,1020) 1 Manufacturer’s designation of software version of the equipment that produced the composite instances. See Section C.7.5.1.1.3.

C.7.6 Common Image IE Modules

The following Image IE Modules are common to all Composite Image IODs that reference the Image IE.

C.7.6.1 General Image Module

Table C.7-9 specifies the Attributes that identify and describe an image within a particular series.

Table C.7-9GENERAL IMAGE MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Instance Number (0020,0013) 2 A number that identifies this image. Note: This Attribute was named Image Number in earlier versions of this Standard.
Patient Orientation (0020,0020) 2C Patient direction of the rows and columns of the image. Required if image does not require Image Orientation (Patient) (0020,0037) and Image Position (Patient) (0020,0032). May be present otherwise. See C.7.6.1.1.1 for further explanation. Note: IOD’s may have attributes other than Patient Orientation, Image Orientation, or Image Position (Patient) to describe orientation in which case this attribute will be zero length.
Content Date (0008,0023) 2C The date the image pixel data creation started. Required if image is part of a series in which the images are temporally related. May be present otherwise. Note: This Attribute was formerly known as Image Date.
Content Time (0008,0033) 2C The time the image pixel data creation started. Required if image is part of a series in which the images are temporally related. May be present otherwise.
Image Type (0008,0008) 3 Image identification characteristics. See C.7.6.1.1.2 for Defined Terms and further explanation.
Acquisition Number (0020,0012) 3 A number identifying the single continuous gathering of data over a period of time that resulted in this image.
Acquisition Date (0008,0022) 3 The date the acquisition of data that resulted in this image started
Acquisition Time (0008,0032) 3 The time the acquisition of data that resulted in this image started
Acquisition DateTime (0008,002A) 3 The date and time that the acquisition of data that resulted in this image started. Note: The synchronization of this time with an external clock is specified in the Synchronization Module in Acquisition Time Synchronized (0018,1800).
Referenced Image Sequence (0008,1140) 3 Other images significantly related to this image (e.g. post-localizer CT image or Mammographic biopsy or partial view images). One or more Items are permitted in this sequence.
>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 CID 7201.
Derivation Description (0008,2111) 3 A text description of how this image was derived. See C.7.6.1.1.3 for further explanation.
Derivation Code Sequence (0008,9215) 3 A coded description of how this image was derived. See C.7.6.1.1.3 for further explanation. One or more Items are permitted in this Sequence. More than one Item indicates that successive derivation steps have been applied.
>Include ‘Code Sequence Macro’ Table 8.8-1 Defined CID 7203.
Source Image Sequence (0008,2112) 3 The set of Image SOP Class/Instance pairs of the Images that were used to derive this Image. One or more Items are permitted in this Sequence. See C.7.6.1.1.4 for further explanation.
>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, that is what role the source image or frame(s) played in the derivation of this image. Only a single Item is permitted in this sequence.
>>Include ‘Code Sequence Macro’ Table 8.8-1 Defined CID 7202.
>Spatial Locations Preserved (0028,135A) 3 The extent to which the spatial locations of all pixels are preserved during the processing of the source image that resulted in the current image Enumerated Values: YES NO REORIENTED_ONLY - A projection radiograph that has been flipped, and/or rotated by a multiple of 90 degrees Notes: 1. This applies not only to images with a known relationship to a 3D space, but also to projection images. For example, a projection radiograph such as a mammogram that is processed by a point image processing operation such as contrast enhancement, or a smoothing or edge enhancing convolution, would have a value of YES for this attribute. A projection radiograph that had been magnified or warped geometrically would have a value of NO for this attribute. A projection radiograph that has been flipped, and/or rotated by a multiple of 90 degrees, such that transformation of pixel locations is possible by comparison of the values of Patient Orientation (0020,0020) would have a value of REORIENTED_ONLY. This attribute is typically of importance in relating images with Presentation Intent Type (0008,0068) values of FOR PROCESSING and FOR PRESENTATION. 2. When the value of this attribute is NO, it is not possible to locate on the current image any pixel coordinates that are referenced relative to the source image, such as for example, might be required for rendering CAD findings derived from a referenced FOR PROCESSING image on the current FOR PRESENTATION image.
>Patient Orientation (0020,0020) 1C The Patient Orientation values of the source image. Required if the value of Spatial Locations Preserved (0028,135A) is REORIENTED_ONLY.
Referenced Instance Sequence (0008,114A) 3 Non-image composite SOP Instances that are significantly related to this Image, including waveforms that may or may not be temporally synchronized with this image. One or more Items are permitted in this sequence.
>Include SOP Instance Reference Macro Table 10-11
>Purpose of Reference Code Sequence (0040,A170) 1 Code describing the purpose of the reference to the Instance(s). Only a single Item shall be included in this sequence.
>>Include 'Code Sequence Macro' Table 8.8-1 Defined CID 7004 for referenced waveforms.
Images in Acquisition (0020,1002) 3 Number of images that resulted from this acquisition of data
Image Comments (0020,4000) 3 User-defined comments about the image
Quality Control Image (0028,0300) 3 Indicates whether or not this image is a quality control or phantom image. Enumerated Values: YES NO If this Attribute is absent, then the image may or may not be a quality control or phantom image. The phantom device in the image can be described using the Device Module. See C.7.6.12
Burned In Annotation (0028,0301) 3 Indicates whether or not image contains sufficient burned in annotation to identify the patient and date the image was acquired. Enumerated Values: YES NO If this Attribute is absent, then the image may or may not contain burned in annotation.
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) 3 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) 3 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. Notes: 1. For example, a compression ratio of 30:1 would be described in this Attribute with a single value of 30. 2. For historical reasons, the lossy compression ratio may also be described in Derivation Description (0008,2111).
Lossy Image Compression Method (0028,2114) 3 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). Note: For historical reasons, the lossy compression method may also be described in Derivation Description (0008,2111).
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 C.7.6.1.1.6 for further explanation.
Presentation LUT Shape (2050,0020) 3 When present, specifies an identity transformation for the Presentation LUT such that the output of all grayscale transformations, if any, are defined to be in P-Values. Enumerated Values are: IDENTITY - output is in P-Values - shall be used if Photometric Interpretation (0028,0004) is MONOCHROME2 or any color photometric interpretation. INVERSE - output after inversion is in P-Values - shall be used if Photometric Interpretation (0028,0004) is MONOCHROME1. When this attribute is used with a color photometric interpretation then the luminance component is in P-Values.
Irradiation Event UID (0008,3010) 3 Unique identification of the irradiation event(s) associated with the acquisition of this image. See C.7.6.1.1.7.

Note: Previous editions of this Standard specified use of the Referenced Waveform Sequence (0008,113A), but that use has been superseded by Referenced Instance Sequence (0008,114A). See PS3.3-2004.

C.7.6.1.1 General Image Attribute Descriptions
C.7.6.1.1.1 Patient Orientation

The Patient Orientation (0020,0020) relative to the image plane shall be specified by two values that designate the anatomical direction of the positive row axis (left to right) and the positive column axis (top to bottom). The first entry is the direction of the rows, given by the direction of the last pixel in the first row from the first pixel in that row. The second entry is the direction of the columns, given by the direction of the last pixel in the first column from the first pixel in that column. Shall be consistent with Image Orientation (Patient) (0020,0037), if both Attributes are present and Patient Orientation (0020,0020) is not zero length.

If Anatomical Orientation Type (0010,2210) is absent or has a value of BIPED, anatomical direction shall be designated by abbreviations using the capital letters:

If Anatomical Orientation Type (0010,2210) has a value of QUADRUPED, anatomical direction shall be designated by the abbreviations using capital letters:

Notes: 1. These abbreviations are capitalized versions of those defined in Smallwood et al for describing radiographic projections. Because of the Code String (CS) Value Representation of the Patient Orientation (0020,0020), lowercase letters cannot be used.

2, It is unfortunate that the conventional veterinary abbreviations (e.g., R for rostral and Rt for right) differ from those chosen for humans for DICOM usage (e.g., R for right), but confusion with in the respective human and animal domains will be reduced. Hanging protocols may need to account for the difference by checking for the correct species.

3. Smallwood et al define an O (Oblique) abbreviation, which is useful for describing radiographic projections, but do not specify its use for directional terms, and hence it is not included here for describing the row and column directions.

4. The terms “anterior” and “posterior” are commonly used in vertebrate zoology to describe the cranial and caudal directions respectively, the veterinary terms are used in preference here, also in order to avoid confusion with the contradictory human use of anterior and posterior to mean ventral and dorsal.

5. For animals other than quadrupeds, for example, birds and fish, it is anticipated that the same nomenclature can be logically extended to describe, for example, wings and fins.

Each value of the orientation attribute shall contain at least one of these abbreviations. If refinements in the orientation descriptions are to be specified, then they shall be designated by one or two additional abbreviations in each value. Within each value, the abbreviations shall be ordered with the principal orientation designated in the first abbreviations.

Notes: 1. For bipeds, since each abbreviation is a single character, no delimiter is required within a single value and none is used. For quadrupeds, though lowercase letters cannot be used, delimiters are not necessary within a single value to eliminate ambiguity, since the abbreviations used are sufficiently distinct, and can be parsed from left to right with a single character of lookahead.

2. E.g., a medio-lateral oblique projection of the left breast of a human might be encoded with Patient Orientation values of “A\FR” rather than “A\F”, since the plane is obliquely inclined such that the colums are directed both downwards and medially, which for a left breast is towards the right, though the downwards direction is the principal column orientation.

3. E.g., a right dorsal-left ventral oblique view of a quadruped’s abdomen might be encoded with Patient Orientation values of “LTV\CD”, rather than “LT\CD”, since the plane is obliquely inclined such that the rows are directed both to the left and ventrally, though the left direction is the principal row orientation. The abbreviations “LTV”, “LT” and “CD”, correspond to the designations in Smallwood et al of “LtV”, “Lt” and “Cd”, respectively

C.7.6.1.1.2 Image Type

The Image Type (0008,0008) Attribute identifies important image identification characteristics. These characteristics are:

a. Pixel Data Characteristics

1. is the image an ORIGINAL Image; an image whose pixel values are based on original or source data

2. is the image a DERIVED Image; an image whose pixel values have been derived in some manner from the pixel value of one or more other images

b. Patient Examination Characteristics

1. is the image a PRIMARY Image; an image created as a direct result of the Patient examination

2. is the image a SECONDARY Image; an image created after the initial Patient examination

c. Modality Specific Characteristics

d. Implementation specific identifiers; other implementation specific identifiers shall be documented in an implementation's conformance statement.

The Image Type attribute is multi-valued and shall be provided in the following manner:

a. Value 1 shall identify the Pixel Data Characteristics; Enumerated Values for the Pixel Data Characteristics are:

ORIGINAL identifies an Original Image

DERIVED identifies a Derived Image

b. Value 2 shall identify the Patient Examination Characteristics; Enumerated Values for the Patient Examination Characteristics are:

PRIMARY identifies a Primary Image

SECONDARY identifies a Secondary Image

c. Value 3 shall identify any Image IOD specific specialization (optional)

d. Other Values which are implementation specific (optional)

Any of the optional values (value 3 and beyond) may be sent either with a value or zero-length, independent of other optional values, unless otherwise specified by a specialization of this attribute in an IOD.

If the pixel data of the derived Image is different from the pixel data of the source images and this difference is expected to affect professional interpretation of the image, the Derived Image shall have a UID different than all the source images.

C.7.6.1.1.3 Derivation Description

If an Image is identified to be a derived image (see C.7.6.1.1.2 Image Type), Derivation Description (0008,2111) and Derivation Code Sequence (0008,9215) describe the way in which the image was derived. They may be used whether or not the Source Image Sequence (0008,2112) is provided. They may also be used in cases when the Derived Image pixel data is not significantly changed from one of the source images and the SOP Instance UID of the Derived Image is the same as the one used for the source image.

Notes: 1. Examples of Derived Images that would normally be expected to affect professional interpretation and would thus have a new UID include:

a. images resulting from image processing of another image (e.g. unsharp masking),

b. a multiplanar reformatted CT image,

c. a DSA image derived by subtracting pixel values of one image from another.

d. an image that has been decompressed after having been compressed with a lossy compression algorithm. To ensure that the user has the necessary information about the lossy compression, the approximate compression ratio may be included in Derivation Description (0008,2111).

An example of a Derived Image that would normally not be expected to affect professional interpretation and thus would not require a new UID is an image that has been padded with additional rows and columns for more display purposes.

2. An image may be lossy compressed, e.g., for long term archive purposes, and its SOP Instance UID changed. PS3.4 provides a mechanism by which a query for the original image Instance may return a reference to the UID of the lossy compressed version of the image using the Alternate Representation Sequence (0008,3001). This allows an application processing a SOP Instance that references the original image UID, e.g., a Structured Report, to obtain a reference to an accessible version of the image even if the original SOP Instance is no longer available.

C.7.6.1.1.4 Source image sequence

If an Image is identified to be a Derived image (see C.7.6.1.1.2 Image Type), Source Image Sequence (0008,2112) is an optional list of Referenced SOP Class UID (0008,1150)/ Referenced SOP Instance UID (0008,1150) pairs that identify the source images used to create the Derived image. It may be used whether or not there is a description of the way the image was derived in Derivation Description (0008,2111) or Derivation Code Sequence (0008,9215).

Note: Multiple Items may be present within Source Image Sequence (0008,2112), in which case either:

a) those images were combined to make the derived image (e.g. multiple source images to make an MPR or MIP), or

b) each of the items represents a step in the successive derivation of an image (e.g. when an image has had successive lossy compression steps applied to it),

c) some combination of the above.

The Purpose of Reference Code Sequence (0040,A170) and the Attributes within the referenced images themselves may be used to determine the history of the derivation, which is not otherwise explicitly specified.

C.7.6.1.1.5 Lossy Image Compression

The Attribute Lossy Image Compression (0028,2110) conveys that the Image has undergone lossy compression. It provides a means to record that the Image has been compressed (at a point in its lifetime) with a lossy algorithm and changes have been introduced into the pixel data. Once the value has been set to “01”, it shall not be reset.

Note: If an image is compressed with a lossy algorithm, the attribute Lossy Image Compression (0028,2110) is set to “01”. Subsequently, if the image is decompressed and transferred in uncompressed format, this attribute value remains “01”.

The value of the Lossy Image Compression (0028,2110) Attribute in SOP Instances containing multiple frames in which one or more of the frames have undergone lossy compression shall be “01”.

Note: It is recommended that the applicable frames be noted in the Attribute Derivation Description (0008,2111).

If an image is originally obtained as a lossy compressed image from the sensor, then Lossy Image Compression (0028,2110) is set to “01” and Value 1 of the Attribute Image Type (0008,0008) shall be set to ORIGINAL.

If an image is a compressed version of another image, Lossy Image Compression (0028,2110) is set to “01”, Value 1 of the Attribute Image Type (0008,0008) shall be set to DERIVED, and if the predecessor was a DICOM image, then the Image shall receive a new SOP Instance UID.

Note: 1. It is recommended that the approximate compression ratio be provided in the Attribute Derivation Description (0008,2111). Furthermore, it is recommended that Derivation Description (0008,2111) be used to indicate when pixel data changes might affect professional interpretation. (see C.7.6.1.1.3).

2. The attribute Lossy Image Compression (0028,2110) is defined as Type 3 for backward compatibility with existing IODs. It is expected to be required (i.e., defined as Type 1C) for new Image IODs and for existing IODs that undergo a major revision (e.g. a new IOD is specified).

The Defined Terms for Lossy Image Compression Method (0028,2114) are:

ISO_10918_1 = JPEG Lossy Compression

ISO_14495_1 = JPEG-LS Near-lossless Compression

ISO_15444_1 = JPEG 2000 Irreversible Compression

ISO_13818_2 = MPEG2 Compression

C.7.6.1.1.6 Icon Image Sequence

An Icon Image may be used as a key representative of an Image. It is defined as a Sequence that contains a single Item encapsulating the Data Set made of the Data Elements of the Icon Image. The Data Elements are defined by the Image Pixel Macro (see Section C.7.6.3). The restrictions defined in Section F.7 shall apply.

C.7.6.1.1.7 Irradiation Event UID

An irradiation event is the occurrence of radiation being applied to a patient in single continuous time-frame between the start (release) and the stop (cease) of the irradiation. Any on-off switching of the irradiation source during the event shall not be treated as separate events, rather the event includes the time between start and stop of irradiation as triggered by the user. E.g., a pulsed fluoro X-Ray acquisition shall be treated as a single irradiation event.

C.7.6.2 Image Plane Module

Table C.7-10 specifies the Attributes that define the transmitted pixel array of a two dimensional image plane.

Note: In previous versions of this Standard, image position and image orientation were specified relative to a specific equipment coordinate system. This equipment coordinate system was not fully defined and a number of ambiguities existed. The equipment based coordinate system has been retired and replaced by the patient based coordinate system defined in this Module.

Table C.7-10IMAGE PLANE MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Pixel Spacing (0028,0030) 1 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.
Image Orientation (Patient) (0020,0037) 1 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) 1 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.
Slice Thickness (0018,0050) 2 Nominal slice thickness, in mm.
Slice Location (0020,1041) 3 Relative position of the image plane expressed in mm. C.7.6.2.1.2 for further explanation.

C.7.6.2.1 Image Plane Attribute Descriptions
C.7.6.2.1.1 Image Position And Image Orientation

The Image Position (0020,0032) specifies the x, y, and z coordinates of the upper left hand corner of the image; it is the center of the first voxel transmitted. Image Orientation (0020,0037) specifies the direction cosines of the first row and the first column with respect to the patient. These Attributes shall be provide as a pair. Row value for the x, y, and z axes respectively followed by the Column value for the x, y, and z axes respectively.

The direction of the axes is defined fully by the patient’s orientation.

If Anatomical Orientation Type (0010,2210) is absent or has a value of BIPED, 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.

If Anatomical Orientation Type (0010,2210) has a value of QUADRUPED, the

Notes: 1. The axes for quadrupeds are those defined and illustrated in Smallwood et al for proper anatomic directional terms as they apply to various parts of the body.

2. It should be anticipated that when quadrupeds are imaged on human equipment, and particularly when they are position in a manner different from the traditional human prone and supine head or feet first longitudinal position, then the equipment may well not indicate the correct orientation, though it will remain an orthogonal Cartesian right-handed system that could be corrected subsequently.

The patient based coordinate system is a right handed system, i.e. the vector cross product of a unit vector along the positive x-axis and a unit vector along the positive y-axis is equal to a unit vector along the positive z-axis.

Note: If a patient is positioned parallel to the ground, in dorsal recumbency (i.e., for humans, face-up on the table), with the caudo-cranial (i.e., for humans, feet-to-head) direction the same as the front-to-back direction of the imaging equipment, the direction of the axes of this patient based coordinate system and the equipment based coordinate system in previous versions of this Standard will coincide.

The Image Plane Attributes, in conjunction with the Pixel Spacing Attribute, describe the position and orientation of the image slices relative to the patient-based coordinate system. In each image frame the Image Position (Patient) (0020,0032) specifies the origin of the image with respect to the patient-based coordinate system. RCS and the Image Orientation (Patient) (0020,0037) attribute values specify the orientation of the image frame rows and columns. The mapping of pixel location [pic] to the RCS is calculated as follows:

[pic] = M [pic]

Where:

P xyz The coordinates of the voxel (i,j) in the frame’s image plane in units of mm.

S xyz The three values of the Image Position (Patient) (0020,0032) attributes. It is the location in mm from the origin of the RCS.

X xyz The values from the row (X) direction cosine of the Image Orientation (Patient) (0020,0037) attribute.

Y xyz The values from the column (Y) direction cosine of the Image Orientation (Patient) (0020,0037) attribute.

i Column index to the image plane. The first column is index zero.

(i Column pixel resolution of the Pixel Spacing (0028,0030) attribute in units of mm.

j Row index to the image plane. The first row index is zero.

(j Row pixel resolution of the Pixel Spacing (0028,0030) attribute in units of mm.

Additional constraints apply:

1) The row and column direction cosine vectors shall be orthogonal, i.e. their dot product shall be zero.

2) The row and column direction cosine vectors shall be normal, i.e. the dot product of each direction cosine vector with itself shall be unity.

C.7.6.2.1.2 Slice Location

The Slice Location (0020,1041) is defined as the relative position of the image plane expressed in mm. This information is relative to an unspecified implementation specific reference point.

C.7.6.3 Image Pixel Module

Table C.7-11a describes the Image Pixel Module.

Table C.7-11aIMAGE PIXEL MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Include ‘Image Pixel Macro’ Table C.7-11b
Pixel Data Provider URL (0028,7FE0) 1C A URL of a provider service that supplies the pixel data of the Image. Required if the image is to be transferred in one of the following presentation contexts identified by Transfer Syntax UID: 1.2.840.10008.1.2.4.94 (DICOM JPIP Referenced Transfer Syntax) 1.2.840.10008.1.2.4.95 (DICOM JPIP Referenced Deflate Transfer Syntax)
Pixel Padding Range Limit (0028,0121) 1C Pixel value that represents one limit (inclusive) of a range of padding values used together with Pixel Padding Value (0028,0120) as defined in the General Equipment Module. See C.7.5.1.1.2 for further explanation. Required if pixel padding is to be defined as a range rather than a single value. Notes: 1. The Value Representation of this Attribute is determined by the value of Pixel Representation (0028,0103). 2. Pixel Padding Value (0028,0120) is also required when this Attribute is present.

Table C.7-11b specifies the common attributes that describe the pixel data of the image.

Table C.7-11b IMAGE PIXEL MACRO ATTRIBUTES

Attribute Name Tag Type Attribute Description
Samples per Pixel (0028,0002) 1 Number of samples (planes) in this image. See C.7.6.3.1.1 for further explanation.
Photometric Interpretation (0028,0004) 1 Specifies the intended interpretation of the pixel data. See C.7.6.3.1.2 for further explanation.
Rows (0028,0010) 1 Number of rows in the image.
Columns (0028,0011) 1 Number of columns in the image
Bits Allocated (0028,0100) 1 Number of bits allocated for each pixel sample. Each sample shall have the same number of bits allocated. 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 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 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. Enumerated Values: 0000H = unsigned integer. 0001H = 2's complement
Pixel Data (7FE0,0010) 1C A data stream of the pixel samples that comprise the Image. See C.7.6.3.1.4 for further explanation. Required if Pixel Data Provider URL (0028,7FE0) is not present.
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 for further explanation.
Pixel Aspect Ratio (0028,0034) 1C Ratio of the vertical size and horizontal size of the pixels in the image specified by a pair of integer values where the first value is the vertical pixel size, and the second value is the horizontal pixel size. Required if the aspect ratio values do not have a ratio of 1:1 and the physical pixel spacing is not specified by Pixel Spacing (0028,0030), or Imager Pixel Spacing (0018,1164) or Nominal Scanned Pixel Spacing (0018,2010), either for the entire Image or per-frame in a Functional Group Macro. See C.7.6.3.1.7.
Smallest Image Pixel Value (0028,0106) 3 The minimum actual pixel value encountered in this image.
Largest Image Pixel Value (0028,0107) 3 The maximum actual pixel value encountered in this image.
Red Palette Color Lookup Table Descriptor (0028,1101) 1C Specifies the format of the Red Palette Color Lookup Table Data (0028,1201) Required if Photometric Interpretation (0028,0004) has a value of PALETTE COLOR or Pixel Presentation (0008,9205) at the image level equals COLOR or MIXED. See C.7.6.3.1.5 for further explanation.
Green Palette Color Lookup Table Descriptor (0028,1102) 1C Specifies the format of the Green Palette Color Lookup Table Data (0028,1202) Required if Photometric Interpretation (0028,0004) has a value of PALETTE COLOR or Pixel Presentation (0008,9205) at the image level equals COLOR or MIXED. See C.7.6.3.1.5 for further explanation.
Blue Palette Color Lookup Table Descriptor (0028,1103) 1C Specifies the format of the Blue Palette Color Lookup Table Data (0028,1203) Required if Photometric Interpretation (0028,0004) has a value of PALETTE COLOR or Pixel Presentation (0008,9205) at the image level equals COLOR or MIXED. See C.7.6.3.1.5 for further explanation.
Red Palette Color Lookup Table Data (0028,1201) 1C Red Palette Color Lookup Table Data. Required if Photometric Interpretation (0028,0004) has a value of PALETTE COLOR or Pixel Presentation (0008,9205) at the image level equals COLOR or MIXED. See C.7.6.3.1.6 for further explanation.
Green Palette Color Lookup Table Data (0028,1202) 1C Green Palette Color Lookup Table Data. Required if Photometric Interpretation (0028,0004) has a value of PALETTE COLOR or Pixel Presentation (0008,9205) at the image level equals COLOR or MIXED. See C.7.6.3.1.6 for further explanation.
Blue Palette Color Lookup Table Data (0028,1203) 1C Blue Palette Color Lookup Table Data. Required if Photometric Interpretation (0028,0004) has a value of PALETTE COLOR or Pixel Presentation (0008,9205) at the image level equals COLOR or MIXED. See C.7.6.3.1.6 for further explanation.
ICC Profile (0028,2000) 3 An ICC Profile encoding the transformation of device-dependent color stored pixel values into PCS-Values. See Section C.11.15.1.1. When present, defines the color space of color Pixel Data (7FE0,0010) values, and the output of Palette Color Lookup Table Data (0028,1201-1203). Note: The profile applies only to the Pixel Data (7FE0,0010) attribute at the same level of the dataset and not to any icons nested within sequences, which may or may not have their own ICC profile specified.

C.7.6.3.1 Image Pixel Attribute Descriptions
C.7.6.3.1.1 Samples Per Pixel

Samples per Pixel (0028,0002) is the number of separate planes in this image. One and three image planes are defined. Other numbers of image planes are allowed, but their meaning is not defined by this Standard.

For monochrome (gray scale) and palette color images, the number of planes is 1. For RGB and other three vector color models, the value of this attribute is 3.

Note: The use of a value of 4 was previously described, but the Photometric Interpretations that used it have been retired.

All image planes shall have the same number of Rows (0028,0010), Columns (0028,0011), Bits Allocated (0028,0100), Bits Stored (0028,0101), High Bit (0028,0102), Pixel Representation (0028,0103), and Pixel Aspect Ratio (0028,0034).

The data in each pixel may be represented as a “Composite Pixel Code”. If Samples Per Pixel is one, the Composite Pixel Code is just the “n” bit pixel sample, where “n” = Bits Allocated. If Samples Per Pixel is greater than one, Composite Pixel Code is a “k” bit concatenation of samples, where “k” = Bits Allocated multiplied by Samples Per Pixel, and with the sample representing the vector color designated first in the Photometric Interpretation name comprising the most significant bits of the Composite Pixel Code, followed in order by the samples representing the next vector colors, with the sample representing the vector color designated last in the Photometric Interpretation name comprising the least significant bits of the Composite Pixel Code. For example, for Photometric Interpretation = “RGB”, the most significant “Bits Allocated” bits contain the Red sample, the next “Bits Allocated” bits contain the Green sample, and the least significant “Bits Allocated” bits contain the Blue sample.

C.7.6.3.1.2 Photometric Interpretation

The value of Photometric Interpretation (0028,0004) specifies the intended interpretation of the image pixel data.

See PS 3.5 for restrictions imposed by compressed Transfer Syntaxes.

The following values are defined. Other values are permitted but the meaning is not defined by this Standard.

MONOCHROME1 = Pixel data represent a single monochrome image plane. The minimum sample value is intended to be displayed as white after any VOI gray scale transformations have been performed. See PS 3.4. This value may be used only when Samples per Pixel (0028,0002) has a value of 1.

MONOCHROME2 = Pixel data represent a single monochrome image plane. The minimum sample value is intended to be displayed as black after any VOI gray scale transformations have been performed. See PS 3.4. This value may be used only when Samples per Pixel (0028,0002) has a value of 1.

PALETTE COLOR = Pixel data describe a color image with a single sample per pixel (single image plane). The pixel value is used as an index into each of the Red, Blue, and Green Palette Color Lookup Tables (0028,1101-1103&1201-1203). This value may be used only when Samples per Pixel (0028,0002) has a value of 1. When the Photometric Interpretation is Palette Color; Red, Blue, and Green Palette Color Lookup Tables shall be present.

RGB = Pixel data represent a color image described by red, green, and blue image planes. The minimum sample value for each color plane represents minimum intensity of the color. This value may be used only when Samples per Pixel (0028,0002) has a value of 3.

HSV = Retired.

ARGB = Retired.

CMYK = Retired.

YBR_FULL = Pixel data represent a color image described by one luminance (Y) and two chrominance planes (CB and CR). This photometric interpretation may be used only when Samples per Pixel (0028,0002) has a value of 3. Black is represented by Y equal to zero. The absence of color is represented by both CB and CR values equal to half full scale.

Note: In the case where the Bits Allocated (0028,0100) has value of 8 half full scale is 128.

In the case where Bits Allocated (0028,0100) has a value of 8 then the following equations convert between RGB and YCBCR Photometric Interpretation.

Y = + .2990R + .5870G + .1140B

CB = - .1687R - .3313G + .5000B + 128

CR = + .5000R - .4187G - .0813B + 128

Note: The above is based on CCIR Recommendation 601-2 dated 1990.

YBR_FULL_422 = The same as YBR_FULL except that the CB and CR values are sampled horizontally at half the Y rate and as a result there are half as many CB and CR values as Y values.

This Photometric Interpretation is only allowed with Planar Configuration (0028,0006) equal to 0. Two Y values shall be stored followed by one CB and one CR value. The CB and CR values shall be sampled at the location of the first of the two Y values. For each Row of Pixels, the first CB and CR samples shall be at the location of the first Y sample. The next CB and CR samples shall be at the location of the third Y sample etc.

Note: This subsampling is often referred to as cosited sampling.

YBR_PARTIAL_422 = The same as YBR_FULL_422 except that:

1. black corresponds to Y = 16;

2. Y is restricted to 220 levels (i.e. the maximum value is 235);

3. CB and CR each has a minimum value of 16;

4. CB and CR are restricted to 225 levels (i.e. the maximum value is 240);

5. lack of color is represented by CB and CR equal to 128.

In the case where Bits Allocated (0028,0100) has value of 8 then the following equations convert between RGB and YBR_PARTIAL_422 Photometric Interpretation

Y = + .2568R + .5041G + .0979B + 16

CB = - .1482R - .2910G + .4392B + 128

CR = + .4392R - .3678G - .0714B + 128

Note: The above is based on CCIR Recommendation 601-2 dated 1990.

YBR_PARTIAL_420 = The same as YBR_PARTIAL_422 except that the CB and CR values are sampled horizontally and vertically at half the Y rate and as a result there are four times less CB and CR values than Y values, versus twice less for YBR_PARTIAL_422.

This Photometric Interpretation is only allowed with Planar Configuration (0028,0006) equal to 0. The CB and CR values shall be sampled at the location of the first of the two Y values. For the first Row of Pixels (etc.), the first CB and CR samples shall be at the location of the first Y sample. The next CB and CR samples shall be at the location of the third Y sample etc. The next Rows of Pixels containing CB and CR samples (at the same locations than for the first Row) will be the third etc.

YBR_ICT = Irreversible Color Transformation:

Pixel data represent a color image described by one luminance (Y) and two chrominance planes (CB and CR). This photometric interpretation may be used only when Samples per Pixel (0028,0002) has a value of 3. Black is represented by Y equal to zero. The absence of color is represented by both CB and CR values equal to zero.

Regardless of the value of Bits Allocated (0028,0100), the following equations convert between RGB and YCBCR Photometric Interpretation.

Y = + .29900R + .58700G + .11400B

CB = - .16875R - .33126G + .50000B

CR = + .50000R - .41869G - .08131B

Notes: 1. The above is based on ISO/IEC 15444-1 (JPEG 2000).

2. In a JPEG 2000 bitstream, DC level shifting (used if the untransformed components are unsigned) is applied before forward color transformation, and the transformed components may be signed (unlike in JPEG ISO/IEC 10918-1).

3. In JPEG 2000, spatial down-sampling of the chrominance components, if performed, is signaled in the JPEG 2000 bitstream.

YBR_RCT = Reversible Color Transformation:

Pixel data represent a color image described by one luminance (Y) and two chrominance planes (CB and CR). This photometric interpretation may be used only when Samples per Pixel (0028,0002) has a value of 3. Black is represented by Y equal to zero. The absence of color is represented by both CB and CR values equal to zero.

Regardless of the value of Bits Allocated (0028,0100), the following equations convert between RGB and YBR_RCT Photometric Interpretation.

Y = ⎣(R + 2G +B) / 4⎦ (Note: ⎣...⎦ mean floor)

CB = B - G

CR = R - G

The following equations convert between YBR_RCT and RGB Photometric Interpretation.

G = Y - ⎣ (CR + CB) / 4⎦

R = CR + G

B = CB + G

Notes: 1. The above is based on ISO/IEC 15444-1 (JPEG 2000).

2. In a JPEG 2000 bitstream, DC level shifting (used if the untransformed components are unsigned) is applied before forward color transformation, and the transformed components may be signed (unlike in JPEG ISO/IEC 10918-1).

3. This photometric interpretation is a reversible approximation to the YUV transformation used in PAL and SECAM.

C.7.6.3.1.3 Planar Configuration

Planar Configuration (0028,0006) indicates whether the color pixel data are sent color-by-plane or color-by-pixel. This Attribute shall be present if Samples per Pixel (0028,0002) has a value greater than 1. It shall not be present otherwise.

Enumerated Values:

0 = The sample values for the first pixel are followed by the sample values for the second pixel, etc. For RGB images, this means the order of the pixel values sent shall be R1, G1, B1, R2, G2, B2, ..., etc.

1 = Each color plane shall be sent contiguously. For RGB images, this means the order of the pixel values sent is R1, R2, R3, ..., G1, G2, G3, ..., B1, B2, B3, etc.

Note: Planar Configuration (0028,0006) is not meaningful when a compression transfer syntax is used that involves reorganization of sample components in the compressed bit stream. In such cases, since the Attribute is required to be sent, then an appropriate value to use may be specified in the description of the Transfer Syntax in PS 3.5, though in all likelihood the value of the Attribute will be ignored by the receiving implementation.

C.7.6.3.1.4 Pixel Data

Pixel Data (7FE0,0010) for this image. The order of pixels sent for each image plane is left to right, top to bottom, i.e., the upper left pixel (labeled 1,1) is sent first followed by the remainder of row 1, followed by the first pixel of row 2 (labeled 2,1) then the remainder of row 2 and so on.

For multi-plane images see Planar Configuration (0028,0006) in this Section.

C.7.6.3.1.5 Palette Color Lookup Table Descriptor

The four values of Palette Color Lookup Table Descriptor (0028,1101-1104) describe the format of the Lookup Table Data in the corresponding Data Element (0028,1201-1204) or (0028,1221-1223). In this section, the term “input value” is either the Palette Color Lookup Table input value described in the Enhanced Palette Color Lookup Table Sequence (0028,140B) or if that attribute is absent, the stored pixel value.

The first value is the number of entries in the lookup table. When the number of table entries is equal to 216 then this value shall be 0. The first value shall be identical for each of the Red, Green, Blue and Alpha Palette Color Lookup Table Descriptors.

The second value is the first input value mapped. This input value is mapped to the first entry in the Lookup Table Data. All input values less than the first value mapped are also mapped to the first entry in the Lookup Table Data if the Photometric Interpretation is PALETTE COLOR.

Note: In the case of the Supplemental Palette Color LUT, the stored pixel values less than the second descriptor value are grayscale values.

An input value one greater than the first value mapped is mapped to the second entry in the Lookup Table Data. Subsequent input values are mapped to the subsequent entries in the Lookup Table Data up to an input value equal to number of entries + first value mapped - 1, which is mapped to the last entry in the Lookup Table Data. Input values greater than or equal to number of entries + first value mapped are also mapped to the last entry in the Lookup Table Data. The second value shall be identical for each of the Red, Green, Blue and Alpha Palette Color Lookup Table Descriptors.

The third value specifies the number of bits for each entry in the Lookup Table Data. It shall take the value of 8 or 16. The LUT Data shall be stored in a format equivalent to 8 bits allocated when the number of bits for each entry is 8, and 16 bits allocated when the number of bits for each entry is 16, where in both cases the high bit is equal to bits allocated-1. The third value shall be identical for each of the Red, Green and Blue Palette Color Lookup Table Descriptors.

Note: Some implementations have encoded 8 bit entries with 16 bits allocated, padding the high bits; this can be detected by comparing the number of entries specified in the LUT Descriptor with the actual value length of the LUT Data entry. The value length in bytes should equal the number of entries if bits allocated is 8, and be twice as long if bits allocated is 16.

When the Red, Green, or Blue Palette Color Lookup Table Descriptor (0028,1101-1103) are used as part of the Palette Color Lookup Table Module or the Supplemental Palette Color Lookup Table Module in an Image or Presentation State IOD, the third value shall be equal to 16. When the Alpha Palette Color Lookup Table Descriptor (0028,1104) is used, the third value shall be equal to 8.

When the Red, Green, or Blue Palette Color Lookup Table Descriptor (0028,1101-1103) are used as part of the Palette Color Lookup Table Module in a Color Palette IOD, the 3rd value of Palette Color Lookup Table Descriptor (0028,1101-1103) (i.e, the number of bits for each entry in the Lookup Table Data) shall be 8.

Notes: 1. A value of 16 indicates the Lookup Table Data will range from (0,0,0) minimum intensity to (65535,65535,65535) maximum intensity.

2. Since the Palette Color Lookup Table Descriptor (0028,1101-1104) Attributes are multi-valued, in an Explicit VR Transfer Syntax, only one value representation (US or SS) may be specified, even though the first and third values are always by definition interpreted as unsigned. The explicit VR actually used is dictated by the VR needed to represent the second value, which will be consistent with Pixel Representation (0028,0103).

C.7.6.3.1.6 Palette Color Lookup Table Data

Palette Color Lookup Table Data (0028,1201-1204) contain the lookup table data corresponding to the Lookup Table Descriptor (0028,1101-1104).

Palette color values must always be scaled across the full range of available intensities. This is indicated by the fact that there are no bits stored and high bit values for palette color data.

Note: For example, if there are 16 bits per entry specified and only 8 bits of value are truly used then the 8 bit intensities from 0 to 255 must be scaled to the corresponding 16 bit intensities from 0 to 65535. To do this for 8 bit values, simply replicate the value in both the most and least significant bytes.

These lookup tables shall be used only when there is a single sample per pixel (single image plane) in the image.

C.7.6.3.1.7 Pixel Aspect Ratio

The pixel aspect ratio is the ratio of the vertical size and horizontal size of the pixels in the image specified by a pair of integer values where the first value is the vertical pixel size, and the second value is the horizontal pixel size. To illustrate, consider the following example pixel size:

[pic]

Pixel Aspect Ratio = Vertical Size \ Horizontal Size = 0.30 mm \0.25 mm. Thus the Pixel Aspect Ratio could be represented as the multivalued integer string "6\5", "60\50", or any equivalent integer ratio.

C.7.6.4 Contrast/Bolus Module

Table C.7-12 specifies the Attributes that describe the contrast /bolus used in the acquisition of the Image.

Table C.7-12CONTRAST/BOLUS MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Contrast/Bolus Agent (0018,0010) 2 Contrast or bolus agent
Contrast/Bolus Agent Sequence (0018,0012) 3 Sequence that identifies the contrast agent. One or more Items are permitted in this sequence.
>Include ‘Code Sequence Macro’ Table 8.8-1 Baseline CID 12.
Contrast/Bolus Route (0018,1040) 3 Administration route of contrast agent
Contrast/Bolus Administration Route Sequence (0018,0014) 3 Sequence that identifies the route of administration of contrast agent. Only a single Item is permitted in this sequence.
>Include ‘Code Sequence Macro’ Table 8.8-1 Baseline CID 11.
>Additional Drug Sequence (0018,002A) 3 Sequence that identifies any additional drug that is administered with the contrast agent bolus. One or more Items are permitted in this sequence.
>>Include ‘Code Sequence Macro’ Table 8.8-1 No Baseline Context ID is defined.
Contrast/Bolus Volume (0018,1041) 3 Volume injected in milliliters of diluted contrast agent
Contrast/Bolus Start Time (0018,1042) 3 Time of start of injection
Contrast/Bolus Stop Time (0018,1043) 3 Time of end of contrast injection
Contrast/Bolus Total Dose (0018,1044) 3 Total amount in milliliters of the undiluted contrast agent
Contrast Flow Rate (0018,1046) 3 Rate(s) of injection(s) in milliliters/sec
Contrast Flow Duration (0018,1047) 3 Duration(s) of injection(s) in seconds. Each Contrast Flow Duration value shall correspond to a value of Contrast Flow Rate (0018,1046).
Contrast/Bolus Ingredient (0018,1048) 3 Active ingredient of agent. Defined Terms: IODINE GADOLINIUM CARBON DIOXIDE BARIUM
Contrast/Bolus Ingredient Concentration (0018,1049) 3 Milligrams of active ingredient per milliliter of (diluted) agent

Note: 1. Flow duration is an alternate method of specifying stop time

2. Flow rate allows for stepped injections by being capable of multiple values (1,N) instances.

3. For a 100 ml injection of 76% Diatrizoate and meglumine/sodium, diluted 1:1,

the Contrast/Bolus Agent would be “76% Diatrizoate” as text

the Contrast/Bolus Volume would be 100 ml,

the Contrast/Bolus Total Dose would be 50 ml,

the Contrast/Bolus Ingredient would be “IODINE”,

the Contrast/Bolus Ingredient Concentration would be 370mg/ml.

C.7.6.4b Enhanced Contrast/Bolus Module

Table C.7-12b specifies the Attributes that describe the contrast/bolus used in the acquisition of the Image.

Table C.7-12bENHANCED CONTRAST/BOLUS MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Contrast/Bolus Agent Sequence (0018,0012) 1 Sequence that identifies one or more contrast agents administered prior to or during the acquisition. One or more Items shall be included in this sequence.
>Include ‘Code Sequence Macro’ Table 8.8-1 Baseline CID 12.
>Contrast/Bolus Agent Number (0018,9337) 1 Identifying number, unique within this SOP Instance, of the agent administered. Used to reference this particular agent from the Contrast/Bolus Functional Group Macro. The number shall be 1 for the first Item and increase by 1 for each subsequent Item.
>Contrast/Bolus Administration Route Sequence (0018,0014) 1 Sequence that identifies the route of administration of contrast agent. Only a single Item shall be included in this sequence.
>>Include ‘Code Sequence Macro’ Table 8.8-1 Baseline CID 11.
>Contrast/Bolus Ingredient Code Sequence (0018,9338) 2 Active ingredient of agent. Zero or more Items shall be included in this sequence.
>>Include ‘Code Sequence Macro’ Table 8.8-1 Baseline CID 13.
>Contrast/Bolus Volume (0018,1041) 2 Total volume administered in milliliters of diluted contrast agent.
>Contrast/Bolus Ingredient Concentration (0018,1049) 2 Milligrams of active ingredient per milliliter of agent.
>Contrast/Bolus Ingredient Percent by Volume (0052,0001) 3 Percentage by volume of active ingredient in the total volume.
>Contrast/Bolus Ingredient Opaque (0018,9425) 3 Absorption of the ingredient greater than the absorption of water (tissue). Enumerated Values: YES NO See Section C.7.6.4b.1.
>Contrast Administration Profile Sequence (0018,9340) 3 Sequence that describes one or more phases of contrast administered. One or more Items are permitted in this sequence.
>>Contrast/Bolus Volume (0018,1041) 2 Volume administered during this phase in milliliters of diluted contrast agent.
>>Contrast/Bolus Start Time (0018,1042) 3 Time of start of administration.
>>Contrast/Bolus Stop Time (0018,1043) 3 Time of end of administration.
>>Contrast Flow Rate (0018,1046) 3 Rate of administration in milliliters/sec. Only a single value shall be present.
>>Contrast Flow Duration (0018,1047) 3 Duration of injection in seconds. Only a single value shall be present.

C.7.6.4b.1 Enhanced Contrast/Bolus Module Attributes
C.7.6.4b.1.1 Contrast/Bolus Ingredient Opaque for X-Ray equipment

Contrast/Bolus Ingredient Opaque (0018,9425) attribute specifies the type of relative X-Ray absorption of the contrast/bolus ingredient, compared to the X-Ray absorption of water. The the meaning for the Enumerated Values are:

YES The contrast/bolus ingredient absorbs more X-Ray photons than water;

NO The contrast/bolus ingredient absorbs less X-Ray photons than water;

Note: The Contrast/Bolus Ingredient Opaque (0018,9425) attribute determines the sign of the gradient of X-Ray beam intensity from inside to outside the injected vessel, thus allowing optimal settings of the image processing applications (e.g. vessel edge detection, etc.), see Figure C.7.6.4b-1.

The relative gray level of the injected vessel with respect to the gray level of the water of Pixel Data (7FE0,0010) is determined by the Contrast/Bolus Ingredient Opaque (0018,9425) and by the Pixel Intensity Relationship Sign (0028,1041). For example, if the contrast/bolus ingredient is more radio graphically dense than water (i.e. YES), and the Pixel Intensity Relationship Sign (0028,1041) is -1, then the contrast/bolus ingredient is represented by higher values of Pixel Data than water.

[pic]

Figure C.7.6.4b-1X-Ray beam intensity vs. Contrast/Bolus Ingredient Opaque

C.7.6.5 Cine Module

Table C.7-13 specifies the Attributes of a Multi-frame Cine Image.

Table C.7-13CINE MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Preferred Playback Sequencing (0018,1244) 3 Describes the preferred playback sequencing for a multi-frame image. Enumerated Values: 0 = Looping (1,2...n,1,2,...n,1,2,....n,...) 1 = Sweeping (1,2,...n,n-1,...2,1,2,...n,...)
Frame Time (0018,1063) 1C Nominal time (in msec) per individual frame. See C.7.6.5.1.1 for further explanation. Required if Frame Increment Pointer (0028,0009) points to Frame Time.
Frame Time Vector (0018,1065) 1C An array that 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. 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.
Start Trim (0008,2142) 3 The frame number of the first frame of the Multi-frame image to be displayed.
Stop Trim (0008,2143) 3 The Frame Number of the last frame of a Multi-frame image to be displayed.
Recommended Display Frame Rate (0008,2144) 3 Recommended rate at which the frames of a Multi-frame image should be displayed in frames/second.
Cine Rate (0018,0040) 3 Number of frames per second.
Frame Delay (0018,1066) 3 Time (in msec) from Content Time (0008,0033) to the start of the first frame in a Multi-frame image.
Image Trigger Delay (0018,1067) 3 Delay time in milliseconds from trigger (e.g., X-Ray on pulse) to the first frame of a Multi-frame image.
Effective Duration (0018,0072) 3 Total time in seconds that data was actually taken for the entire Multi-frame image.
Actual Frame Duration (0018,1242) 3 Elapsed time of data acquisition in msec per each frame.
Multiplexed Audio Channels Description Code Sequence (003A,0300) 2C Description of any multiplexed audio channels. See Section C.7.6.5.1.3. Zero or more items may be included in this sequence. Required if the Transfer Syntax used to encode the multi-frame image contains multiplexed (interleaved) audio channels, such as is possible with MPEG2.
>Channel Identification Code (003A,0301) 1 A reference to the audio channel as identified within Transfer Syntax encoded bit stream (1 for the main channel, 2 for the second channel and 3 to 9 to the complementary channels).
>Channel Mode (003A,0302) 1 A coded descriptor qualifying the mode of the channel: Enumerated Values: MONO = 1 signal STEREO = 2 simultaneously acquired (left and right) signals
>Channel Source Sequence (003A,0208) 1 A coded descriptor of the audio channel source. Only a single Item shall be included in this sequence.
>>Include 'Code Sequence Macro' Table 8.8-1. Defined Context ID Audio Channel Source 3000.

C.7.6.5.1 Cine Attribute Descriptions
C.7.6.5.1.1 Frame Time

Frame Time (0018,1063) is the nominal time (in milliseconds) between individual frames of a Multi-frame image. If the Frame Increment Pointer points to this Attribute, Frame Time shall be used in the following manner to calculate 'the relative time' for each frame:

Frame 'Relative Time' (n) = Frame Delay + Frame Time * (n-1)

where: n = number of frame within the Multi-frame image and the first frame number is one

Note: When there is only one frame present, Frame Time (0018,1063) may have either a value of 0, or a nominal value that would apply if there were multiple frames.

C.7.6.5.1.2 Frame Time Vector

Frame Time Vector (0018,1065) is an array that contains the time increments (in milliseconds) between the nth frame and the previous frame for a Multi-frame image. The first frame always has a time increment of 0. If the Frame Increment Pointer points to this Attribute, the Frame Time Vector shall be used in the following manner to calculate 'relative time' T(n) for frame n :

[pic]

where Δti is the ith Frame Time Vector component.

C.7.6.5.1.3 Multiplexed Audio

During a video acquisition, audio may be used for voice commentary of what is being observed, as well as to record sound-based physiological information such as Doppler audio.

Some Transfer Syntaxes allow for the multiplexing of interleaved audio with video data, and the Attributes of the Cine Module support this encoding paradigm. They are not intended to describe audio acquired simultaneously when it is encoded in other SOP Instances or within Attributes other than Pixel Data (7FE0,0010) of the same SOP Instance.

Synchronization between audio and video is assumed to be encoded at the Transfer Syntax level (i.e. within the encoded bit stream).

Note: If no audio was recorded, the Multiplexed Audio Channels Description Code Sequence (003A,0300) will be present and contain no sequence items.

C.7.6.6 Multi-Frame Module

Table C.7-14 specifies the Attributes of a Multi-frame pixel data Image.

Table C.7-14MULTI-FRAME MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Number of Frames (0028,0008) 1 Number of frames in a Multi-frame Image. See C.7.6.6.1.1 for further explanation.
Frame Increment Pointer (0028,0009) 1 Contains the Data Element Tag of the attribute that is used as the frame increment in Multi-frame pixel data. See C.7.6.6.1.2 for further explanation.

C.7.6.6.1 Multi-Frame Attribute Descriptions
C.7.6.6.1.1 Number Of Frames And Frame Increment Pointer

A Multi-frame Image is defined as a Image whose pixel data consists of a sequential set of individual Image Pixel frames. A Multi-frame Image is transmitted as a single contiguous stream of pixels. Frame headers do not exist within the data stream.

Each individual frame shall be defined (and thus can be identified) by the Attributes in the Image Pixel Module (see C.7.6.3). All Image IE Attributes shall be related to the first frame in the Multi-frame image.

The total number of frames contained within a Multi-frame Image is conveyed in the Number of Frames (0028,0008).

C.7.6.6.1.2 Frame Increment Pointer

The frames within a Multi-frame Image shall be conveyed as a logical sequence. The information that determines the sequential order of the frames shall be identified by the Data Element Tag or tags conveyed by the Frame Increment Pointer (0028,0009). Each specific Image IOD that supports the Multi-frame Module specializes the Frame Increment Pointer (0028,0009) to identify the Attributes that may be used as sequences.

Even if only a single frame is present, Frame Increment Pointer (0028,0009) is still required to be present and have at least one value, each of which shall point to an attribute that is also present in the dataset and has a value.

Note: For example, in single-frame instance of an IOD that is required to or may contain the Cine Module, it may be appropriate for Frame Time (0018,1063) to be present with a value of 0, and be the only target of Frame Increment Pointer (0028,0009).

C.7.6.7 Bi-Plane Sequence Module (Retired)

C.7.6.8 Bi-Plane Image Module (Retired)

C.7.6.9 Frame Pointers Module

Table C.7-15 specifies the attributes of a Frame Pointer Module.

Table C.7-15FRAME POINTERS MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Representative Frame Number (0028,6010) 3 The frame number selected for use as a pictorial representation (e.g. icon) of the Multi-frame Image
Frame Numbers Of Interest (FOI) (0028,6020) 3 Frame number(s) selected as frames of interest. A frame number may appear more than once.
Frame Of Interest Description (0028,6022) 3 Description of each one of the Frame(s) of Interest selected in (0028,6020). If multiple Frames of Interest are selected and this Attribute is used, it shall contain the same number of values as are in Frame Numbers of Interest (0028,6020).
Frame of Interest Type (0028,6023) 3 A defined term for each one of the Frame(s) of Interest (0028,6020) that identifies the significance of the frame. If multiple Frames of Interest are selected and this Attribute is used, it shall contain the same number of values as are in Frame Numbers of Interest (0028,6020). Defined Terms are: HIGHMI = a frame acquired at the time of the high power pulse that destroys acoustic contrast RWAVE = the frame closest to the R-Wave TRIGGER = a trigger frame, for example a set delay from the R Wave ENDSYSTOLE = the frame closest to end of systole, at the end of the T-wave

Notes: 1. Frame numbers begin at 1.

2. Frame of Interest Description is intended to indicate such frames as Systolic, Diastolic, Stenotic Artery, or trigger label.

C.7.6.10 Mask Module

Table C.7-16 specifies the Attributes that describe mask operations for a Multi-frame image.

Table C.7-16MASK MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Mask Subtraction Sequence (0028,6100) 1 Defines a sequence that describes mask subtraction operations for a Multi-frame Image. One or more items shall be included in this sequence.
>Mask Operation (0028,6101) 1 Defined Term identifying the type of mask operation to be performed. See C.7.6.10.1 for further explanation.
>Subtraction Item ID (0028,9416) 1C Identification of the Subtraction Item used to associate a certain Mask Sub-Pixel Shift (0028,6114) in the Frame Pixel Shift Functional Group. See C.7.6.16.2.14.1. Required if SOP Class UID (0008,0016) equals “1.2.840.10008.5.1.4.1.1.12.1.1” or “1.2.840.10008.5.1.4.1.1.12.2.1”. May be present otherwise.
>Applicable Frame Range (0028,6102) 1C Each pair of numbers in this multi-valued attribute specify a beginning and ending frame number inclusive of a range where this particular mask operation is valid. Discontinuous ranges are represented by multiple pairs of numbers. Frames in a Multi-frame Image are specified by sequentially increasing number values beginning with 1. If this Attribute is missing in this particular sequence item, then the mask operation is applicable throughout the entire Multi-frame Image, subject to certain limits as described in C.7.6.10.1.1. Required if Mask Operation (0028,6101) equals REV_TID. May be present otherwise.
>Mask Frame Numbers (0028,6110) 1C Specifies the frame numbers of the pixel data used to generate this mask. Frames in a Multi-frame Image are specified by sequentially increasing number values beginning with 1. Required if the Mask Operation (0028,6101) is AVG_SUB.
>Contrast Frame Averaging (0028,6112) 3 Specifies the number of contrast frames to average together before performing the mask operation. If the Attribute is missing, no averaging is performed.
>Mask Sub-pixel Shift (0028,6114) 3 A pair of floating point numbers specifying the fractional vertical [adjacent row spacing] and horizontal [adjacent column spacing] pixel shift applied to the mask before subtracting it from the contrast frame. See Section C.7.6.10.1.2. Note: When the Frame Pixel Shift Functional Group is present the values of the Mask Pixel Shift attribute of that Functional Group prevails over the values specified in this module.
>TID Offset (0028,6120) 2C If Mask Operation is TID, specifies the offset to be subtracted from the current frame number in order to locate the mask frame in TID mode. If Mask Operation is REV_TID, specifies the initial offset to be subtracted from the first contrast frame number. See section C.7.6.10.1.1. If zero length, TID Offset defaults to 1. Required if Mask Operation (0028,6101) is TID or REV_TID.
>Mask Operation Explanation (0028,6190) 3 Free form explanation of this particular mask operation.
>Mask Selection Mode (0028,9454) 3 Specifies the method of selection of the mask operations of this item. Defined Terms: SYSTEM USER
Recommended Viewing Mode (0028,1090) 2 Specifies the recommended viewing protocol(s). Defined terms: SUB = for subtraction with mask images; NAT = native viewing of image as sent. Note: If an implementation does not recognize the defined term for Recommended Viewing Mode (0028,1090) , reverting to native display mode is recommended.

Note: Frame numbers begin at 1.

C.7.6.10.1 Mask Subtraction Attribute Descriptions
C.7.6.10.1.1 Mask Operation

Mask Operation (0028,6101) specifies a type of mask operation to be performed. The Defined Terms identifying the mask operation to be performed are as follows:

NONE (No Subtraction) No mask subtraction operation is specified;

AVG_SUB (Average Subtraction) The frames specified by the Mask Frame Numbers (0028,6110) are averaged together, shifted by the amount specified in the Mask Sub-pixel Shift (0028,6114), then subtracted from the contrast frames in the range specified in the Applicable Frame Range (0028,6102) . Contrast Frame Averaging (0028,6112) number of frames starting with the current frame are averaged together before the subtraction. If the Applicable Frame Range is not present in this sequence item, the Applicable Frame Range is assumed to end at the last frame number of the image minus Contrast Frame Averaging (0028,6112) plus one;

TID (Time Interval Differencing) The mask for each frame within the Applicable Frame Range (0028,6102) is selected by subtracting TID Offset (0028,6120) from the respective frame number. If the Applicable Frame Range is not present in this sequence item, the Applicable Frame Range is assumed to be a range where TID offset subtracted from any frame number with the range results in a valid frame number within the Multi-frame image.

Note: A positive value for TID Offset (0028,6120) means that the mask frame numbers are lower than the subtracted frame numbers. A negative TID Offset means that the mask frame numbers are higher than the subtracted frame numbers.

REV_TID (Reversed Time Interval Differencing) The number of the mask frame for each contrast frame within the Applicable Frame Range (0028,6102) is calculated by subtracting the TID Offset (0028,6120) from the first frame within the Applicable Frame Range, the TID Offset (0028,6120) +2 from the second frame within the Applicable Frame Range, the TID Offset (0028,6120) +4 from the third frame and so on. The Applicable Frame Range (0028,6102) shall be present.

When multiple pairs of frame numbers are specified in the Applicable Frame Range attribute, the beginning frame numbers (i.e. the first frame number in each pair) shall be in increasing order.

Algorithm to calculate the Mask Frame Number:

MFN = (FCFN - TID Offset) - (CFN - FCFN)

In which:

MFN = Mask Frame Number

CFN = Contrast Frame Number

FCFN = First Contrast Frame Number, the first frame number of the first pair in the Applicable Frame Range

Note: A positive value for TID Offset (0028,6120) means that the mask frame numbers are lower than the subtracted frame numbers. A negative TID Offset means that the mask frame numbers are higher than the subtracted frame numbers.

Note: Example of TID Offset, see Figure C.7.6.10-1:

[pic]

Figure C.7.6.10-1

Number of Frames: 32

Applicable Frame Range: 20 to 30

TID Offset: 5

For Calculating the TID Offset for Mask Operation REV_TID see table C.7.6.10-1:

Table C.7.6.10-1 Example Mask Frame Numbers for Mask Operation REV_TID

Contrast Frame Number (CFN) (Absolute value) Mask Frame Number (MFN) (Absolute value)
20 15
21 14
22 13
28 7
29 6
30 5

In this example the acquisition of the mask frames starts with frame 5 and ends with frame 15. The acquisition of the contrast frames starts with frame 20 and ends with frame 30 (Applicable Frame Range). The number 5 for TID Offset indicates a gap between “end of mask frames” and “begin of contrast frames” of 4 frames, e.g. injection phase and/or time needed to drive C-arm in reverse. Additionally, in this example, the first 4 frames and the last two frames are not used for this Reversed Time Interval Differencing loop.

C.7.6.10.1.2 Mask Sub-pixel Shift

A pair of floating point numbers specifying the fractional vertical [adjacent row spacing] and horizontal [adjacent column spacing] pixel shift applied to the mask before subtracting it from the contrast frame. The row offset results in a shift of the pixels along the column axis. The column offset results in a shift of the pixels along the row axis. A positive row offset is a shift toward the pixels of the lower row of the pixel plane. A positive column offset is a shift toward the pixels of the left hand side column of the pixel plane.

C.7.6.11 Display Shutter Module

The Display shutter is a geometric mask consisting of one or more combined shapes that may be applied on the image for presentation purposes in order to neutralize the display of any of the pixels located outside of the shutter shape. Geometry of the shutter 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 represents a row spacing (vertical) and a column coordinate represents a column spacing (horizontal). Up to three different shutter shapes may be used and superimposed.

The manner in which the display area is neutralized (black-out, gray, or other means) is defined by the Attribute Shutter Presentation Value (0018,1622), or undefined if this Attribute is absent or empty.

Table C.7-17DISPLAY SHUTTER MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Include ‘Display Shutter Macro’ Table C.7-17A.

Table C.7-17ADISPLAY SHUTTER MACRO ATTRIBUTES

Attribute Name Tag Type Attribute Description
Shutter Shape (0018,1600) 1 Shape(s) of the shutter defined for display. Enumerated Values: RECTANGULAR CIRCULAR POLYGONAL This multi-valued Attribute shall contain at most one of each Enumerated Value. When multiple values are present, and the shutter is applied to a displayed image, then all of the shapes shall be combined and applied simultaneously, that is, the least amount of image remaining shall be visible (unoccluded). See Figure C.7-4b.
Shutter Left Vertical Edge (0018,1602) 1C Required if Shutter Shape (0018,1600) is RECTANGULAR. Location of the left edge of the rectangular shutter with respect to pixels in the image given as column.
Shutter Right Vertical Edge (0018,1604) 1C Required if Shutter Shape (0018,1600) is RECTANGULAR. Location of the right edge of the rectangular shutter with respect to pixels in the image given as column.
Shutter Upper Horizontal Edge (0018,1606) 1C Required if Shutter Shape (0018,1600) is RECTANGULAR. Location of the upper edge of the rectangular shutter with respect to pixels in the image given as row.
Shutter Lower Horizontal Edge (0018,1608) 1C Required if Shutter Shape (0018,1600) is RECTANGULAR. Location of the lower edge of the rectangular shutter with respect to pixels in the image given as row.
Center of Circular Shutter (0018,1610) 1C Required if Shutter Shape (0018,1600) is CIRCULAR. Location of the center of the circular shutter with respect to pixels in the image given as row and column.
Radius of Circular Shutter (0018,1612) 1C Required if Shutter Shape (0018,1600) is CIRCULAR. Radius of the circular shutter with respect to pixels in the image given as a number of pixels along the row direction.
Vertices of the Polygonal Shutter (0018,1620) 1C Required if Shutter Shape (0018,1600) 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 shutter. Polygon shutters are implicitly closed from the last vertex to the origin vertex and all edges shall be non-intersecting except at the vertices.
Shutter Presentation Value (0018,1622) 3 A single gray unsigned value used to replace those parts of the image occluded by the shutter, when rendered on a monochrome display. The units are specified in P-Values, from a minimum of 0000H (black) up to a maximum of FFFFH (white). Note: The maximum P-Value for this Attribute may be different from the maximum P-Value from the output of the Presentation LUT, which may be less than 16 bits in depth.
Shutter Presentation Color CIELab Value (0018,1624) 3 A color triplet value used to replace those parts of the image occluded by the shutter, when rendered on a color display. The units are specified in PCS-Values, and the value is encoded as CIELab. See C.10.7.1.1.

The following figures illustrate the values of coordinate attributes for 1:1 aspect and 2:1 aspect ratio images with rectangular and circular display shutters applied.

[pic]

Figure C.7-1Rectangular Display Shutter(1:1 aspect ratio image)

[pic]

Figure C.7-2Rectangular Display Shutter(2:1 aspect ratio images as they would appear before interpolation for display)

[pic]

Figure C.7-3Circular Display Shutter(1:1 aspect ratio image)

[pic]

Figure C.7-4Circular Display Shutter(2:1 aspect ratio images as they would appear before interpolation for display)

The following figure illustrates the combined application of rectangular and circular display shutters to show the least amount of visible image.

[pic]

Figure C.7-4bCombined Rectangular and Circular Display Shutter

C.7.6.12 Device Module

Table C.7-18 describes the Attributes of devices or calibration objects (e.g., catheters, markers, baskets) that are associated with a study and/or image.

Table C.7-18DEVICE MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Device Sequence (0050,0010) 1 A sequence of items describing devices used that may be visible in the image. One or more Items shall be included in this Sequence.
>Include ‘Code Sequence Macro’ Table 8.8-1 Baseline CID 4051.
>Manufacturer (0008,0070) 3 Manufacturer of the device
>Manufacturer’s Model Name (0008,1090) 3 Manufacturer’s model name of the device
>Device Serial Number (0018,1000) 3 Manufacturer’s serial number of the device
>Device ID (0018,1003) 3 User-supplied identifier for the device
>Device Length (0050,0014) 3 Length in mm of device. See C.7.6.12.1.1.
>Device Diameter (0050,0016) 3 Unit diameter of device. See C.7.6.12.1.1.
>Device Diameter Units (0050,0017) 2C Required if Device Diameter (0050,0016) is present. Defined terms: FR = French GA = Gauge IN = Inch MM = Millimeter
>Device Volume (0050,0018) 3 Volume of device in ml. See C.7.6.12.1.1..
>Inter-Marker Distance (0050,0019) 3 Distance in mm between markers on calibrated device. See C.7.6.12.1.1.
>Device Description (0050,0020) 3 Further description in free form text describing the device.

C.7.6.12.1 Device Attribute Descriptions
C.7.6.12.1.1 Device Type and Size

Depending on the type of device specified by the Code Value (0008,0100) in an item of the Device Sequence (0050,0010), various device size attributes (e.g., Device Length (0050,0014), Device Diameter (0050,0016), Device Volume (0050,0018), Inter Marker Distance (0050,0019)) may be required to fully characterize the device.

C.7.6.13 Intervention Module

Table C.7-19 describes the Attributes of therapies (e.g. interventions during an angiographic procedure) that are associated with a study and/or image.

Table C.7-19INTERVENTION MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Intervention Sequence (0018,0036) 3 Introduces sequence of items describing interventional therapies or procedures. One or more Items are permitted in this Sequence.
>Include ‘Code Sequence Macro’ Table 8.8-1 Baseline CID 9.
>Intervention Status (0018,0038) 2 Temporal relation of SOP Instance to intervention Enumerated Values: PRE INTERMEDIATE POST NONE
>Intervention Drug Code Sequence (0018,0029) 3 Sequence that identifies the interventional drug. 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 interventional drug.
>Intervention Drug Stop Time (0018,0027) 3 Time of completion of administration of the intervention drug.
>Administration Route Code Sequence (0054,0302) 3 Sequence that identifies the Administration Route. Only a single Item is permitted in this sequence.
>>Include ‘Code Sequence Macro’ Table 8.8-1 Baseline CID 11.
>Intervention Description (0018,003A) 3 Further description in free form text describing the therapy or other intervention.

Note: Therapy Description (0018,0039) was included in this Module in earlier editions, but its use has been retired. See PS 3.3-2003.

C.7.6.14 Acquisition Context Module

Table C.7.6.14-1 specifies Attributes for description of the conditions present during data acquisition.

This Module shall not contain descriptions of conditions that replace those that are already described in specific Modules or Attributes that are also contained within the IOD that contains this Module.

Notes: 1. Each item of the Acquisition Context Sequence (0040,0555) contains one item of the Concept Name Code Sequence (0040,A043) and one of the mutually-exclusive Observation-value Attributes: Concept Code Sequence (0040,A168), the pair of Numeric Value (0040,A30A) and Measurement Units Code Sequence (0040,08EA), Date (0040,A121), Time (0040,A122), Person Name (0040,A123) or Text Value (0040,A160).

2. If this SOP Instance is a Multi-frame SOP Instance, each item of the Acquisition Context Sequence (0040,0555) may be configured to describe one frame, all frames, or any specifically enumerated subset set of frames of the Multi-frame SOP Instance.

Table C.7.6.14-1 - ACQUISITION CONTEXT MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Acquisition Context Sequence (0040,0555) 2 A sequence of Items that describes the conditions present during the acquisition of the data of the SOP Instance. Zero or more items shall be included in this sequence.
>Value Type (0040,A040) 3 The type of the value encoded in this Item. Defined Terms: TEXT NUMERIC CODE DATE TIME PNAME See Section 10.2.
>Concept Name Code Sequence (0040,A043) 1 A concept that constrains the meaning of (i.e. defines the role of) the Observation Value. The “Name” component of a Name/Value pair. Only a single Item shall be included in this sequence.
>>Include ‘Code Sequence Macro’ Table 8.8-1 No Baseline Context is defined.
>Referenced Frame Numbers (0040,A136) 1C References one or more frames in a Multi-frame SOP Instance. The first frame shall be denoted as frame number one. Required if this SOP Instance is a Multi-frame SOP Instance and the values in this sequence item do not apply to all frames.
>Numeric Value (0040,A30A) 1C This is the Value component of a Name/Value pair when the Concept implied by Concept Name Code Sequence (0040,A043) is a set of one or more numeric values. Required if the value that Concept Name Code Sequence (0040,A043) requires (implies) is a set of one or more integers or real numbers. Shall not be present otherwise.
>Measurement Units Code Sequence (0040,08EA) 1C Units of measurement. Only a single Item shall be included in this Sequence. Required if Numeric Value (0040,A30A) is sent. Shall not be present otherwise.
>>Include ‘Code Sequence Macro’ Table 8.8-1 Baseline CID 82.
>Date (0040,A121) 1C This is the Value component of a Name/Value pair when the Concept implied by Concept Name Code Sequence (0040,A043) is a date. Note: The purpose or role of the date value could be specified in Concept Name Code Sequence (0040,A043). Required if the value that Concept Name Code Sequence (0040,A043) requires (implies) is a date. Shall not be present otherwise.
>Time (0040,A122) 1C This is the Value component of a Name/Value pair when the Concept implied by Concept Name Code Sequence (0040,A043) is a time. Note: The purpose or role of the time value could be specified in Concept Name Code Sequence (0040,A043). Required if the value that Concept Name Code Sequence (0040,A043) requires (implies) is a time. Shall not be present otherwise.
>Person Name (0040,A123) 1C This is the Value component of a Name/Value pair when the Concept implied by Concept Name Code Sequence (0040,A043) is a Person Name. Note: The role of the person could be specified in Concept Name Code Sequence (0040,A043). Required if the value that Concept Name Code Sequence (0040,A043) irequires (implies) is a person name. Shall not be present otherwise.
>Text Value (0040,A160) 1C This is the Value component of a Name/Value pair when the Concept implied by Concept Name Code Sequence (0040,A043) is a Text Observation Value. Required if Date (0040,A121), Time (0040,A122), and Person Name (0040,A123) do not fully describe the concept specified by Concept Name Code Sequence (0040,A043). Shall not be present otherwise.
>Concept Code Sequence (0040,A168) 1C This is the Value component of a Name/Value pair when the Concept implied by Concept Name Code Sequence (0040,A043) is a Coded Value. Only a single Item shall be included in this sequence. Required if Date (0040,A121), Time (0040,A122), Person Name (0040,A123), Text Value (0040,A160), and the pair of Numeric Value (0040,A30A) and Measurement Units Code Sequence (0040,08EA) are not present.
>>Include ‘Code Sequence Macro’ Table 8.8-1 No Baseline Context is defined.
Acquisition Context Description (0040,0556) 3 Free-text description of the image-acquisition context.

C.7.6.15 Bitmap Display Shutter Module

The Bitmap Display Shutter is a bitmap that defines an arbitrary shape that may be applied on the image for presentation purposes in order to neutralize the display of any of the pixels defined in the bitmap.

The manner in which the display area is neutralized (black-out, gray, or other means) is defined by the Attribute Shutter Presentation Value (0018,1622).

The bitmap is specified as a reference to an instance of the Overlay Plane Module C.9.2. The referenced Overlay is specialized such that:

- Overlay Type (60xx,0040) shall be “G”,

- Overlay Bits Allocated (60xx,0100) shall be 1,

- Overlay Bit Position (60xx,0102) shall be 0 and

- Overlay Origin (60xx,0050) shall be 1\1.

Overlay Rows (60xx,0010) and Overlay Columns (60xx,0011) shall be the same as Rows (0028,0010) and Columns (0028,0011) in the image respectively.

A value of 1 in the Overlay Data (60xx,3000) shall indicate a pixel to which the shutter is applied, i.e. replaced with Shutter Presentation Value (0018,1622).

The Overlay specified in this Attribute shall not be activated (used as a conventional overlay) by the Overlay Activation Module C.11.7.

Table C.7.6.15-1BITMAP DISPLAY SHUTTER MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Shutter Shape (0018,1600) 1 Shape of the shutter defined for display. Enumerated Values are: BITMAP This Attribute shall contain one Value.
Shutter Overlay Group (0018,1623) 1 Specifies the Group (60xx) of an Overlay stored within the Presentation State IOD that contains the bitmap data, as defined in the Overlay Plane Module C.9.2.
Shutter Presentation Value (0018,1622) 1 A single gray unsigned value used to replace those parts of the image occluded by the shutter, when rendered on a monochrome display. The units are specified in P-Values, from a minimum of 0000H (black) up to a maximum of FFFFH (white). Note: The maximum P-Value for this Attribute may be different from the maximum P-Value from the output of the Presentation LUT, which may be less than 16 bits in depth.
Shutter Presentation Color CIELab Value (0018,1624) 3 A color triplet value used to replace those parts of the image occluded by the shutter, when rendered on a color display. The units are specified in PCS-Values, and the value is encoded as CIELab. See C.10.7.1.1.

C.7.6.16 Multi-frame Functional Groups Module

Table C.7.6.16-1 specifies the attributes of the Multi-frame Functional Groups Module. This module is included in SOP instances even if there is only one frame in the instance.

Table C.7.6.16-1MULTI-FRAME FUNCTIONAL GROUPS MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Shared Functional Groups Sequence (5200,9229) 2 Sequence that contains the Functional Group Macros that are shared for all frames in this SOP Instance and Concatenation. Note: The contents of this sequence are the same in all SOP Instances that comprise a Concatenation. Zero or one Item shall be included in this sequence. See section C.7.6.16.1.1 for further explanation.
>Include one or more Functional Group Macros that are shared by all frames. The selected Functional Group Macros shall not be present in the Per-frame Functional Groups Sequence (5200,9230). For each IOD that includes this module, a table is defined in which the permitted Functional Group Macros and their usage is specified.
Per-frame Functional Groups Sequence (5200,9230) 1 Sequence that contains the Functional Group Sequence Attributes corresponding to each frame of the Multi-frame Image. The first Item corresponds with the first frame, and so on. One or more Items shall be included in this sequence. The number of Items shall be the same as the number of frames in the Multi-frame image. See Section C.7.6.16.1.2 for further explanation.
>Include one or more Functional Group Macros. For each IOD that includes this module, a table is defined in which the permitted Functional Group Macros and their usage is specified.
Instance Number (0020,0013) 1 A number that identifies this instance. The value shall be the same for all SOP Instances of a Concatenation, and different for each separate Concatenation and for each SOP Instance not within a Concatenation in a series.
Content Date (0008,0023) 1 The date the data creation was started. Note: For instance, this is the date the pixel data is created, not the date the data is acquired.
Content Time (0008,0033) 1 The time the data creation was started. Note: For instance, this is the time the pixel data is created, not the time the data is acquired.
Number of Frames (0028,0008) 1 Number of frames in a multi-frame image. See C.7.6.6.1.1 for further explanation.
Concatenation Frame Offset Number (0020,9228) 1C Offset of the first frame in a multi-frame image of a concatenation. Logical frame numbers in a concatenation can be used across all its SOP instances. This offset can be applied to the implicit frame number to find the logical frame number in a concatenation. The offset is numbered from zero; i.e., the instance of a concatenation that begins with the first frame of the concatenation has a Concatenation Frame Offset Number (0020,9228) of zero. Required if Concatenation UID (0020,9161) is present.
Representative Frame Number (0028,6010) 3 The frame number selected for use as a pictorial representation (e.g. icon) of the multi-frame Image.
Concatenation UID (0020,9161) 1C Identifier of all SOP Instances that belong to the same concatenation. Required if a group of multi-frame image SOP Instances within a Series are part of a Concatenation.
SOP Instance UID of Concatenation Source (0020,0242) 1C The SOP Instance UID of the single composite SOP Instance of which the Concatenation is a part. All SOP Instances of a concatenation shall use the same value for this attribute, see C.7.6.16.1.3. Note: May be used to reference the entire instance rather than individual instances of the concatenation, which may be transient (e.g., from a presentation state). Required if Concatenation UID (0020,9161) is present.
In-concatenation Number (0020,9162) 1C Identifier for one SOP Instance belonging to a concatenation. See C.7.6.16.2.2.4 for further specification. The first instance in a concatentation (that with the lowest Concatenation Frame Offset Number (0020,9228) value) shall have an In-concatenation Number (0020,9162) value of 1, and subsequent instances shall have values monotonically increasing by 1. Required if Concatenation UID (0020,9161) is present.
In-concatenation Total Number (0020,9163) 3 The number of SOP Instances sharing the same Concatenation UID.

C.7.6.16.1 Multi-frame Functional Groups Module Attribute Description
C.7.6.16.1.1 Functional Group

A Functional Group is a set of Attributes that are logically related and may vary together. Functional Groups are defined in Macros. Those Functional Group Macros that apply to all frames are included in the Shared Functional Groups Sequence (5200,9229). Functional Group Macros whose attribute values may vary from frame to frame are included in the Per-frame Functional Groups Sequence (5200,9230).

A single Functional Group Macro shall not be included in both the Shared Functional Groups Sequence (5200,9229)and the Per-frame Functional Groups Sequence (5200,9230).

Notes: 1. In the case of a SOP Instance containing a single frame, some Functional Group Macros may be contained in the Shared Functional Groups Sequence (5200,9229) and others in the one Item of the Per-frame Functional Groups Sequence (5200,9230).

2. Even if there are no Functional Group Macros in the Per-frame Functional Groups Sequence 5200,9230) an empty Item is encoded for every frame.

It may happen that a Functional Group Sequence does not contain any value (e.g., a condition for a single Type 1C attribute in the sequence is not met) or is not required for a particular frame (e.g., an optional Functional Group). In this case the Functional Group Sequence is not included in the Shared Functional Groups Sequence (5200,9229) or the Per-frame Functional Groups Sequence (5200,9230) for a particular frame.

Note: The absence of the sequence attribute corresponding to a particular functional group macro indicates that the functional group is not used for a particular frame.

Private Functional Groups may be defined. The attributes of such a group may be standard or private attributes. A Private Functional Group may not replicate the attributes of a standard Functional Group.

A Private Functional Group can be added to either the Shared Functional Groups Sequence (5200,9229) or the Per-frame Functional Groups Sequence (5200,9230).

C.7.6.16.1.2 Per-frame Functional Groups Sequence

The Per-frame Functional Groups Sequence Attribute (5200,9230) consists of a Sequence of Items. Each Item describes the frame of the same rank in the multi-frame pixel data. The first Item describes frame 1, the second Item describes frame 2, etc. Frames are implicitly numbered starting from 1. See Figure C.7.6.16-1.

[pic]

Figure C.7.6.16-1A Graphical Presentation of the Multi-frame Functional Groups structure

C.7.6.16.1.3 SOP Instance UID of Concatenation Source

The SOP Instance UID of Concatenation Source (0020,0242) attribute contains the SOP Instance UID of the original, not concatenated, SOP Instance and does not change when a concatenation is created. It is independent of the Concatenation UID (0020,9161) because a SOP Instance can be divided into concatenations only during exchance and there can be more than one concatenation with different Concatenation UIDs of an original SOP Instance; see Figure C.7.6.16-2.

[pic]Figure C.7.6.16-2 SOP Instance UID of Concatenation Source

C.7.6.16.2 Common Functional Group Macros

The following sections contain Functional Group macros common to more than one IOD specification.

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.7.6.16.2.1 Pixel Measures Macro

Table C.7.6.16-2 specifies the attributes of the Pixel Measures Functional Group macro.

Table C.7.6.16-2PIXEL MEASURES MACRO ATTRIBUTES

Attribute Name Tag Type Attribute Description
Pixel Measures Sequence (0028,9110) 1 Identifies the physical characteristics of the pixels of this frame. Only a single Item shall be included in this sequence.
>Pixel Spacing (0028,0030) 1C Physical distance in the imaging target (patient, specimen, or phantom) between the centers 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. Note: In the case of CT images with an Acquisition Type (0018,9302) of CONSTANT_ANGLE, the pixel spacing is that in a plane normal to the central ray of the diverging X-Ray beam as it passes through the data collection center. Required if Volumetric Properties (0008,9206) is other than DISTORTED or SAMPLED. May be present otherwise.
>Slice Thickness (0018,0050) 1C Nominal reconstructed slice thickness (for tomographic imaging) or depth of field (for optical non-tomographic imaging), in mm. See C.7.6.16.2.3.1 for further explanation. Note: Depth of field may be an extended depth of field created by focus stacking (see C.8.12.4). Required if Volumetric Properties (0008,9206) is VOLUME or SAMPLED. May be present otherwise.

C.7.6.16.2.2 Frame Content Macro

Table C.7.6.16-3 specifies the attributes of the Frame Content Functional Group macro.

This Functional Group Macro may only be part of the Per-frame Functional Groups Sequence (5200,9230) attribute.

Table C.7.6.16-3FRAME CONTENT MACRO ATTRIBUTES

Attribute Name Tag Type Attribute Description
Frame Content Sequence (0020,9111) 1 Identifies general characteristics of this frame. Only a single Item shall be included in this sequence.
>Frame Acquisition Number (0020,9156) 3 A number identifying the single continuous gathering of data over a period of time that resulted in this frame.
>Frame Reference DateTime (0018,9151) 1C The point in time that is most representative of when data was acquired for this frame. See C.7.6.16.2.2.1 and C.7.6.16.2.2.2 for further explanation. Note: The synchronization of this time with an external clock is specified in the synchronization Module in Acquisition Time synchronized (0018,1800). Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise.
>Frame Acquisition DateTime (0018,9074) 1C The date and time that the acquisition of data that resulted in this frame started. See C.7.6.16.2.2.1 for further explanation. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise.
>Frame Acquisition Duration (0018,9220) 1C The actual amount of time [in milliseconds] that was used to acquire data for this frame. See C.7.6.16.2.2.1 and C.7.6.16.2.2.3 for further explanation. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise.
>Cardiac Cycle Position (0018,9236) 3 Description of the position in the cardiac cycle that is most representative of this frame. Defined Terms: END_SYSTOLE END_DIASTOLE UNDETERMINED
>Respiratory Cycle Position (0018,9214) 3 Description of the position in the respiratory cycle that is most representative of this frame. Defined Terms: START _RESPIR END_RESPIR UNDETERMINED
>Dimension Index Values (0020,9157) 1C Contains the values of the indices defined in the Dimension Index Sequence (0020,9222) for this multi-frame header frame. The number of values is equal to the number of Items of the Dimension Index Sequence and shall be applied in the same order. See section C.7.6.17.1 for a description. Required if the value of the Dimension Index Sequence (0020,9222) exists.
>Temporal Position Index (0020,9128) 1C Ordinal number (starting from 1) of the frame in the set of frames with different temporal positions. Required if the value of SOP Class UID (0008,0016) equals “1.2.840.10008.5.1.4.1.1.130”. May be present otherwise. See C.7.6.16.2.2.6.
>Stack ID (0020,9056) 1C Identification of a group of frames, with different positions and/or orientations that belong together, within a dimension organization. See C.7.6.16.2.2.4 for further explanation. Required if the value of SOP Class UID (0008,0016) equals “1.2.840.10008.5.1.4.1.1.130”. May be present otherwise. See C.7.6.16.2.2.7.
>In-Stack Position Number (0020,9057) 1C The ordinal number of a frame in a group of frames, with the same Stack ID Required if Stack ID (0020,9056) is present. See section C.7.6.16.2.2.4 for further explanation.
>Frame Comments (0020,9158) 3 User-defined comments about the frame.
>Frame Label (0020,9453) 3 Label corresponding to a specific dimension index value. Selected from a set of dimension values defined by the application. This attribute may be referenced by the Dimension Index Pointer (0020,9165) attribute in the Multi-frame Dimension Module. See C.7.6.16.2.2.5 for further explanation.

C.7.6.16.2.2.1 Timing Parameter Relationships

Figure C.7.6.16-2 shows the relationships among the various timing parameters used.

[pic]

Figure C.7.6.16-2Relationship of Timing Related Attributes

C.7.6.16.2.2.2 Frame Reference DateTime

The Frame Reference DateTime (0018,9151) is used to indicate the point in time that is most representative for that specific frame.

Notes: 1. For example, in the case of MR it might be the time of acquisition of the data for the k y =0 line in k-space (the central Fourier segment).

2. For cardiac gated acquisitions the choice of the Frame Reference DateTime (0018,9151) is influenced by the Nominal Cardiac Trigger Delay Time (0020,9153). For respiratory gated acquisitions the choice of the Frame Reference DateTime (0018,9151) is influenced by the Nominal Respiratory Trigger Delay Time (0020,9255).

C.7.6.16.2.2.3 Frame Acquisition Duration

The Frame Acquisition Duration (0018,9220) is used to indicate the duration of the acquisition related to this frame.

For SOP Instances or Concatenations of the Enhanced PET Image Storage SOP Class (1.2.840.10008.5.1.4.1.1.130) the Frame Acquisition Duration (0018,9220) is the sum of the portion of each cycle during which data contributing to this frame has actually been acquired for all of the cardiac or respiratory cycles of a gated acquisition (i.e. if Cardiac Synchronization Technique (0018,9037) equals other than NONE, and/or if Respiratory Motion Compensation Technique (0018,9170) equals other than NONE).

C.7.6.16.2.2.4 Concatenations and Stacks

Due to implementation specific reasons (such as maximum object size) the information of a multi-frame image may be split into more than one SOP Instance. These SOP Instances form together a Concatenation. This is a group of SOP Instances within a Series that is uniquely identified by the Concatenation UID (0020,9161).

The Dimension Index Sequence (0020,9222) for each SOP Instance with the same Concatenation UID (0020,9161) shall contain exactly the same tags and values.

In a Concatenation the Dimension Index Sequence (0020,9222) items of the Shared Functional Groups (5200,9229) shall be identical and have the same values for all individual SOP Instances. The items of the Per-frame Functional Groups (5200,9230) shall be identical for all individual SOP Instances but the values may change per frame. For all other Attributes of all the Modules of the IOD, the same Attributes shall be present and the values shall be identical, with the exception of the following Attributes:

Note: The intent of Concatenations is to split what might have been encoded in a single SOP Instance into smaller fragments for more convenient storage or transmission. All the multiple SOP Instances of a Concatenation should be able to be assembled into a valid single SOP Instance. Hence it is not permitted to change such Attributes as Photometric Interpretation (0028,0004), Rows (0028,0010), Columns (0028,0011), etc.

Stacks describe application-specific groups of frames that have a geometric relationship. Stacks have a Stack ID (0020,9056) that contains a descriptive name that identifies the stack. A Stack ID (0020,9056) may be re-used in another SOP Instance even outside a concatenation. The value of Stack ID (0020,9056) is unique within the scope of a particular Dimension Organization UID (0020,9164) if present, otherwise it is unique within the scope of a particular Concatenation UID (0020,9161). See Figure C7.6.16-3 for an example.

[pic] Figure C.7.6.16-3 Identifying attributes for Concatenation, SOP Instances, Frames and Stacks

Each frame in a stack has an In-Stack Position Number (0020,9057) that is the ordinal number (starting from 1) of the frame within the set of frames with the same Stack ID (0020,9056), see Figure C.7.6.16-4 for an example.

[pic]

Figure C.7.6.16-4 Example of multiple stacks

In order to allow interoperable operations on stacks, 2 different frames with the same Stack ID (0020,9056) can only have the same In-Stack Position Number (0020,9057) if they have the same values for the following attributes:

  1. Dimension Organization UID (0020,9164) or if absent Concatenation UID (0020,9161) to qualify the Stack ID

  2. Image Position (Patient) (0020,0032)

  3. Image Orientation (Patient) (0020,0037)

  4. Rows (0028,0010) ( first value of Pixel Spacing (0028,0030) (= field of view in the row direction)

  5. Columns (0028,0011) ( second value of Pixel Spacing (0028,0030) (= field of view in the column direction)

  6. Slice Thickness (0018,0050)

C.7.6.16.2.2.5 Frame Label

The Frame Label attribute (0020,9453) can be used to label frames that need to be handled as a group in application. The Dimension Index Pointer (0020,9165) from the Dimension Module may point to this attribute if it is the base of a dimension.

C.7.6.16.2.2.6 Temporal Position Index and Stack ID in PET images

For PET Dynamic images, i.e. images in which Image Type (0008,0008) Value 3 is DYNAMIC, Temporal Position Index is used to distinguish between the multiple acquisitions of the same anatomical area. Similarly, the frames that result from one acquisition over the anatomic area shall be contained in one stack. Thus, for Dynamic images, Temporal Position Index (0020,9128), Stack ID (0020,9056), and In-Stack Position Number (0020,9057) shall be used as three of the dimensions of the image, in that order.

Figure C.7.6.16-4b describes the usage for a PET dynamic image.

[pic]

Figure C.7.6.16-4bPET dynamic frame organization

C.7.6.16.2.2.7 Stack ID usage in PET static, whole body and gated images

For static and whole body PET images, a single Stack ID (0020,9056) is used to group all of the transverse slices over the entire imaged volume together. That is, a single Stack ID (0020,9056) is used no matter how many acquisition bed positions are involved. In-Stack Position Number (0020,9057) is then used as the spatial dimension index. When rectangular sagittal, coronal or oblique images are created from these, a single Stack ID (0020,9056) is again used.

Similarly, in cardiac or respiratory gated images, the entire volume is again identified by a single Stack ID (0020,9056), and In-Stack Position Number (0020,9057) is the spatial dimension index. The time dimension is indicated by one of the timing attributes, such as trigger delay time or respiratory phase.

C.7.6.16.2.3 Plane Position (Patient) Macro

Table C.7.6.16-4 specifies the attributes of the Plane Position (Patient) Functional Group macro.

Table C.7.6.16-4PLANE POSITION (PATIENT) MACRO ATTRIBUTES

Attribute Name Tag Type Attribute Description
Plane Position Sequence (0020,9113) 1 Identifies the position of the plane of this frame. Only a single Item shall be included in this sequence.
>Image Position (Patient) (0020,0032) 1C The x, y, and z coordinates of the upper left hand corner (center of the first voxel transmitted) of the frame, in mm. See C.7.6.2.1.1 and C.7.6.16.2.3.1 for further explanation. Note: In the case of CT images with an Acquisition Type (0018,9302) of CONSTANT_ANGLE the image plane is defined to pass through the data collection center and be normal to the central ray of the diverging X-Ray beam. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL and Volumetric Properties (0008,9206) of this frame is other than DISTORTED, may be present otherwise.

C.7.6.16.2.3.1 Position and Orientation for SAMPLED Frames

In the case of Volumetric Properties (0008,9206) having a value of SAMPLED, the Image Position (0020,0032), Image Orientation (0020,0037) and Slice Thickness (0018,0050) shall represent the volume from which the frame was derived based on the orientation of the sampling performed.

Note: For example in the case of MAX_IP:

The Image Orientation shall be the direction of the ray used for projection of the center of the plane.

The image position shall contain the x, y, and z coordinates of the intersection of the mid-plane of the sampled volume with the ray used to project the upper left hand corner of the frame.

The Slice Thickness shall contain the distance that the ray used for projection of the center of the plane traveled through the volume.

C.7.6.16.2.4 Plane Orientation (Patient) Macro

Table C.7.6.16-5 specifies the attributes of the Plane Orientation (Patient) Functional Group macro.

Table C.7.6.16-5PLANE ORIENTATION (PATIENT) MACRO ATTRIBUTES

Attribute Name Tag Type Attribute Description
Plane Orientation Sequence (0020,9116) 1 Identifies orientation of the plane of this frame. Only a single Item shall be included in this sequence.
>Image Orientation (Patient) (0020,0037) 1C The direction cosines of the first row and the first column with respect to the patient. See C.7.6.2.1.1 and C.7.6.16.2.3.1 for further explanation. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL and Volumetric Properties (0008,9206) of this frame is other than DISTORTED. May be present otherwise.

C.7.6.16.2.5 Referenced Image Macro

Table C.7.6.16-6 specifies the attributes of the Referenced Image Functional Group macro.

Table C.7.6.16-6REFERENCED IMAGE MACRO ATTRIBUTES

Attribute Name Tag Type Attribute Description
Referenced Image Sequence (0008,1140) 2 The set of images or other composite SOP Instances used to plan the acquisition, if any, and other significant related images. See Section C.7.6.16.2.5.1 for further explanation. Zero or more Items shall be included in this Sequence.
>Include ‘Image SOP Instance Reference Macro’ Table 10-3
>Purpose of Reference Code Sequence (0040,A170) 1 Describes the purpose for which the reference is made. Only a single Item shall be included in this sequence. See C.7.6.16.2.5.1 for further explanation.
>>Include ‘Code Sequence Macro’ Table 8.8-1 Defined CID 7201.

C.7.6.16.2.5.1 Use of Referenced Image Macro

Referenced Image Sequence (0008,1140) shall be used to identify other data objects used to plan the acquisition of this image. Instances referenced for this purpose shall have the same Frame of Reference UID (0020,0052) as this image. For each Item that contains such a reference, the value of the Purpose of Reference Code Sequence (0040,A170) shall be (”121311”, DCM, ”Localizer"). Applications can use the Referenced Image Sequence (0008,1140) in combination with data in Plane Position (Patient) and Plane Orientation (Patient) Macros to provide projections of the position of an image with respect to the referenced image.

The Referenced Image Sequence (0008,1140) may also be present when references to other images (or frames within other images) are required for other reasons, as specified by Purpose of Reference Code Sequence (0040,A170).

Note: An Image may contain references to itself (e.g. to other frames within itself).

C.7.6.16.2.6 Derivation Image Macro

Table C.7.6.16-7 specifies the attributes of the Derivation Image Functional Group macro.

Table C.7.6.16-7DERIVATION IMAGE MACRO ATTRIBUTES

Attribute Name Tag Type Attribute Description
Derivation Image Sequence (0008,9124) 2 The set of Images or other composite SOP Instances that were used to derive this frame. Zero or more Items shall be included in this Sequence.
>Derivation Description (0008,2111) 3 A text description of how this frame data was derived. See C.7.6.1.1.3 for further explanation.
>Derivation Code Sequence (0008,9215) 1 A coded description of how this frame was derived. See C.7.6.1.1.3 for further explanation. One or more Items shall be included in this Sequence. More than one Item indicates that successive derivation steps have been applied.
>>Include ‘Code Sequence Macro’ Table 8.8-1 Defined CID 7203.
>Source Image Sequence (0008,2112) 2 The set of Images or other Composite SOP Instances that were used to derive this frame. Zero or more Items shall be included in this Sequence. See C.7.6.1.1.4 for further explanation.
>>Include ‘Image SOP Instance Reference Macro’ Table 10-3
>>Purpose of Reference Code Sequence (0040,A170) 1 Describes the purpose for which the reference is made, that is what role the source image or frame played in the derivation of this image or frame. Only a single Item shall be included in this sequence.
>>>Include ‘Code Sequence Macro’ Table 8.8-1 Defined CID 7202.

C.7.6.16.2.7 Cardiac Synchronization Macro

Table C.7.6.16-8 specifies the attributes of the Cardiac Synchronization Functional Group macro.

Table C.7.6.16-8CARDIAC SYNCHRONIZATION MACRO ATTRIBUTES

Attribute Name Tag Type Attribute Description
Cardiac Synchronization Sequence (0018,9118) 1 Sequence that describes the frame specific cardiac synchronization parameters. Only a single Item shall be included in this sequence.
>Nominal Percentage of Cardiac Phase (0020,9241) 1C The nominal time relative to the preceding R peak divided by the nominal R-R interval multiplied by 100. Required if used as a dimension index, may be present otherwise.
>Nominal Cardiac Trigger Delay Time (0020,9153) 1 The nominal time in ms from the time of the previous R-peak to the value of the Frame Reference DateTime (0018,9151) expressed as a positive value. See C.7.6.16.2.7.1 for further explanation.
>Actual Cardiac Trigger Delay Time (0020,9252) 1C The actual time in ms from the time of the previous R-peak to the value of the Frame Reference DateTime (0018,9151) expressed as a positive value . See C.7.6.16.2.7.1 for further explanation. Required if Intervals Acquired (0018,1083) is present and has a value of 1. May be present otherwise.
>Nominal Cardiac Trigger Time Prior to R-peak (0020,9154) 3 The nominal time in ms from the time of the next R-peak to the value of the Frame Reference DateTime (0018,9151) expressed as a negative value. See C.7.6.16.2.7.1 for further explanation.
>Actual Cardiac Trigger Time Prior to R-peak (0020,9155) 3 The actual time in ms from the time of the next R-peak to the value of the Frame Reference DateTime (0018,9151) expressed as a negative value. See C.7.6.16.2.7.1 for further explanation.
>Intervals Acquired (0018,1083) 3 Number of R-R intervals acquired.
>Intervals Rejected (0018,1084) 3 Number of R-R intervals rejected.
>Heart Rate (0018,1088) 3 Average number of heart beats per minute for the collection period for this frame. This shall include all accepted beats as well as rejected beats. Note: During prolonged acquisitions the average heart rate may differ from the reciprocal of the nominal R-R interval.
>R-R Interval Time Nominal (0020,9251) 1C Nominal R-peak - R-peak interval time in ms for the cardiac cycle used for the acquisition of this frame. See C.7.6.16.2.7.1 for further explanation. Required if Cardiac Synchronization Technique (0018,9037) equals other than NONE or REALTIME. May be present otherwise.
>Low R-R Value (0018,1081) 3 R-R interval low limit for beat rejection, in ms.
>High R-R Value (0018,1082) 3 R-R interval high limit for beat rejection, in ms.

C.7.6.16.2.7.1 Relationship of Cardiac Timing Attributes

The Nominal Cardiac Trigger Delay Time (0020,9153) is the nominal trigger delay time in ms from the previous R-peak to the value of the Frame Reference DateTime (0018,9151). When frames are acquired with prospective gating, that is, the data acquisition actually begins in response to a timed delay from the R-peak, it may be that Actual Cardiac Trigger Delay Time (0020,9252) and the Nominal Cardiac Trigger Delay Time (0020,9153) have the same value.

However, when frames are the result of retrospective gating, that is, the data is continuously acquired and then later compared with a simultaneously acquired ECG waveform and fitted into time slots corresponding to nominal phases of the cardiac cycle, then Nominal Cardiac Trigger Delay Time (0020,9153) and the Actual Cardiac Trigger Delay Time (0020,9252) may have different values. When applicable the same is valid for the Nominal Cardiac Trigger Time Prior to R-peak (0020,9154) and the Actual Cardiac Trigger Time Prior to R-peak (0020,9155) attributes.

When multiple cardiac cycles are averaged together, then the Low R-R Value (0018,1081), and High R-R Value (0018,1082) are an average of the cardiac cycles that were accepted in the frame.

Note: For cardiac gated acquisitions the choice of the Frame Reference DateTime (0018,9151) is influenced by the Nominal Cardiac Trigger Delay Time (0020,9153). For respiratory gated acquisitions the choice of the Frame Reference DateTime (0018,9151) is influenced by the Nominal Respiratory Trigger Delay Time (0020,9255).

Figure C.7.6.16-5a depicts the usage.

[pic]

Figure C.7.6.16-5aCardiac Timing Tags

Nominal Cardiac Trigger Time Prior to R-peak (0020,9154) and the Actual Cardiac Trigger Time Prior to R-peak (0020,9155) attributes can be used to store a time of the next R-peak to the value of the Frame Reference DateTime (0018,9151) expressed as a negative value. In this case the Actual Cardiac Trigger Delay Time (0020,9252), when present, and the Nominal Cardiac Trigger Delay Time (0020,9153) shall contain a value calculated based on the R-R interval applicable for this frame. See Figure C.7.6.16-5b.

[pic]

Figure C.7.6.16-5bCardiac Timing Relationships

Note: Specifying the time interval prior to the R-peak is relevant for applications such as capturing P- and Q-wave related morphology.

C.7.6.16.2.8 Frame Anatomy Macro

Table C.7.6.16-9 specifies the attributes of the Frame Anatomy Functional Group macro.

Table C.7.6.16-9FRAME ANATOMY MACRO ATTRIBUTES

Attribute Name Tag Type Attribute Description
Frame Anatomy Sequence (0020,9071) 1 Identifies anatomic characteristics of this frame. Only a single Item shall be included in this sequence.
>Frame Laterality (0020,9072) 1 Laterality of (possibly paired) body parts (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 frames 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.
>Include 'General Anatomy Mandatory Macro' Table 10-5 Defined Context ID for the Anatomic Region Sequence (0008,2218) is 4030. Defined Context ID for Anatomic Region Modifier Sequence (0008,2220) and Primary Anatomic Structure Modifier Sequence (0008,2230) is 2.

C.7.6.16.2.9 Pixel Value Transformation Macro

Table C.7.6.16-10 specifies the attributes of the Pixel Value Transformation Functional Group macro.

Note: This Macro is equivalent with the Modality LUT transformation in non Multi-frame IODs.

Table C.7.6.16-10PIXEL VALUE TRANSFORMATION MACRO ATTRIBUTES

Attribute Name Tag Type Attribute Description
Pixel Value Transformation Sequence (0028,9145) 1 Contains the attributes involved in the transformation of stored pixel values. Only a single Item shall be included in this sequence.
>Rescale Intercept (0028,1052) 1 The value b in relationship between stored values (SV) and the output units. Output units = m*SV + b.
>Rescale Slope (0028,1053) 1 m in the equation specified by Rescale Intercept (0028,1052).
>Rescale Type (0028,1054) 1 Specifies the output units of Rescale Slope (0028,1053) and Rescale Intercept (0028,1052). See C.11.1.1.2 for further explanation. Enumerated Value: US = Unspecified if Modality (0008,0060) equals MR or PT.

Note: Window Center (0028,1050) and Window Width (0028,1051) are applied after Rescale Slope (0028,1053) and Rescale Intercept (0028,1054) have been applied to Stored Pixel Values, see C.11.2.1.2.

C.7.6.16.2.9b Identity Pixel Value Transformation Macro

Table C.7.6.16-10b specifies the attributes of the Identity Pixel Value Transformation Functional Group macro.

Note: This Macro constrains the Modality LUT Transformation step in the grayscale rendering pipleine to be an identity transformation.

Table C.7.6.16-10bIDENTITY PIXEL VALUE TRANSFORMATION MACRO ATTRIBUTES

Attribute Name Tag Type Attribute Description
Pixel Value Transformation Sequence (0028,9145) 1 Contains the attributes involved in the transformation of stored pixel values. Only a single Item shall be included in this sequence.
>Rescale Intercept (0028,1052) 1 The value b in relationship between stored values (SV) and the output units. Output units = m*SV + b. Enumerated Value: 0
>Rescale Slope (0028,1053) 1 m in the equation specified by Rescale Intercept (0028,1052). Enumerated Value: 1
>Rescale Type (0028,1054) 1 Specifies the output units of Rescale Slope (0028,1053) and Rescale Intercept (0028,1052). See C.11.1.1.2 for further explanation. Enumerated Value: US - Unspecified

C.7.6.16.2.10 Frame VOI LUT Macro

Table C.7.6.16-11 specifies the attributes of the Frame VOI LUT Functional Group macro.

Table C.7.6.16-11FRAME VOI LUT MACRO ATTRIBUTES

Attribute Name Tag Type Attribute Description
Frame VOI LUT Sequence (0028,9132) 1 Window Center and Width values applied to the frame. Only a single item is permitted in this sequence.
>Window Center (0028,1050) 1 Window Center for display. See C.11.2.1.2 for further explanation.
>Window Width (0028,1051) 1 Window Width for display. See C.11.2.1.2 for further explanation.
>Window Center & Width Explanation (0028,1055) 3 Explanation of the Window Center and Width. Defined Terms for CT: BRAIN SOFT_TISSUE LUNG BONE
>VOI LUT Function (0028,1056) 3 Describes a VOI LUT function to apply to the values of Window Center (0028,1050) and Window Width (0028,1051). See C.11.2.1.3 for further explanation. Defined terms: LINEAR SIGMOID When this attribute is not present, the interpretation of the values of Window Center (0028,1050) and Window Width (0028,1051) is linear as in C.11.2.1.2.

C.7.6.16.2.10b Frame VOI LUT With LUT Macro

Table C.7.6.16-11b specifies the attributes of the Frame VOI LUT With LUT Functional Group macro. This macro contains one or more sets of linear or sigmoid window values and/or one or more sets of lookup tables.

Table C.7.6.16-11bFRAME VOI LUT WITH LUT MACRO ATTRIBUTES

Attribute Name Tag Type Attribute Description
Frame VOI LUT Sequence (0028,9132) 1 The VOI LUT transformations applied to this frame. Only a single item is permitted in this sequence.
>Include VOI LUT Macro Table C.11-2b

C.7.6.16.2.11 Real World Value Mapping Macro

Table C.7.6.16-12 specifies the attributes of the Real World Value Mapping Functional Group macro.

Table C.7.6.16-12REAL WORLD VALUE MAPPING MACRO ATTRIBUTES

Attribute Name Tag Type Attribute Description
Real World Value Mapping Sequence (0040,9096) 1 The mapping of stored values to associated real world values. One or more Items shall be included in this sequence.
>Real World Value First Value Mapped (0040,9216) 1 Specifies the first stored value mapped for the Real Word Value Intercept (0040,9224) and Real World Value Slope (0040,9225) or Real World Value LUT (0040,9212) of this Item. See C.7.6.16.2.11.1 for further explanation.
>Real World Value Last Value Mapped (0040,9211) 1 Specifies the last stored value mapped for the Real Word Value Intercept (0040,9224) and Real World Value Slope (0040,9225) or Real World Value LUT (0040,9212) of this Item. See C.7.6.16.2.11.1 for further explanation.
>Real World Value Intercept (0040,9224) 1C The Intercept value in relationship between stored values (SV) and the real world values. See section C.7.6.16.2.11.2 for further explanation. Required if Real World Value LUT Data (0040,9212) is not present.
>Real World Value Slope (0040,9225) 1C The Slope value in relationship between stored values (SV) and the real world values. See section C.7.6.16.2.11.2 for further explanation. Required if Real World Value LUT Data (0040,9212) is not present.
>Real World Value LUT Data (0040,9212) 1C LUT Data in this Sequence. Required if Real World Value Intercept (0040,9224) is not present.
>LUT Explanation (0028,3003) 1 Free form text explanation of the meaning of the transformation in this Item.
>LUT Label (0040,9210) 1 Label that is used to identify the transformation of this Item.
>Measurement Units Code Sequence (0040,08EA) 1 Units of measurement. Only a single Item shall be included in this sequence. See C.7.6.16.2.11.1 for further explanation.
>>Include Code Sequence Macro Table 8.8-1 Defined CID 82, or as specified in the macro invocation.

C.7.6.16.2.11.1 Real World Value representation

C.7.6.16.2.11.1.1 Real World Value Mapping Sequence

The items in the Real World Value Mapping Sequence (0040,9096) may be used to translate stored values into real world values when there is such a relationship. The Real World Value Mapping Sequence (0040,9096) is independent of the Modality LUT (or Pixel Value Transformation Macro), as illustrated in Figure C.7.6.16-6.

Each item specifies the range of stored values as well as the associated mapping function. Each item can specify either a linear mapping, using Real World Value Slope (0040,9225) and Real World Value Intercept (0040,9224), or a non-linear mapping using Real World Value LUT Data (0040,9212). More than one Real World Value Mapping Item is allowed.

The range of stored pixel values specified by different Real Value World Mapping Sequence (0040,9096) Items can overlap (as illustrated in the example in Figure C.7.6.16-7).

[pic]

Figure C.7.6.16-6The Real World Value LUT and the Image Viewing pipeline

Note: For example, MR images may contain data that is not only the result of the physical/chemical properties of the scanned anatomy, but may also contain information that is representing real world values, such as, temperature [in degrees C], flow [in l/min], speed [in m/sec], relative activity [in %], relative contrast enhancement [in %], diffusion [in sec/mm2], etc.

In some cases the conversion from Stored Values to Real World Values can be linear (through "slope" and "intercept") or non-linear (through look-up tables).

Both transformation methods can be applied to one range of stored values. Overlapped ranges might be used for different representations such as log versus linear scales or for different representations in units such as cm/sec versus mm/sec. Alternative methods can be identified by the labels assigned to the transformations.

C.7.6.16.2.11.1.2 Real World Values Mapping Sequence Attributes

The Real World Value First Value Mapped (0040,9216) and Real World Value Last Value Mapped (0040,9211) Attributes describe the range of stored pixel values that are mapped by the Sequence Item. Stored pixel values less than the first value mapped, or greater than the last value mapped have no real value attached.

When the Real World Value Intercept (0040,9224) and Real World Value Slope (0040,9225) attributes are supplied, the stored value (SV) is converted to a real world value (RV) using the equation:

RV = (Real World Value Slope) * SV + Real World Value Intercept

When the Real World Value LUT Data (0040,9212) attribute is supplied, Real World Values are obtained via a lookup operation. The stored pixel value of the first value mapped is mapped to the first entry in the LUT Data. Subsequent stored pixel values are mapped to the subsequent entries in the LUT Data up to a stored pixel value equal to the last value mapped.

The number of entries in the LUT data is given by:

Number of entries = Real World Value Last Value Mapped- Real World Value First Value Mapped + 1

The physical units for the real world values obtained from the sequence item are given by the Measurement Units Code Sequence (0040,08EA).

[pic]

Figure C.7.6.16-7Example of mapping stored values to real world values

C.7.6.16.2.12 Contrast/Bolus Usage Macro

Table C.7.16-13 specifies the attributes of the Contrast/Bolus Usage macro.

Table C.7.16-13CONTRAST/BOLUS USAGE MACRO ATTRIBUTES

Attribute Name Tag Type Attribute Description
Contrast/Bolus Usage Sequence (0018,9341) 1 Contains the attributes describing the use of contrast for this frame. One or more Items shall be included in this sequence.
>Contrast/Bolus Agent Number (0018,9337) 1 Identifying number corresponding to the agent described in the Enhanced Contrast/Bolus Module.
>Contrast/Bolus Agent Administered (0018,9342) 1 The administration of the selected agent had begun by the time this frame was acquired. Enumerated Values: YES NO
>Contrast/Bolus Agent Detected (0018,9343) 2 The selected agent was detected in the frame. Enumerated Values: YES NO May only be zero length if the acquisition device is not capable of detecting the presence of this contrast agent in the frame.
>Contrast/Bolus Agent Phase (0018,9344) 2C Nominal phase of intravenous contrast administration. Defined terms: PRE_CONTRAST POST_CONTRAST IMMEDIATE DYNAMIC STEADY_STATE DELAYED ARTERIAL CAPILLARY VENOUS PORTAL_VENOUS Required if Contrast/Bolus Administration Route Sequence (0018,0014) for the Contrast/Bolus Agent Number (0018,9337) defined in the Contrast/Bolus Agent Sequence (0018,0012) is (G-D101, SRT, “Intravenous route”) or (G-D101, SNM3, “Intravenous route”); may be present otherwise. Note: SRT is the preferred designator for SNOMED, but SNM3 is allowed for backward compatibility. See PS3.16.

C.7.6.16.2.13 Pixel Intensity Relationship LUT Macro

Table C.7.6.16-14 specifies the attributes of the Pixel Intensity Relationship LUT Functional Group macro.

Table C.7.6.16-14PIXEL INTENSITY RELATIONSHIP LUT MACRO ATTRIBUTES

Attribute Name Tag Type Attribute Description
Pixel Intensity Relationship LUT Sequence (0028,9422) 1 Defines a sequence of Pixel Intensity Relationship LUTs. One or more items shall be included in this sequence. At least one item with LUT Function (0028,9474) equals TO_LINEAR LUT shall be present if Pixel Intensity Relationship (0028,1040) equals LOG. Only a single item with LUT Function (0028,9474) equals TO_LINEAR LUT shall be present.
>LUT Descriptor (0028,3002) 1 Specifies the format of the LUT Data in this Sequence. See C.11.1.1 and C.7.6.16.2.13.1 for further explanation.
>LUT Data (0028,3006) 1 LUT Data in this Sequence.
>LUT Function (0028,9474) 1 The transformation function this LUT applies to the stored pixel values. Defined Terms: TO_LOG TO_LINEAR

C.7.6.16.2.13.1 Pixel Intensity Relationship LUT

The purpose of this Pixel Intensity Relationship LUT Sequence is to provide information to recalculate the pixel values proportional to the X-Ray beam intensity from the stored pixel values. It is intended to be used by any application that needs transformed pixel values (e.g. scaled back to acquired pixel values) pixel values for further processing and not as replacement of the Modality LUT in the display pipeline, see Figure C.7.6.16-7.

[pic]

Figure C.7.6.16-7Purpose of Pixel Intensity Relationship LUT

C.7.6.16.2.13.2 Pixel Intensity Relationship LUT Data Attribute

The number of bits in the LUT Data attribute (0028,3006) may be different from the value of Bit Stored attribute (0028,0101).

C.7.6.16.2.14 Frame Pixel Shift Macro

Table C.7.6.16-15 specifies the attributes of the Frame Pixel Shift Functional Group macro.

Table C.7.6.16-15FRAME PIXEL SHIFT MACRO ATTRIBUTES

Attribute Name Tag Type Attribute Description
Frame Pixel Shift Sequence (0028,9415) 1 Sequence containing the pixel shift for a number of masks for this frame. One or more items shall be included in this sequence.
>Subtraction Item ID (0028,9416) 1 Identifier of the Subtraction Item in the Mask Subtraction Sequence (0028,6100) to which this pixel shift is associated. See C.7.6.16.2.14.1.
>Mask Sub-pixel Shift (0028,6114) 1 A pair of floating point numbers specifying the fractional vertical [adjacent row spacing] and horizontal [adjacent column spacing] pixel shift applied to the mask before subtracting it from this contrast frame. Note: If no pixel shift has to be applied a pair of zero values should be specified. See Section C.7.6.10.1.2.

C.7.6.16.2.14.1 Subtraction Item ID Description

Subtraction Item ID (0028,9416) specifies the ID of a subtraction operation to which the Mask Sub-pixel Shift (0028,6114) is associated. The Subtraction Item ID is also present in the Mask Subtraction Sequence (0028,6100) to allow this association.

When used as per-frame macro, the Subtraction Item ID (0028,9416) allows to specify different values of Mask Sub-pixel Shift (0028,6114) individually frame by frame, and relate them to a single item of the Mask Subtraction Sequence (0028,6100).

Note: There is no restriction in the number of Subtraction Item ID’s associated to each contrast frame. The same contrast frame may be present in several items of the Mask Subtraction Sequence, each item having a different value of Subtraction Item ID.

When used as shared macro, the Subtraction Item ID (0028,9416) allows to specify one or more values of Mask Sub-pixel Shift that will be applied to all the frames of the Multi-frame image.

Note: Example of usage of Subtraction Item ID in a per-frame macro, see Figure C.7.6.16-8:

In this example of Multi-Frame Image with 3 frames, one Mask Frame (i.e., Frame 1) is applied to the next two frames of the Multi-Frame image (i.e., Frames 2 and 3). Therefore, there is only one item in the Mask Subtraction Sequence, containing its own Subtraction Item ID value (i.e., 100). The Frame Pixel Shift Macro allows to define a Mask Sub-Pixel Shift different for each contrast frame.

First Frame Subtracted: Subtraction of Frame 1 (Mask) to Frame 2, with Sub-Pixel Shift 1.3\2.4

Second Frame Subtracted: Subtraction of Frame 1 (Mask) to Frame 3, with Sub-Pixel Shift 1.9\3.0

[pic]

Figure C.7.6.16-8Example of usage of Subtraction Item ID in a per-frame Macro

C.7.6.16.2.15 Patient Orientation in Frame Macro

Table C.7.6.16-16 specifies the attributes of the Patient Orientation in Frame Functional Group macro.

Table C.7.6.16-16PATIENT ORIENTATION IN FRAME MACRO ATTRIBUTES

Attribute Name Tag Type Attribute Description
Patient Orientation in Frame Sequence (0020,9450) 1 Sequence containing the row and column directions for this frame in the patient. Only a single Item shall be included in this sequence.
>Patient Orientation (0020,0020) 1 Patient direction of the rows and columns of this frame. See C.7.6.1.1.1 for further explanation.

C.7.6.16.2.16 Frame Display Shutter

Table C.7.6.16-17 specifies the attributes of the Frame Display Shutter Functional Group macro.

Table C.7.6.16-17FRAME DISPLAY SHUTTER MACRO ATTRIBUTES

Attribute Name Tag Type Attribute Description
Frame Display Shutter Sequence (0018,9472) 1 Sequence containing the display shutter parameters for this frame. Only a single Item shall be included in this sequence.
>Include ‘Display Shutter Macro’ Table C.7-17A.

C.7.6.16.2.17 Respiratory Synchronization Macro

Table C.7.6.16-18 specifies the attributes of the Respiratory Synchronization Functional Group macro.

Table C.7.6.16-18RESPIRATORY SYNCHRONIZATION MACRO ATTRIBUTES

Attribute Name Tag Type Attribute Description
Respiratory Synchronization Sequence (0020,9253) 1 Sequence that describes the frame specific respiratory synchronization parameters. Only a single Item shall be included in this sequence.
>Respiratory Interval Time (0020,9254) 1C Measured interval time in ms from maximum respiration peak to the next peak for the respiratory cycle in which this frame occurs. See C.7.6.16.2.17.1 for further explanation. Required if Respiratory Motion Compensation Technique (0018,9170) equals other than NONE or REALTIME and Respiratory Trigger Type (0020,9250) is absent or has a value of TIME or BOTH.
>Nominal Percentage of Respiratory Phase (0020,9245) 1C The nominal time relative to the preceding respiratory inspiration maximum divided by the nominal respiratory interval multiplied by 100. Required if used as a dimension index, may be present otherwise.
>Nominal Respiratory Trigger Delay Time (0020,9255) 1 The nominal time in ms from the beginning of the respiratory interval to the value of the Frame Reference DateTime (0018,9151). See C.7.6.16.2.17.1 for further explanation.
>Actual Respiratory Trigger Delay Time (0020,9257) 1C The actual time in ms from the beginning of the respiratory interval to the value of the Frame Reference DateTime (0018,9151). See C.7.6.16.2.17.1 for further explanation. Required if Respiratory Trigger Type (0020,9250) is TIME or BOTH.
>Starting Respiratory Amplitude (0020,9246) 1C Nominal amplitude of the respiratory signal at which the acquisition of data for this frame begins, in percent of the nominal maximum value (which represents maximum inspiration). Required if Respiratory Trigger Type (0020,9250) is AMPLITUDE or BOTH.
>Starting Respiratory Phase (0020,9247) 1C The phase of respiration at which the Starting Respiratory Amplitude (0020,9246) was measured. Enumerated Value: INSPIRATION MAXIMUM EXPIRATION MINIMUM Required if Starting Respiratory Amplitude (0020,9246) is present.
>Ending Respiratory Amplitude (0020,9248) 1C Nominal amplitude of the respiratory signal at which the acquisition of data for this frame ends, in percent of the nominal maximum value (which represents maximum inspiration). Required if Respiratory Trigger Type (0020,9250) is AMPLITUDE or BOTH.
>Ending Respiratory Phase (0020,9249) 1C The phase of respiration at which the Ending Respiratory Amplitude (0020,9248) was measured. Enumerated Value: INSPIRATION MAXIMUM EXPIRATION MINIMUM Required if Ending Respiratory Amplitude (0020,9248) is present.

C.7.6.16.2.17.1 Relationship of Respiratory Timing Attributes

For time based respiratory gating, the Nominal Respiratory Trigger Delay Time (0020,9255) is the prescribed trigger delay time in ms from the previous Respiratory-peak to the value of the Frame Reference DateTime (0018,9151). When frames are acquired with prospective gating, that is, the data acquisition actually begins in response to a timed delay from the Respiratory trigger, it may be that Actual Respiratory Trigger Delay Time (0020,9257) and the Nominal Respiratory Trigger Delay Time (0020,9255) have the same value.

However, when frames are the result of retrospective gating, that is, the data is continuously acquired and then later compared with a simultaneously acquired respiratory waveform and fitted into bins corresponding to nominal phases of the respiratory cycle, then Nominal Respiratory Trigger Delay Time (0020,9255) and the Actual Respiratory Trigger Delay Time (0020,9257) may have different values.

Figure C.7.6.16-9a and C.7.6.16-9b depict the usage.

[pic]

Figure C.7.6.16-9aRespiratory Timing Tags

[pic]

Figure C.7.6.16-9bRelationship of Respiratory Amplitude Attributes

C.7.6.16.2.18 Irradiation Event Identification Macro

Table C.7.6.16-19 specifies the attributes containing the Irradiation Event Identification Functional Group macro.

Table C.7.6.16-19IRRADIATION EVENT IDENTIFICATION MACRO ATTRIBUTES

Attribute Name Tag Type Attribute Description
Irradiation Event Identification Sequence (0018,9477) 1 Sequence containing the Irradiation Event Identification for this frame. Only a single Item shall be included in this sequence.
>Irradiation Event UID (0008,3010) 1 Unique identification of the irradiation event(s) associated with the acquisition of this image.

C.7.6.16.2.19 Radiopharmaceutical Usage Macro

Table C.7.6.16.2-20 specifies the attributes of the Radiopharmaceutical Usage Functional Group macro.

Table C.7.6.16.2-20RADIOPHARMACEUTICAL USAGE MACRO ATTRIBUTES

Attribute Name Tag Type Attribute Description
Radiopharmaceutical Usage Sequence (0018,9737) 1 One or more Items shall be included in this sequence.
>Radiopharmaceutical Agent Number (0018,9729) 1 Identifying number corresponding to the radiopharmaceutical described in the Enhanced PET Isotope Module.

C.7.6.16.2.20 Patient Physiological State Macro

Table C.7.6.16.2-21 specifies the attributes of the Patient Physiological State Functional Group Macro, which describes the physiological state of the patient.

Table C.7.6.16.2-21PATIENT PHYSIOLOGICAL STATE MACRO

Attribute Name Tag Type Attribute Description
Patient Physiological State Sequence (0018,9771) 1 Contains the attributes describing the physiological sate of the patient for this frame. Only a single Item shall be included in this sequence.
>Patient Physiological State Code Sequence (0018,9772) 1 The physiological state of the patient. Only a single Item shall be included in this sequence.
>>Include ‘Code Sequence Macro’ Table 8.8-1 Defined CID 3101

C.7.6.16.2.21 Plane Position (Volume) Macro

Table C.7.6.16.2.21-1 specifies the attributes of the Plane Position (Volume) Functional Group macro.

Table C.7.6.16.2.21-1PLANE POSITION (VOLUME) MACRO ATTRIBUTES

Attribute Name Tag Type Attribute Description
Plane Position (Volume) Sequence (0020,930E) 1 Identifies the position of the plane of this frame. Only a single Item shall be included in this sequence.
>Image Position (Volume) (0020,9301) 1 The x, y, and z coordinates, in mm, of the upper left hand corner (center of the first voxel transmitted) of the plane in the Volume Frame of Reference.

C.7.6.16.2.22 Plane Orientation (Volume) Macro

Table C.7.6.16.2.22-1 specifies the attributes of the Plane Orientation (Volume) Functional Group macro.

Table C.7.6.16.2.22-1PLANE ORIENTATION (VOLUME) MACRO ATTRIBUTES

Attribute Name Tag Type Attribute Description
Plane Orientation (Volume) Sequence (0020,930F) 1 Identifies orientation of the plane of this frame. Only a single Item shall be included in this sequence.
>Image Orientation (Volume) (0020,9302) 1 The direction cosines of the first row and the first column of the frame with respect to the Volume Frame of Reference.

C.7.6.16.2.23 Temporal Position Macro

Table C.7.6.16.2.23-1 specifies the attributes of the Temporal Position Functional Group macro.

Table C.7.6.16.2.23-1TEMPORAL POSITION MACRO ATTRIBUTES

Attribute Name Tag Type Attribute Description
Temporal Position Sequence (0020,9310) 1 Identifies the temporal position of the plane of this frame. Only a single Item shall be included in this sequence.
>Temporal Position Time Offset (0020,930D) 1 Time offset of the frame in the set of frames with different temporal positions, in seconds.

C.7.6.16.2.24 Image Data Type Macro

Table C.7.6.16.2.24-1 specifies the attributes of the Image Data Type Functional Group macro.

Table C.7.6.16.2.24-1 IMAGE DATA TYPE MACRO

Attribute Name Tag Type Attribute Description
Image Data Type Sequence (0018,9807) 1 Identifies the data type characteristics of this frame. Only a single Item shall be included in this sequence.
>Data Type (0018,9808) 1 Identification of the data type of a frame. See C.7.6.16.2.24.1 for Defined Terms and further explanation.
>Aliased Data Type (0018,980B) 1 Indicates whether this data type is “aliased”. Enumerated Values: YES = data are aliased values NO = data are not aliased values See C.7.6.16.2.24.2 for further explanation.

C.7.6.16.2.24.1 Data Type

Data Type (0018,9808) indicates the data type of an image frame. Table C.7.6.16.2.24.1-1 lists Defined Terms for this value.

Table C.7.6.16.2.24.1-1

DATA TYPE DEFINED TERMS

Defined Term Name Defined Term Description
TISSUE_INTENSITY Tissue intensity typically displayed as grayscale (e.g. B-mode)
TISSUE_VELOCITY Velocity (Doppler shifts) of tissue
FLOW_VELOCITY Velocity (Doppler shifts) of blood flow
FLOW_POWER Power contained in the Doppler signal
FLOW_VARIANCE Statistical variance of blood velocity relative to mean
ELASTICITY Scalar value related to the elastic properties of the tissue
PERFUSION Scalar value related to the volume of blood perfusing into tissue
SOUND_SPEED Speed of sound in tissue
ATTENUATION Reduction in strength of ultrasound signal as the wave traverses through the medium

C.7.6.16.2.24.2 Aliased Data Type

Some data types require special treatment when interpolating data values whose type is “aliased”, such as FLOW_VELOCITY when derived from discrete data samples as is done for PW Doppler or sampled CW Doppler. Values of these types are “cyclical” in that the maximum value should be considered adjacent to the minumum value in any interpolation algorithm. Aliased Data Type (0018,980B) indicates whether modular arithmetic is necessary for the associated data type.

Note: For example, when Data Type (0018,9808) is FLOW_VELOCITY, Aliased Data Type (0018,980B) should be set to YES indicating that an interpolation algorithm should support aliased data. When several FLOW_VELOCITY values near the maximum or minimum are interpolated, this algorithm should produce a value near the maximum or minimum. It would be incorrect to use an interpolation algorithm such as the arithmetic mean, which would erroneously produce a result near the mid-point of the range.

C.7.6.17 Multi-frame Dimension Module

The Multi-frame Dimension Module contains a sequence with items pointing to attributes defining a set of dimensions that are usually known prior to the acquisition commencing. It is up to the generating applications to decide what attributes are important to describe the multi-frame dimensions.

The application that generates the Concatenation or SOP Instances may use the order of Dimension Index Pointers (0020,9165) in the Dimension Index Sequence (0020,9222) to guide the receiving application in determining the order of the presentation of image frames. The first index has the highest ranking, the next index has a lower ranking, etc. Frames with higher values for the dimension with the highest ranking would only be presented after all frames that have values for Dimension Index Pointers (0020,9165) of the lower rankings have been presented.

If the set of Dimension Index Pointers does not provide an attribute set whose values are unique for each frame then the order for the frames with the same value set will be incompletely specified. The receiving application could use the logical frame number to resolve this ambiguity. If the attribute set contains more dimensions than are needed to specify a unique ordering, the lower order ranking attribute(s) will have no effect on the ordering.

Note: For example if there were the following indices in the following order:

- Stack ID (1-3)

- In-stack Position Number (1-2 for Stack ID 1, 1-4 for Stack ID 2, 1-3 for Stack ID 3)

- Effective Echo Time (1-2), i.e. every slice has been scanned with 2 different effective echo's

Then the frames could be presented in the following order:

(Stack ID, In-stack Position, Effective Echo Time)

(1,1,1), (1,1,2), (1,2,1), (1,2,2),

(2,1,1), (2,1,2), (2,2,1), (2,2,2), (2,3,1), (2,3,2), (2,4,1), (2,4,2)

(3,1,1), (3,1,2), (3,2,1), (3,2,2), (3,3,1), (3,3,2)

The actual order of the frames in the object is up to the generating application.

If the effective echo time was not included in the Dimension Index Pointers in the above example then the order of sorting for the frames with the same indices will be undefined - in this case there would be 2 frames with the index set (Stack ID, In-stack Position) = (1,1) and the order of these frames is not specified.

If there were another attribute appended to the Dimension Index Pointers, for example TR, then the TR index would not be used in determining the order of the frames. So the Index Frame Pointers would contain (Stack ID, In-stack Position, Effective Echo Time, TR) but the TR index would be irrelevant for frame ordering purposes.

Table C.7.6.17-1 specifies the attributes of the Multi-frame Dimension Module.

Table C.7.6.17-1MULTI-FRAME DIMENSION MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Dimension Organization Sequence (0020,9221) 1 Sequence that lists the Dimension Organization UIDs referenced by the containing SOP Instance. See section C.7.6.17.2 for further explanation. One or more Items shall be included in this Sequence.
>Dimension Organization UID (0020,9164) 1 Uniquely identifies a set of dimensions referenced within the containing SOP Instance. See section C.7.6.17.2 for further explanation.
Dimension Organization Type (0020,9311) 3 Dimension organization of the instance. Defined Terms: 3D Spatial Multi-frame image of parallel planes (3D volume set) 3D_TEMPORAL Temporal loop of parallel-plane 3D volume sets.
Dimension Index Sequence (0020,9222) 1 Identifies the sequence containing the indices used to specify the dimension of the multi-frame object. One or more Items shall be included in this sequence.
>Dimension Index Pointer (0020,9165) 1 Contains the Data Element Tag that is used to identify the Attribute connected with the index. See section C.7.6.17.1 for further explanation.
>Dimension Index Private Creator (0020,9213) 1C Identification of the creator of a group of private data elements. Required if the Dimension Index Pointer (0020,9165) value is the Data Element Tag of a Private Attribute.
>Functional Group Pointer (0020,9167) 1C Contains the Data Element Tag of the Functional Group Sequence that contains the Attribute that is referenced by the Dimension Index Pointer (0020,9165). See section C.7.6.17.1 for further explanation. Required if the value of the Dimension Index Pointer (0020,9165) is the Data Element Tag of an Attribute that is contained within a Functional Group Sequence.
>Functional Group Private Creator (0020,9238) 1C Identification of the creator of a group of private data elements. Required if the Functional Group Pointer 0020,9167) value is the Data Element Tag of a Private Attribute.
>Dimension Organization UID (0020,9164) 1C Uniquely identifies a set of dimensions referenced within the containing SOP Instance. In particular the dimension described by this sequence item is associated with this Dimension Organization UID. See section C.7.6.17.2 for further explanation. Required if the value of the Dimension Organization Sequence (0020,9221) contains Items
>Dimension Description Label (0020,9421) 3 Free text description that explains the meaning of the dimension.

C.7.6.17.1 Dimension Indices

With the Dimension Index Sequence (0020,9222) , Data Element Tags are specified that identify the indices used for a particular SOP Instance.

The actual index values for each frame in a multi-frame header are stored in a single Dimension Index Values Attribute (0020,9157) defined in the Frame Content Functional Group. For each SOP Instance this Attribute has a Value Multiplicity equal to the number of Items in the Sequence. The ordering of the Items in the Sequence defines the ordering in the Dimension Index Values Attribute: Item 1 of the Sequence relates to Value 1, Item 2 to Value 2, etc.

The Dimension Index Pointer (0020,9165) stores ordinal numbers that comprise logical indices for a referenced Attribute. Each Attribute referenced in the Dimension Index Sequence (0020,9222) will have an index stored in the Dimension Index Values (0020,9157) for each frame. Frames assigned the same index shall contain nominally the same value for the underlying Attribute. If the Attribute is not present for some frames, or is present but has no value, then a single index shall be assigned to indicate the lack of the value (i.e., all such frames shall have the same index value, which is different from other index values). It is at the discretion of the SOP Instance creator whether the Attribute values are equivalent, and therefore appropriate for assignment to the same index value.

The Dimension Index Pointer (0020,9165) shall contain the Data Element Tag (gggg,eeee) of the Attribute being indexed.

Notes: 1. Dimension Index Pointer (0020,9165) may point to a Sequence containing a Functional Group. In that case all the Attributes of the Sequence are associated with the index value.

2. The Dimension Index Pointer (0020,9165) may point to a Data Element Tag (gggg,eeee) which is not present for all frames of an object, or does not have a value for all frames of an object. For such frames, index values are still assigned, as described above.

The Functional Group Pointer (0020,9167) value is the Data Element Tag (gggg,eeee) of the Functional Group Sequence that contains the Attribute being indexed. If the Dimension Index Pointer 0020,9165) contains a Data Element Tag that identifies a Functional Group Sequence then the Functional Group Pointer (0020,9167) shall not be present.

If the Dimension Index Pointer (0020,9165) attribute contains a Private Data Element, then the Dimension Index Private Creator (0020,9213) shall contain the Private Creator of the block of Private Data Elements.

If the Functional Group Pointer (0020,9167) attribute contains a Private Data Element, then the Functional Group Private Creator (0020,9238) shall contain the Private Creator of the block of Private Data Elements.

Note: An example of the usage of the Dimension Index Sequence (0020,9222) and Dimension Index Values (0020,9157) attributes:

Dimension Index Sequence (0020,9222) specifies two indices:

Cardiac Trigger Delay Time (0020,9153)Image Position (Patient) (0020,0032)

The Dimension Index Sequence (0020,9222) is filled with the following contents:

Item Attribute Value
1 Dimension Index Pointer (0020,9153)
Functional Group Pointer (0018,9118)
......
2 Dimension Index Pointer (0020,0032)
Functional Group Pointer (0020,9113)
......

The Dimension Index Values (0020,9157) (in the Frame Content Functional Group) for each frame consists of two values:

Index of Cardiac Trigger Delay Time \ Index of Image Position

The SOP Instance creator is responsible for maintaining consistency between the actual value of the attribute listed as the Dimension Index Pointer (0020,9165) and the corresponding value in the Dimension Index Values (0020,9157) attribute.

See Figure C.7.6.17-1 for an illustration of this example.

[pic]

Figure C.7.6.17-1Example of Dimension Index Sequence and Dimension Index Values attributes

C.7.6.17.2 Dimension Organization UID

The Dimension Organization UID (0020,9164) value identifies a set of dimensions to which an Item of the Dimension Index Sequence (0020,9222) belongs.

When different SOP Instances share the same Dimension Organization UID (0020,9164) for a particular Item of the Dimension Index Sequence (0020,9222), equivalent indices from the corresponding Dimension Index Values (0020,9157) shall have the same meaning across the SOP Instances.

This mechanism allows an image creator to explicitly specify that indices are intended to convey identical information across SOP Instances.

The Dimension Organization Sequence attribute (0020,9221) contains a summary of all the Dimension Organization UID (0020,9164) values used in a SOP Instance.

Note: Figure C.7.6.17-2 illustrates how this is used for a SOP Instance created by a multi-planar reformat application from a SOP Instance containing three Items in the Dimension Index Sequence. The meaning of the indices for Temporal Position Index (0020,9128), and MR Echo Sequence (0018,9114) were preserved in the derived SOP Instance, so it shares the Dimension Organization UID for these attributes with the original. Since the reformat was performed with a different orientation, the meaning of the In-Stack Position Number (0020,9057) was not preserved. Therefore a new Dimension Organization UID (0020,9164) was created.

[pic] Figure C.7.6.17-2 Example of use of Dimension Organization Module

C.7.6.18 Physiological Synchronization

C.7.6.18.1 Cardiac Synchronization Module

Table C.7.6.18-1 specifies the attributes of the Cardiac Synchronization Module.

Table C.7.6.18-1 CARDIAC SYNCHRONIZATION MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Cardiac Synchronization Technique (0018,9037) 1C Defines if a cardiac synchronization technique was applied during or after the acquisition. Enumerated Values: NONE REALTIME = total time for the acquisition is shorter than cardiac cycle, no gating is applied PROSPECTIVE = certain thresholds have been set for a gating window that defines the acceptance of measurement data during the acquisition RETROSPECTIVE = certain thresholds have been set for a gating window that defines the acceptance of measurement data after the acquisition PACED = there is a constant RR interval (e.g., Pacemaker), which makes thresholding not required Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise.
Cardiac Signal Source (0018,9085) 1C Cardiac Signal Source. Defined Terms: ECG = electrocardiogram VCG = vector cardiogram PP = peripheral pulse MR = magnetic resonance, i.e. M-mode or cardiac navigator Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED and Cardiac Synchronization Technique (0018,9037) equals other than NONE. Otherwise may be present if Image Type (0008,0008) Value 1 is DERIVED and Cardiac Synchronization Technique (0018,9037) equals other than NONE.
Cardiac RR Interval Specified (0018,9070) 1C R-R interval in ms measured prior to or during the scan. Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED and Cardiac Synchronization Technique (0018,9037) equals other than NONE. Otherwise may be present if Image Type (0008,0008) Value 1 is DERIVED and Cardiac Synchronization Technique (0018,9037) equals other than NONE. Note: The Heart Rate (0018,1088) attribute is not used in this Module, since its value can be derived as 1/ Cardiac RR Interval Specified (0018,9070).
Cardiac Beat Rejection Technique (0018,9169) 1C Cardiac arrhythmia rejection technique. Defined Terms: NONE RR_INTERVAL = rejection based on deviation from average RR interval QRS_LOOP = rejection based on deviation from regular QRS loop PVC = rejection based on PVC criteria Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED and Cardiac Synchronization Technique (0018,9037) equals PROSPECTIVE or RETROSPECTIVE. Otherwise may be present if Image Type (0008,0008) Value 1 is DERIVED and Cardiac Synchronization Technique (0018,9037) equals PROSPECTIVE or RETROSPECTIVE.
Low R-R Value (0018,1081) 2C R-R interval low limit for beat rejection, in ms. Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED and Cardiac Synchronization Technique (0018,9037) equals PROSPECTIVE or RETROSPECTIVE. Otherwise may be present if Image Type (0008,0008) Value 1 is DERIVED and Cardiac Synchronization Technique (0018,9037) equals PROSPECTIVE or RETROSPECTIVE.
High R-R Value (0018,1082) 2C R-R interval high limit for beat rejection, in ms. Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED and Cardiac Synchronization Technique (0018,9037) equals PROSPECTIVE or RETROSPECTIVE. Otherwise may be present if Image Type (0008,0008) Value 1 is DERIVED and Cardiac Synchronization Technique (0018,9037) equals PROSPECTIVE or RETROSPECTIVE.
Intervals Acquired (0018,1083) 2C Number of R-R intervals acquired and used to create the image (not including the intervals rejected). Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED and Cardiac Synchronization Technique (0018,9037) equals other than NONE. Otherwise may be present if Image Type (0008,0008) Value 1 is DERIVED and Cardiac Synchronization Technique (0018,9037) equals other than NONE.
Intervals Rejected (0018,1084) 2C Number of R-R intervals rejected. Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED and Cardiac Synchronization Technique (0018,9037) equals other than NONE. Otherwise may be present if Image Type (0008,0008) Value 1 is DERIVED and Cardiac Synchronization Technique (0018,9037) equals other than NONE.
Skip Beats (0018,1086) 3 Number of beats prescribed to be skipped after each detected arrhythmia.
Cardiac Framing Type (0018,1064) 1C Description of type of framing performed. See C.7.6.18.1.1.1 for description and Defined Terms. Required if type of framing is not time forward from trigger, may be present otherwise.

Note: Low R-R Value (0018,1081), High R-R Value (0018,1082), Intervals Acquired (0018,1083) and Intervals Rejected (0018,1084) in this Module apply to the entire Image. The Cardiac Gating Sequence (0018,9118) in the Cardiac Gating Functional Group uses the same attributes and specifies the values for a single frame.

C.7.6.18.1.1 Attribute Descriptions

C.7.6.18.1.1.1 Cardiac Framing Type

Cardiac Framing Type (0018,1064) is the mechanism used to select the data acquired to construct the frames within a specified cardiac timing interval.

Defined Terms:

FORW = time forward from trigger

BACK = time back before trigger

PCNT = percentage of R-R forward from trigger

C.7.6.18.2 Respiratory Synchronization Module

Table C7.6.18-2 specifies the attributes of the Respiratory Synchronization Module.

Table C.7.6.18-2RESPIRATORY SYNCHRONIZATION MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Respiratory Motion Compensation Technique (0018,9170) 1C Applied technique 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 Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise.
Respiratory Signal Source (0018,9171) 1C Signal source from which respiratory motion is derived. Defined Terms: NONE BELT = includes various devices that detect or track expansion of the chest 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 Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED and Respiratory Motion Compensation Technique (0018,9170) equals other than NONE. Otherwise may be present if Image Type (0008,0008) Value 1 is DERIVED and Respiratory Motion Compensation Technique (0018,9170 equals other than NONE.
Respiratory Trigger Delay Threshold (0020,9256) 1C Respiratory trigger threshold in percent of the chest expansion for the frame relative to the last Respiratory-Peak. See C.7.6.16.2.17.1 for further explanation. Required if Respiratory Motion Compensation Technique (0018,9170) equals other than NONE, REALTIME or BREATH_HOLD and if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise.
Respiratory Trigger Type (0020,9250) 1C Characteristic of the respiratory signal used to the define the respiratory triggering. Defined Terms: TIME AMPLITUDE BOTH Required if the value is not TIME, may be present otherwise.

C.7.6.18.3 Bulk Motion Synchronization Module

Table C7.6.18-3 specifies the attributes of the Bulk Motion Synchronization Module.

Table C.7.6.18-3BULK MOTION SYNCHRONIZATION MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Bulk Motion Compensation Technique (0018,9172) 1C Applied technique to reduce bulk or other physiology motion artifacts. Defined Terms: NONE REALTIME = image acquisition shorter than motion cycle GATING = prospective gating TRACKING = prospective through and/or in-plane motion tracking RETROSPECTIVE = retrospective gating CORRECTION = retrospective image correction Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise.
Bulk Motion Signal Source (0018,9173) 1C Signal source to measure motion. Defined Terms: JOINT = joint motion detection NAVIGATOR = MR navigator and organ edge detection MR_PHASE = phase (of center k-space line) Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED and Bulk Motion Compensation Technique (0018,9172) equals other than NONE. Otherwise may be present if Image Type (0008,0008) Value 1 is DERIVED and Bulk Motion Compensation Technique (0018,9172) equals other than NONE.

C.7.6.19 Supplemental Palette Color Lookup Table Module

This module is used in conjunction with Multi-frame IODs that use RGB color in a number of frames. The value of the Pixel Presentation (0008,9205) for such frames equals COLOR.

Table C.7.6.19-1 specifies the Attributes that describe the Lookup table data.

Table C.7.6.19-1SUPPLEMENTAL PALETTE COLOR TABLE LOOKUP MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Red Palette Color Lookup Table Descriptor (0028,1101) 1 Specifies the format of the Red Palette Color Lookup Table Data (0028,1201). See C.7.6.3.1.5 for further explanation.
Green Palette Color Lookup Table Descriptor (0028,1102) 1 Specifies the format of the Green Palette Color Lookup Table Data (0028,1202). See C.7.6.3.1.5 for further explanation.
Blue Palette Color Lookup Table Descriptor (0028,1103) 1 Specifies the format of the Blue Palette Color Lookup table Data (0028,1203). See C.7.6.3.1.5 for further explanation.
Red Palette Color Lookup Table Data (0028,1201) 1 Red Palette Color Lookup Table Data. See C.7.6.3.1.6 for further explanation.
Green Palette Color Lookup Table Data (0028,1202) 1 Green Palette Color Lookup Table Data. See C.7.6.3.1.6 for further explanation.
Blue Palette Color Lookup Table Data (0028,1203) 1 Blue Palette Color Lookup Table Data. See C.7.6.3.1.6 for further explanation.

C.7.6.20 Patient Orientation Module

This section describes attributes of the Patient Orientation Module by describing the patient orientation related to gravity and equipment. Table C.7.6.20-1 contains IOD Attributes that describe the Patient Orientation.

Table C.7.6.20-1 PATIENT ORIENTATION MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Include ‘Patient Orientation Macro’ Table 10-15

C.7.6.21 Image - Equipment Coordinate Relationship Module

This section describes the Image - Equipment Coordinate Relationship module. Table C.7.6.21-1 contains the attributes that specify how the equipment (e.g. gantry) and patient oriented coordinate system (in conjunction with the Image Position (Patient) (0020,0032) and Image Orientation (Patient) (0020,0037) attributes) are related.

Table C.7.6.21-1IMAGE - EQUIPMENT COORDINATE RELATIONSHIP MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Image to Equipment Mapping Matrix (0028,9520) 1 A 4x4 homogeneous transformation matrix that maps patient coordinate space of the reconstructed image to the equipment defined original coordinate space. Matrix elements shall be listed in row-major order. See C.7.6.21.1.
Equipment Coordinate System Identification (0028,9537) 1 Identification of the type of equipment coordinate system in which the projection images were acquired. See C.7.6.21.2. Defined Terms: ISOCENTER

C.7.6.21.1 Image to Equipment Mapping Matrix

The Image to Equipment Mapping Matrix (0028,9520) is used to describe the relationship between the Patient oriented coordinate system and a modality specific equipment coordinate system. This mapping can only be used with systems that have a well-defined equipment coordinate system (such as XA, etc.).

The Image to Equipment Mapping Matrix A M B describes how to transform a point ( B x, B y, B z) with respect to the Patient coordinate system into ( A x, A y, A z) with respect to the equipment coordinate system according to the equation below.

Error! Not a valid embedded object.

The Image to Equipment Mapping Matrix is a rigid transformation that involves only translations and rotations. Mathematically, the matrix shall be orthonormal and can describe six degrees of freedom: three translations, and three rotations.

Note: Both the Patient Coordinate System and the Equipment Coordinate System are expressed in millimeters.

C.7.6.21.2 Equipment Coordinate System Identification

The Equipment Coordinate System Identification (0028,9537) identifies the Reference Coordinate System to which the Image to Equipment Mapping Matrix (0028,9520) is related.

The Defined Term ISOCENTER refers to a coordinate reference system where the origin corresponds with the center of rotation of the projections.

Note: For X-Ray 3D Angiographic Images created from SOP Instances of the Enhanced XA SOP Class (1.2.840.10008.5.1.4.1.1.12.1.1) the isocenter coordinate system is used to describe the positioning of the table and positioner (see C.8.19.6.13), and will use only the Defined Term ISOCENTER.

C.7.6.22 Specimen Module

Table C.7.6.22-1 specifies the Attributes that identify one or more Specimens being imaged.

Table C.7.6.22-1

SPECIMEN MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Include ‘Specimen Macro’ Table C.7.6.22-2

Table C.7.6.22-2

SPECIMEN MACRO

Attribute Name Tag Type Attribute Description
Container Identifier (0040,0512) 1 The identifier for the container that contains the specimen(s) being imaged. See Section C.7.6.22.1.1.
Issuer of the Container Identifier Sequence (0040,0513) 2 Organization that assigned the Container Identifier. Zero or one Item shall be included in this sequence.
>Include ‘HL7v2 Hierarchic Designator’ Macro Table 10-17
Alternate Container Identifier Sequence (0040,0515) 3 Sequence of alternate identifiers for the container that contains the specimen(s) being imaged. These may have been assigned, e.g., by the manufacturer, or by another institution that collected the specimen. One or more Items are permitted in this sequence.
>Container Identifier (0040,0512) 1 The identifier for the container that contains the specimen(s) being imaged.
>Issuer of the Container Identifier Sequence (0040,0513) 2 Organization that assigned the Container Identifier. Zero or one Item shall be included in this sequence.
>>Include ‘HL7v2 Hierarchic Designator Macro’ Table 10-17
Container Type Code Sequence (0040,0518) 2 Type of container that contains the specimen(s) being imaged. Zero or one Item shall be included in this sequence.
>Include ‘Code Sequence Macro’ Table 8.8-1 Baseline CID 8101
Container Description (0040,051A) 3 Description of the container.
Container Component Sequence (0040,0520) 3 Description of one or more components of the container (e.g., description of the slide and of the coverslip). One or more Items are permitted in this sequence.
>Container Component Type Code Sequence (0050,0012) 1 Type of container component. Only a single Item shall be included in this sequence.
>>Include ‘Code Sequence Macro’ Table 8.8-1 Baseline CID 8102
>Manufacturer (0008,0070) 3 Manufacturer of the container component.
>Manufacturer's Model Name (0008,1090) 3 Manufacturer’s model name of the container component.
>Container Component ID (0050,001B) 3 Manufacturer’s identifier of the container component, e.g., Lot Number and/or Version.
>Container Component Length (0050,001C) 3 Length in mm of container component.
>Container Component Width (0050,0015) 3 Width in mm of container component.
>Container Component Diameter (0050,001D) 3 Diameter in mm of container component for cylindrical or circular components.
>Container Component Thickness (0050,0013) 3 Thickness in mm of container component
>Container Component Material (0050,001A) 3 Material of container component. Defined Terms: GLASS PLASTIC METAL
>Container Component Description (0050,001E) 3 Container component text description.
Specimen Description Sequence (0040,0560) 1 Sequence of identifiers and detailed description of the specimen(s) being imaged. One or more Items shall be included in this sequence. Each specimen imaged in the Pixel Data shall be identified by an Item in this Sequence. Other specimens in/on the container, but not imaged in the Pixel Data, may also be identified by Items in this Sequence.
>Specimen Identifier (0040,0551) 1 A departmental information system identifier for the Specimen. See Sections C.7.6.22.1.1 and C.7.6.22.1.2. If a single specimen is present in a container, the value of the Specimen Identifier and the value of the Container Identifier are typically the same.
>Issuer of the Specimen Identifier Sequence (0040,0562) 2 The name or code for the institution that has assigned the Specimen Identifier. Zero or one Item shall be included in this sequence.
>>Include ‘HL7v2 Hierarchic Designator Macro’ Table 10-17
>Specimen UID (0040,0554) 1 Unique Identifier for Specimen. See Section C.7.6.22.1.2.
>Specimen Type Code Sequence (0040,059A) 3 Specimen Type. Only a single Item is permitted in this sequence.
>>Include ‘Code Sequence Macro’ Table 8.8-1 Baseline CID 8103
>Specimen Short Description (0040,0600) 3 Short textual specimen description (may include ancestor specimen descriptions).
>Specimen Detailed Description (0040,0602) 3 Detailed textual specimen description (may include ancestor specimen descriptions).
>Specimen Preparation Sequence (0040,0610) 2 Sequence of Items identifying the process steps used to prepare the specimen for image acquisition. This includes description of all processing necessary to interpret the image. Zero or more Items shall be included in this sequence. This Sequence includes description of the specimen sampling step from an ancestor specimen, potentially back to the original part collection. See Section C.7.6.22.1.3.
>>Specimen Preparation Step Content Item Sequence (0040,0612) 1 Sequence of Content Items identifying the processes used in one preparation step to prepare the specimen for image acquisition. One or more Items shall be included in this sequence.
>>>Include ‘Content Item Macro’ Table 10-2 Baseline Template ID is 8001 Specimen Preparation
>Include ‘Primary Anatomic Structure Macro’ Table 10-8 Original anatomic location in patient of specimen. This location may be identical to that of the parent specimen, may be further refined by modifiers depending on the sampling procedure for this specimen, or may be a distinct concept.
>Specimen Localization Content Item Sequence (0040,0620) 1C Sequence of Content Items identifying the location of the specimen in the container and/or in the image. See Section C.7.6.22.1.4. One or more Items shall be included in this sequence. Required if multiple specimens present in the image. May be present otherwise.
>>Include ‘Content Item Macro’ Table 10-2 Defined Template ID is 8004 Specimen Localization

C.7.6.22.1 Specimen Module Attributes
C.7.6.22.1.1 Container Identifier and Specimen Identifier

“Specimen” is the role played by a discrete physical object (or a collection of objects that are considered as a unit) that is the subject of pathology examination.

A specimen is a physical object (or a collection of objects) when the laboratory considers it a single discrete, uniquely identified unit that is the subject of one or more steps in the laboratory (diagnostic) workflow. This includes objects at all levels of processing, including fresh tissue, dissected organs, tissue embedded in paraffin, sections made from embedded tissue, and liquid preparations.

Specimens are physically managed by being placed in or on a container. The concept of container includes buckets, cassettes, vials, and slides. While there is usually one specimen per container, it is possible, in some laboratory workflows, for multiple specimens to be in/on a container.

Both specimens and specimen containers have logical identifiers for workflow management. The logical identifier of a container is usually conveyed on a label on the container. The specimen itself will typically not be physically labeled with its identifier. For the usual case of a single specimen in/on a container, the logical identifiers may be identical. However, when there are multiple specimens in/on a container, each specimen receives a distinct logical identifier. These identifiers are encoded in the SOP Instance using attributes Container Identifier (0040,0512) and Specimen Identifier (0040,0551).

Notes: 1. This definition of “specimen” extends the common definition beyond the part or parts that were submitted for examination (e.g., from surgery) to include any derivative piece that may be separately analyzed or examined, such as a block or slide preparation.

2. Although many Pathology Information Systems use a hierarchical system for identifying parts, blocks and slides, there should be no assumption made that this will be the case and in particular, there should be no attempt to parse a given Specimen Identifier to retrieve an accession number or other higher level identifier.

C.7.6.22.1.2 Specimen Identifier and Specimen UID

The Specimen Identifier (0040,0551) must be unique at least within the Study; the actual scope of uniqueness is determined by the departmental information system that assigns the IDs. Each specimen shall also be assigned a globally unique Specimen UID (0040,0554) that allows referencing beyond the scope of a Study. This UID may be used, for instance, if a specimen is sent to another institution for further analysis.

C.7.6.22.1.3 Specimen Preparation Sequence and Specimen Preparation Step Content Item Sequence

Interpretation of specimen images requires information about the source of the specimen and its preparation (e.g., sampling, fixation, staining). The processing steps used to prepare a specimen are recorded in the Specimen Preparation Sequence (0040,0610). This sequence may include one Item for each processing step (as defined in the laboratory workflow) in the history of the specimen, and those Items are composed of a set of Content Items in the Specimen Preparation Step Content Item Sequence (0040,0612).

The Specimen Preparation Sequence may include description of the original part collected from the patient, the processing of that part, the sampling of tissue from the part and the preparation of that sample, and the further sub-sampling and processing of the tissue. In other words, the description of a specfic specimen may include descriptions of the specimen’s ancestors.

The Specimen Preparation Sequence Items shall be in ascending chronological order.

C.7.6.22.1.4 Specimen Localization Content Item Sequence

When there are multiple specimens in/on a container, the Specimen Localization Content Item Sequence (0040,0620) is used to identify the location of the specimen in the container, as there is no physical label with the Specimen Identifier. This Content Item Sequence, in accordance with TID 8004, allows the specimen to be localized by a distance in one to three dimensions from a reference point on the container, by an identified physical description such as a colored ink, or by its location as shown in a referenced image of the container. The referenced image may use an overlay, burned-in annotation, or an associated Presentation State SOP Instance to specify the location of the specimen.

C.7.6.23 Enhanced Palette Color Lookup Table Module

Table C.7.6.23-1 specifies the attributes that define data flow through the Enhanced Blending and Display Pipeline. See C.7.6.23.1 for an overview of the Enhanced Blending and Display Pipeline.

Table C.7.6.23-1 ENHANCED PALETTE COLOR LOOKUP TABLE MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description
Data Frame Assignment Sequence (0028,1401) 1 Sequence of items each assigning frames of one particular value of Data Type (0018,9808) to a data path in the Enhanced Blending and Display Pipeline. One, two, or three items shall be included in this sequence.
>Data Type (0018,9808) 1 Identification of the data type of frames using this data path assignment.
>Data Path Assignment (0028,1402) 1 The data path to use for this data type in the Enhanced Blending and Display Pipeline. Enumerated vaules: PRIMARY_PVALUES PRIMARY_SINGLE SECONDARY_SINGLE SECONDARY_HIGH SECONDARY_LOW See C.7.6.23.2 for usage.
>Bits Mapped to Color Lookup Table (0028,1403) 3 The number of most significant bits of each value of Pixel Data (7FE0,0010) from this frame contributing to the Palette Color Lookup Table input. If absent, Bits Stored (0028,0101) bits of each value of Pixel Data (7FE0,0010) from this frame contributes to the Palette Color Lookup Table input. See C.7.6.23.3 for usage.
>Include VOI LUT Macro Table C.11-2b
Blending LUT 1 Sequence (0028,1404) 1C Specification of the weight of the primary path input to the Blending Operation, i.e. the value which is referred to as “Weight 1” in the Enhanced Blending and Display Pipeline. Only a single item shall be included in this sequence. Required if there are one or more items of the Data Path Assignment Sequence (0028,1402) other than PRIMARY_PVALUES.
>Blending LUT 1 Transfer Function (0028,1405) 1 Specifies the algorithm used to determine the output value of Blending LUT 1. Enumerated vaules: CONSTANT ALPHA_1 ALPHA_2 TABLE See C.7.6.23.4 for details.
>Blending Weight Constant (0028,1406) 1C Constant value of the Weight input to blending operation. Shall be from 0.0 to 1.0, inclusive. Required if Blending LUT 1 Transfer Function (0028,1405) is CONSTANT.
>Blending Lookup Table Descriptor (0028,1407) 1C Specifies the format of Blending Lookup Table Data (0028,1408) in this sequence item. The second value (first stored pixel value mapped) shall be zero. See Section C.7.6.23.5 for further explanation. Required if Blending LUT 1 Transfer Function (0028,1405) is TABLE.
>Blending Lookup Table Data (0028,1408) 1C Contains the Blending Lookup Table values for this Weight input to the Blending Operation. Required if Blending LUT 1 Transfer Function (0028,1405) is TABLE.
Blending LUT 2 Sequence (0028,140C) 1C Specification of the weight of the secondary path input to the Blending Operation, i.e. the value which is referred to as “Weight 2” in the Enhanced Blending and Display Pipeline. Only a single item shall be included in this sequence. Required if there are one or more items of the Data Path Assignment Sequence (0028,1402) other than PRIMARY_PVALUES.
>Blending LUT 2 Transfer Function (0028,140D) 1 Specifies the algorithm used to determine the output value of Blending LUT 2. Enumerated values: CONSTANT ONE_MINUS ALPHA_1 ALPHA_2 TABLE See C.7.6.23.4 for details.
>Blending Weight Constant (0028,1406) 1C Constant value of the Weight input to blending operation. Shall be from 0.0 to 1.0, inclusive. Required if Blending LUT 2 Transfer Function (0028,140D) is CONSTANT.
>Blending Lookup Table Descriptor (0028,1407) 1C Specifies the format of Blending Lookup Table Data (0028,1408) in this sequence item. The second value (first stored pixel value mapped) shall be zero. See Section C.7.6.23.5 for further explanation. Required if Blending LUT 2 Transfer Function (0028,140D) is TABLE.
>Blending Lookup Table Data (0028,1408) 1C Contains the Blending Lookup Table values for this Weight input to the Blending operation. Required if Blending LUT 2 Transfer Function (0028,140D) is TABLE.
Enhanced Palette Color Lookup Table Sequence (0028,140B) 1C This sequence contains the Palette Color Lookup Table. One or two items shall be included in this sequence. Required if Data Path Assignment (0028,1402) is present with a value other than PRIMARY_PVALUES.
>Data Path ID (0028,140E) 1 Identifier of the data path in which this Palette Color Lookup Table is used. Enumerated values: PRIMARY SECONDARY Each item shall have a distinct value of Data Path ID.
>RGB LUT Transfer Function (0028,140F) 1 Specifies the mapping that takes place between the input value and RGB input to the Blending Operation. Enumerated values: EQUAL_RGB Output is R=G=B=input value TABLE Output is RGB LUT values
>Alpha LUT Transfer Function (0028,1410) 1 Specifies the transformation that is used to create the Alpha input to the Blending LUTs. Note: Depending on the values of Blending LUT 1 Transfer Function (0028,1405) and Blending LUT 2 Transfer Function (0028,140D) the Alpha LUT value may be ignored. It is recommended that IDENTITY be used if this is the case. Enumerated values: NONE IDENTITY TABLE
>Red Palette Color Lookup Table Descriptor (0028,1101) 1C Specifies the format of the Red Palette Color Lookup Table Data (0028,1201). The second value (first stored pixel value mapped) shall be zero. Required if RGB LUT Transfer Function (0028,140F) is TABLE.
>Green Palette Color Lookup Table Descriptor (0028,1102) 1C Specifies the format of the Green Palette Color Lookup Table Data (0028,1202). The second value (first stored pixel value mapped) shall be zero. Required if RGB LUT Transfer Function (0028,140F) is TABLE.
>Blue Palette Color Lookup Table Descriptor (0028,1103) 1C Specifies the format of the Blue Palette Color Lookup Table Data (0028,1203). The second value (first stored pixel value mapped) shall be zero. Required if RGB LUT Transfer Function (0028,140F) is TABLE.
>Alpha Palette Color Lookup Table Descriptor (0028,1104) 1C Specifies the format of the Alpha Palette Color Lookup Table Data. The second value (first stored pixel value mapped) shall be zero. Required if Alpha LUT Transfer Function (0028,1410) is TABLE.
>Red Palette Color Lookup Table Data (0028,1201) 1C Red Palette Color Lookup Table Data. Required if RGB LUT Transfer Function (0028,140F) is TABLE.
>Green Palette Color Lookup Table Data (0028,1202) 1C Green Palette Color Lookup Table Data. Required if RGB LUT Transfer Function (0028,140F) is TABLE.
>Blue Palette Color Lookup Table Data (0028,1203) 1C Blue Palette Color Lookup Table Data. Required if RGB LUT Transfer Function (0028,140F) is TABLE.
>Alpha Palette Color Lookup Table Data (0028,1204) 1C Alpha LUT contains the blending values for the data frames. Required if Alpha LUT Transfer Function (0028,1410) is TABLE.
ICC Profile (0028,2000) 1C An ICC Profile encoding the transformation of device-dependent color stored pixel values into PCS-Values. See Section C.11.15.1.1 When present, defines the color space of the output of the Enhanced Blending and Display Pipeline. Required if Data Path Assignment (0028,1402) is present and there exists any value other than PRIMARY_PVALUES.

C.7.6.23.1 Description of the Enhanced Blending and Display Pipeline

The Enhanced Blending and Display Pipeline describes a scheme for blending of data frames of different Data Types and a color/grayscale mapping for display recommended by the provider of this information. There are no requirements upon an receiving application to utilize this recommendation in the processing and display of the referenced image.

The blending transformation model in Figure C.7.6.23-1 applies for mapping images derived from one, two, or three data frames with the same image position and orientation but of different values of Data Type (0018,9808) to grayscale P-values or color PCS-values for presentation. These inputs to the pipeline are frames of pixel values obtained from Pixel Data (7FE0,0010) and structured as described by attributes of the Image Pixel Module. Co-located pixels from each data frame are processed through the Pipeline, resulting in one output sample at that location.

The model utilizes up to two data paths called the Primary and the Secondary data paths. Each input data frame may be initially processed by a Modality LUT and a VOI LUT. If not explicitly specified, the Modality LUT and VOI LUT are assumed to be identity transformations. The Primary path may be used alone to obtain only grayscale transformation without blending. In this case, the Primary data path input after going through the Modality LUT and VOI LUT is mapped through a Presentation LUT to obtain device independent grayscale values (P-values) for presentation.

Either Primary or Secondary paths alone or both paths together may be used to obtain color transformation with blending. Up to one data frame input in the Primary data path and up to two data frames input in the Secondary data path are allowed for this blending transformation. These frames may be mapped to color using one-input or two-input palette color lookup tables depending on the number of data frames input to the data path. Alternatively if a path has one data frame, values may be converted to RGB (where R=G=B) before blending, if pseudo-color presentation of this data path is not desired. RGB values from Primary and Secondary data paths are combined via a “Blending Operation” in which the RGB color components are multiplied by a corresponding blending weight function (Weight 1 and Weight 2, respectively), and for each color component the two products are added together to produce the blended output value of that component. All inputs to the Blending Operation are normalized to the range 0.0 to 1.0, inclusive, even if they are fixed integer values that had been the entries in a lookup table.

Each of the Weight inputs to the blending operation is the output of a corresponding Blending LUT Transfer Function, which is selectable as either a constant or a derivation of the data frame values as described in C.7.6.23.4.

The RGB output from the Blending Operation is clamped to limit each color component (R, G, and B) to fall within the range 0.0 to 1.0, inclusive. The clamping function simply sets the value of any color component to 1.0 if the output from the Blending operation for that component exceeds 1.0. The RGB output of the clamping function is made available for use in rendering and slicing algorithms. Further, the output of the clamping function is transformed by the Profile Connection Space Transformation to device independent color values (PCS-values) for presentation.

If the input data frame values are representative of real world data, then they can be mapped to the real world values and units using the Real World Value Mapping Macro.

Note: PS3.17 “Enhanced US Data Type Blending Examples” describes a number of examples of the Enhanced Blending and Display Pipeline with specific attribute values for each example that invoke particular data flows through the pipeline.

[pic]

Figure C.7.6.23-1: Enhanced Blending and Display Pipeline

C.7.6.23.2 Data Path Assignment

Data Path Assignment (0028,1402) specifies the data path to use in the Enhanced Blending and Display Pipeline for each data frames of a particular data type.

Enumerated values:

PRIMARY_PVALUES Data Frame values are passed through the Presentation LUT to produce grayscale P-values. No blending is performed.

PRIMARY_SINGLE Data Frame values are inputs to the Primary Palette Color Lookup Table.

SECONDARY_SINGLE Data Frame values are inputs to the Secondary Palette Color Lookup Table.

SECONDARY_HIGH Data Frame values having Data Path Assignment (0028,1402)of SECONDARY_HIGH are concatenated as the most significant bits with Data Frame values having Data Path Assignment of SECONDARY_LOW to form inputs to the Secondary Palette Color Lookup Table.

SECONDARY_LOW Data Frame values having Data Path Assignment (0028,1402)of SECONDARY_LOW are concatenated as the least significant bits with Data Frame values having Data Path Assignment of SECONDARY_HIGH to form inputs to the Secondary Palette Color Lookup Table.

C.7.6.23.3 Bits Mapped To Color Lookup Table

The number of entries of each Palette Color Lookup Table is specified in the Palette Color Lookup Table Descriptors of the lookup table components. As described in Section C.7.6.3.1.5, a maximum of 65,536 (2 16 ) data entries is permitted, which would require input values of 16 bits to access all Palette Color Lookup Table entries. For tables with less than the maximum number of Palette Color Lookup Table entries, correspondingly smaller input values are required.

In the Enhanced Blending and Display Pipeline, the Palette Color Lookup Table input values are obtained from one or two data frames, depending on the values of the Data Path Assignment (0028,1402) attributes; for Data Path Assignment (0028,1402)= PRIMARY_SINGLE or SECONDARY_SINGLE, the input values are obtained from stored pixel values of a single data frame (after processing through the Modality LUT and/or VOI LUT), while for Data Path Assignment (0028,1402)= SECONDARY_HIGH and SECONDARY_LOW, the input values are constructed from stored pixel values of two data frames (after processing through Modality LUTs and/or VOI LUTs) as described below.

The number of bits in each data frame stored pixel value is specified by the value of Bits Stored (0028,0101). It is possible that the number of bits in the PRIMARY_SINGLE or SECONDARY_SINGLE data frame or the sum of the numbers of bits in the SECONDARY_HIGH and SECONDARY_LOW data frames is greater than the number of bits needed to address all Palette Color Lookup Table entries. The values of Bits Mapped to Color Lookup Table (0028,1403) specify the number of bits from the corresponding data frame stored pixel values that contribute to the Palette Color Lookup Table input values, as follows:

If Data Path Assignment is PRIMARY_SINGLE or SECONDARY_SINGLE, the input to the Palette Color Lookup Table is the number of most significant bits specified by Bits Mapped to Color Lookup Table (0028,1403) from the data frame stored pixel values. For Data Path Assignment SECONDARY_HIGH or SECONDARY_LOW, the number of most significant bits specified by Bits Mapped to Color Lookup Table (0028,1403) from each data frame’s stored pixel values are concatenated to create the Palette Color Lookup Table input values, with the SECONDARY_HIGH frame’s bits comprising the most significant part of the input value and the SECONDARY_LOW frame’s bits comprising the least significant part of the input value.

If the resulting Palette Color Lookup Table input value is greater than the number of Palette Color Lookup Table entries as specified by the Palette Color Lookup Table Descriptor first value, then the output from the Palette Color Lookup Table shall be the last value in the Palette Color Lookup Table. However, it is recommended that the values of Bits Mapped To Color Lookup Table (0028,1403) and number of Palette Color Lookup Table entries be selected such that all input values are mapped to distinct entries in the Palette Color Lookup Table.

C.7.6.23.4 Blending LUT Transfer Function

The value of the Blending LUT 1 Transfer Function (0028,1405) and Blending LUT 2 Transfer Function (0028,140D) specify the algorithm used to determine the output values of the Blending LUT 1 and Blending LUT 2, respectively.

Enumerated values:

CONSTANT A constant floating point value from 0.0 to 1.0, inclusive.

ALPHA_1 Pass-through the Alpha 1 input value from the Alpha Palette Color Lookup Table of the Primary data path.

ALPHA_2 Pass-through the Alpha 2 input value from the Alpha Palette Color Lookup Table of the Secondary data path.

TABLE The output of a Table defining a function of the Alphas from both data paths: The Alpha 1 input value from the Alpha Palette Color Lookup Table of the Primary data path and the Alpha 2 input value from the Alpha Palette Color Lookup Table of the Secondary data are concatenated to form an index into a Lookup Table, with the Alpha 1 value providing the most significant bits of the index and the Alpha 2 value providing the least significant bits of the index.

If the index is too large for the number of entries in the Lookup Table, the last value of the Lookup Table is used for any index value greater than the number of Lookup Table entries. If the index is too small for the number of entries in the Lookup Table, than not all entries in the Lookup Table are accessed. The total number of bits in the index value shall be equal to or less than 16.

ONE_MINUS The Blending LUT 2 value is (1 - Blending LUT 1 output). Used for Blending LUT 2 Transfer Function (0028,140D) only.

C.7.6.23.5 Blending LUT Descriptor

The three values of the Blending Lookup Table Descriptor (0028,1407) describe the format of the data in Blending Lookup Table Data (0028,1408).

The first value is the number of entries in the lookup table. When the number of table entries is equal to 65,536 (2 16 ), then this value shall be 0. The number of entries shall be equal to the number of possible values in the input.

Note: For example, for 8 bit input to the Blending LUT the tables must have 256 entries, while for 16 bit input to the Blending LUT the tables must have 65,536 entries.

The second value is the first input value mapped, and shall always be 0 for an Blending LUT. This input value is mapped to the first entry in the LUT. Subsequent input values are mapped to the subsequent entries in the LUT Data up to an input value equal to number of entries + first value mapped - 1 which is mapped to the last entry in the LUT Data. There are no input values greater than number of entries - 1.

The third value specifies the number of bits for each entry in the LUT Data. This value shall be between 8 and 16, inclusive. The LUT Data shall be stored in a format equivalent to 16 bits allocated where the high bit is equal to bits stored - 1, where bits stored is the third value.

C.7.6.23.6 Lossy Compression and Palette Color Lookup Tables (Informative)

Image objects containing non-monotonic Palette Color LUTs that are lossy compressed may potentially experience a change in the index values that results in the displayed image having a significantly different appearance than the original image.

C.7.7 Patient Summary Module

Retired. See PS 3.3 2004.

C.7.8 Study Content Module

Retired. See PS 3.3 2004.

C.7.9 Palette Color Lookup Table Module

Table C.7-22 specifies the Attributes that describe the Lookup table data for images with Palette Color photometric interpretation.

When the Palette Color Lookup Table Module is present in an Image IOD, the conditional requirements for the use of Palette Color Lookup Table Data (0028,1201-1203) and Segmented Palette Color Lookup Table Data (0028,1221-1223), described in Table C.7.9, shall take precedence over the conditional requirements described in the Image Pixel Module (See Section C.7.6.3). When the Palette Color Lookup Table Module is present in a Presentation State IOD or Color Palette IOD, the Palette Color Lookup Table Data (0028,1201-1203) attributes are mandatory and the Segmented Palette Color Lookup Table Data (0028,1221-1223) shall not be present.

When the Palette Color Lookup Table Module is present in a Color Palette IOD, the 3rd value of Palette Color Lookup Table Descriptor (0028,1101-1103) (i.e, the number of bits for each entry in the Lookup Table Data) shall be 8.

Table C.7-22 PALETTE COLOR LOOKUP MODULE

Attribute Name Tag Type Attribute Description
Include ‘Palette Color Lookup Macro’ Table C.7-22a

Table C.7-22a PALETTE COLOR LOOKUP MACRO

Attribute Name Tag Type Attribute Description
Red Palette Color Lookup Table Descriptor (0028,1101) 1 Specifies the format of the Red Palette Color Lookup Table Data (0028,1201). See C.7.6.3.1.5 for further explanation.
Green Palette Color Lookup Table Descriptor (0028,1102) 1 Specifies the format of the Green Palette Color Lookup Table Data (0028,1202). See C.7.6.3.1.5 for further explanation.
Blue Palette Color Lookup Table Descriptor (0028,1103) 1 Specifies the format of the Blue Palette Color Lookup table Data (0028,1203). See C.7.6.3.1.5 for further explanation.
Palette Color Lookup Table UID (0028,1199) 3 Palette Color Lookup Table UID. See C.7.9.1 for further explanation.
Red Palette Color Lookup Table Data (0028,1201) 1C Red Palette Color Lookup Table Data. Required if segmented data is NOT used in an Image IOD, or if the IOD is a Presentation State IOD or Color Palette IOD. See C.7.6.3.1.6 for further explanation.
Green Palette Color Lookup Table Data (0028,1202) 1C Green Palette Color Lookup Table Data. Required if segmented data is NOT used in an Image IOD, or if the IOD is a Presentation State IOD or Color Palette IOD. See C.7.6.3.1.6 for further explanation.
Blue Palette Color Lookup Table Data (0028,1203) 1C Blue Palette Color Lookup Table Data. Required if segmented data is NOT used in an Image IOD, or if the IOD is a Presentation State IOD or Color Palette IOD. See C.7.6.3.1.6 for further explanation.
Segmented Red Palette Color Lookup Table Data (0028,1221) 1C Segmented Red Palette Color Lookup Table Data. Required if segmented data is used in an Image IOD; shall not be present in a Presentation State IOD or Color Palette IOD. See C.7.9.2 for further explanation.
Segmented Green Palette Color Lookup Table Data (0028,1222) 1C Segmented Green Palette Color Lookup Table Data. Required if segmented data is used in an Image IOD; shall not be present in a Presentation State IOD. or Color Palette IOD See C.7.9.2 for further explanation.
Segmented Blue Palette Color Lookup Table Data (0028,1223) 1C Segmented Blue Palette Color Lookup Table Data. Required if segmented data is used in an Image IOD; shall not be present in a Presentation State IOD or Color Palette IOD. See C.7.9.2 for further explanation.

C.7.9.1 Palette Color Lookup Table UID

This data element uniquely identifies a palette color lookup table set (red, green, blue).

Note: This can be used to avoid reloading a palette if a system already has that palette loaded without examining all the data entries in the palette.

If this Attribute is present in a Color Palette IOD, it shall have the same value as the SOP Instance UID.

C.7.9.2 Segmented Palette Color Lookup Table Data

The Segmented Palette Color Lookup Table Data (0028,1221-1223) is stored as a series of segments, see Table C.7-23. When the segments are expanded into the actual lookup table data, it shall have the number of table entries specified by the first value of the Palette Color Lookup Table Descriptors (0028,1101-1103), Number of Table Entries.

These lookup tables shall be used only when segmented lookup table data use is desriable and there is a single sample per pixel (single image plane) in the image.

Table C.7-23COMPRESSED PALETTE COLOR LOOKUP TABLE DATA

Segment 0
Segment 1
...
Segment n

There are currently three types of segments: discrete, linear, and indirect. The segments type is identified by the opcodes in Table C.7-24:

Table C.7-24SEGMENT TYPES

Opcode Segment type
0 Discrete
1 Linear
2 Indirect
3 & above reserved

C.7.9.2.1 Discrete Segment Type

The discrete segment is used to represent a series of palette components which are not monotonic with respect to their predecessors or successors. The SegmentLength indicates the number of lookup table entries.

The format of the Discrete Segment Type shall be as in Table C.7-25:

Table C.7-25DISCRETE SEGMENT TYPE

Segment Opcode = 0
Segment Length
Segment Length number of lookup table entries

C.7.9.2.2 Linear Segment Type

The linear segment represents a series of palette components whose values may be represented by a straight line.

X = palette address, Y = Value contained in the palette.

(Xo, Yo) = end of the previous segment

(Xo + SegmentLength, Y1) = end of this linear segment

Where: Y1 is contained in the data portion of this segment.

During expansion, the application should “connect” the previous segment’s endpoint, (Xo, Yo), with this segment’s endpoint, (Xo + SegmentLength, Y1) using a straight line, by computing the values for each point between the endpoints.

Note: Because the linear segment uses the end point from the previous segment, a linear segment can not be the first segment.

The linear segment’s format shall be as as in Table C.7-26:

Table C.7-26LINEAR SEGMENT TYPE

Segment Opcode = 1
SegmentLength
Y1

C.7.9.2.3 Indirect Segment Type

The indirect segment allows the re-use of repetitive regions within lookup table without respecifying the segment. The opcode is followed by the number of segments to copy and one offset pointer to the first segment to copy. The byte offset is relative to the beginning of the lookup table. For example, if an indirect segment wants to point to the first segment, then the offset will be zero. The offset is a 32 bit value but is stored in the segment as a least significant 16 bit value followed by a most significant 16 bit value. An indirect segment shall not point to or copy another indirect segment. This avoids the need for recursion and also avoids the possibility of infinite loops.

The indirect segment’s format shall be as follows:

Table C.7-27INDIRECT SEGMENT TYPE

Segment Opcode = 2
Number of segments to copy
Least significant 16 bits of byte offset to first segment to copy
Most significant 16 bits of byte offset to first segment to copy

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