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A.86.1.2.3 RT Physician Intent IOD Module Table

Table A.86.1.2-1. RT Physician Intent IOD Modules

IE	Module	Reference	Usage
Patient	Patient	C.7.1.1	M
Patient	Clinical Trial Subject	C.7.1.3	U
Study	General Study	C.7.2.1	M
	Patient Study	C.7.2.2	U
	Clinical Trial Study	C.7.2.3	U
Series	General Series	C.7.3.1	M
	Clinical Trial Series	C.7.3.2	U
	Enhanced RT Series	C.36.3	M
Equipment	General Equipment	C.7.5.1	M
Equipment	Enhanced General Equipment	C.7.5.2	M
RT Physician Intent	General Reference	C.12.4	M
	RT Physician Intent	C.36.5	M
	RT Enhanced Prescription	C.36.6	U
	RT Treatment Phase Intent	C.36.7	C - Required if RT Treatment Phase Intent Presence Flag (3010,0045) equals YES.
	SOP Common	C.12.1	M
	Common Instance Reference	C.12.2	M
	Radiotherapy Common Instance	C.36.4	M

A.86.1.2.4 RT Physician Intent IOD Constraints

A.86.1.2.4.1 Modality Attribute

The value of Modality (0008,0060) shall be RTINTENT.

A.86.1.2.4.2 Radiotherapy Common Instance Module

The following Code Sequences shall have a value from the specified CID:

Code Sequence	CID
Author Identification Sequence (3010,0019)	For Organizational Role Code Sequence (0044,010A) DCID 9536 “Radiotherapy Prescribing and Segmenting Person Role” shall be used.

A.86.1.3 RT Segment Annotation IOD

A.86.1.3.1 RT Segment Annotation IOD Description

The RT Segment Annotation IOD annotates any general-purpose entity that represents geometric information such as Segmentation IOD, Surface Segmentation IOD, and RT Structure Set IOD with radiotherapy-specific information that cannot be encoded in the content of the annotated SOP Instance, or overrides that content with new or additional interpretation.

A.86.1.3.2 RT Segment Annotation IOD Entity-Relationship Model

A.86.1.3.3 RT Segment Annotation IOD Module Table

Table A.86.1.3-1. RT Segment Annotation IOD Modules

IE	Module	Reference	Usage
Patient	Patient	C.7.1.1	M
Patient	Clinical Trial Subject	C.7.1.3	U
Study	General Study	C.7.2.1	M
	Patient Study	C.7.2.2	U
	Clinical Trial Study	C.7.2.3	U
Series	General Series	C.7.3.1	M
	Clinical Trial Series	C.7.3.2	U
	Enhanced RT Series	C.36.3	M
Equipment	General Equipment	C.7.5.1	M
Equipment	Enhanced General Equipment	C.7.5.2	M
RT Segment Annotation	RT Segment Annotation	C.36.8	M
	Segment Reference	C.36.9	M
	General Reference	C.12.4	M
	SOP Common	C.12.1	M
	Common Instance Reference	C.12.2	M
	Radiotherapy Common Instance	C.36.4	M

A.86.1.3.4 RT Segment Annotation IOD Constraints

A.86.1.3.4.1 Modality Attribute

The value of Modality (0008,0060) shall be RTSEGANN.

A.86.1.3.4.2 Radiotherapy Common Instance Module

The following Code Sequences shall have a value from the specified CID:

Code Sequence	CID
Author Identification Sequence (3010,0019)	For Organizational Role Code Sequence (0044,010A) DCID 9536 “Radiotherapy Prescribing and Segmenting Person Role” shall be used.

A.86.1.4 RT Radiation Set IOD

A.86.1.4.1 RT Radiation Set IOD Description

The RT Radiation Set IOD represents an RT Radiation Set, which is a set of radiation deliveries that are intended to be delivered together in a single fraction (see Section 7.14.5). The RT Radiation Set also contains a description of the fractionation pattern, the intended number of fractions and the associated dose contributions.

A.86.1.4.2 RT Radiation Set IOD Entity-Relationship Model

A.86.1.4.3 RT Radiation Set IOD Module Table

Table A.86.1.4-1. RT Radiation Set IOD Modules

IE	Module	Reference	Usage
Patient	Patient	C.7.1.1	M
Patient	Clinical Trial Subject	C.7.1.3	U
Study	General Study	C.7.2.1	M
	Patient Study	C.7.2.2	U
	Clinical Trial Study	C.7.2.3	U
Series	General Series	C.7.3.1	M
	Clinical Trial Series	C.7.3.2	U
	Enhanced RT Series	C.36.3	M
Equipment	General Equipment	C.7.5.1	M
Equipment	Enhanced General Equipment	C.7.5.2	M
Frame of Reference	Frame of Reference	C.7.4.1	M
RT Radiation Set	General Reference	C.12.4	M
	RT Radiation Set	C.36.10	M
	RT Dose Contribution	C.36.11	C - Required if the dose delivered is tracked.
	SOP Common	C.12.1	M
	Common Instance Reference	C.12.2	M
	Radiotherapy Common Instance	C.36.4	M

A.86.1.4.4 RT Radiation Set IOD Constraints

A.86.1.4.4.1 Modality Attribute

The value of Modality (0008,0060) shall be RTRAD.

A.86.1.4.4.2 RT Radiation Set and Referenced RT Radiation Instances

The User Content Label (3010,0033) in each RT Radiation Instance shall be unique across all SOP Instances referenced by an Instance of the RT Radiation Set.

A.86.1.4.4.3 Radiotherapy Common Instance Module

The following Code Sequences shall have a value from the specified CID:

Code Sequence	CID
Author Identification Sequence (3010,0019)	For Organizational Role Code Sequence (0044,010A) DCID 9555 “Radiotherapy Treatment Planning Person Role” shall be used.

A.86.1.4.4.4 RT Dose Contribution Module

Where dose contributions are not available at the time of RT Radiation Set definition and application (e.g., for emergency treatments) this Module may be absent. This does not exclude retrospective dose calculation and creation of associated RT Dose Image objects.

A.86.1.5 C-Arm Photon-Electron Radiation IOD

A.86.1.5.1 C-Arm Photon-Electron Radiation IOD Description

The C-Arm Photon-Electron Radiation IOD describes a radiotherapy treatment to be performed on a C-Arm delivery device using photon or electron radiation.

A.86.1.5.2 C-Arm Photon-Electron Radiation IOD Entity-Relationship Model

A.86.1.5.3 C-Arm Photon-Electron Radiation IOD Module Table

Table A.86.1.5-1. C-Arm Photon-Electron Radiation IOD Modules

IE	Module	Reference	Usage
Patient	Patient	C.7.1.1	M
Patient	Clinical Trial Subject	C.7.1.3	U
Study	General Study	C.7.2.1	M
	Patient Study	C.7.2.2	U
	Clinical Trial Study	C.7.2.3	U
Series	General Series	C.7.3.1	M
	Clinical Trial Series	C.7.3.2	U
	Enhanced RT Series	C.36.3	M
Equipment	General Equipment	C.7.5.1	M
Equipment	Enhanced General Equipment	C.7.5.2	M
Frame of Reference	Frame of Reference	C.7.4.1	M
RT Radiation	General Reference	C.12.4	M
	RT Delivery Device Common	C.36.12	M
	RT Radiation Common	C.36.13	M
	C-Arm Photon-Electron Delivery Device	C.36.14	M
	C-Arm Photon-Electron Beam	C.36.15	M
	SOP Common	C.12.1	M
	Common Instance Reference	C.12.2	M
	Radiotherapy Common Instance	C.36.4	M

A.86.1.5.4 C-Arm Photon-Electron Radiation IOD Constraints

A.86.1.5.4.1 Modality Attribute

The Value of Modality (0008,0060) shall be RTRAD.

A.86.1.5.4.2 RT Delivery Device Common Module

The Equipment Frame of Reference UID (300A,0675) shall be 1.2.840.10008.1.4.3.1, which identifies the [IEC 61217] Fixed Coordinate System Frame of Reference; see Section C.36.12.2.1.

The Frame of Reference identifies the Patient Coordinate System used to define the geometric setup of the radiation beam with respect to the patient. The relationship of the patient-based coordinates to the Equipment Frame of Reference is specified by a transformation (see Section 10.39).

The following Code Sequences shall have a value from the specified CID:

Code Sequence	CID
Radiation Dosimeter Unit Sequence (300A,0658)	DCID 9552 “C-Arm Photon-Electron Dosimeter Unit”.

The RT Device Distance Reference Location Code Sequence (300A,0659) shall contain the value (130358, DCM, "Nominal Radiation Source Location").

A.86.1.5.4.3 RT Radiation Common Module

The value of RT Record Flag (300A,0639) shall be NO.

The following Code Sequences shall have a value from the specified CID:

Code Sequence	CID
RT Treatment Technique Code Sequence (3010,0080)	DCID 9511 “General External Radiotherapy Procedure Technique”.
Treatment Machine Special Mode Code Sequence (300A,0635)	DCID 9543 “Radiotherapy Treatment Machine Mode”.

A.86.1.5.4.4 Radiotherapy Common Instance Module

The following Code Sequences shall have a value from the specified CID:

Code Sequence	CID
Author Identification Sequence (3010,0019)	Organizational Role Code Sequence (0044,010A) DCID 9555 “Radiotherapy Treatment Planning Person Role”

A.86.1.6 Tomotherapeutic Radiation IOD

A.86.1.6.1 Tomotherapeutic Radiation IOD Description

The Tomotherapeutic Radiation IOD represents the information required to describe a radiotherapy treatment on a serial or helical tomotherapeutic delivery device.

A.86.1.6.2 Tomotherapeutic Radiation IOD Entity-Relationship Model

A.86.1.6.3 Tomotherapeutic Radiation IOD Module Table

Table A.86.1.6-1. Tomotherapeutic Radiation IOD Modules

IE	Module	Reference	Usage
Patient	Patient	C.7.1.1	M
Patient	Clinical Trial Subject	C.7.1.3	U
Study	General Study	C.7.2.1	M
	Patient Study	C.7.2.2	U
	Clinical Trial Study	C.7.2.3	U
Series	General Series	C.7.3.1	M
	Clinical Trial Series	C.7.3.2	U
	Enhanced RT Series	C.36.3	M
Equipment	General Equipment	C.7.5.1	M
Equipment	Enhanced General Equipment	C.7.5.2	M
Frame of Reference	Frame of Reference	C.7.4.1	M
RT Radiation	General Reference	C.12.4	M
	RT Delivery Device Common	C.36.12	M
	RT Radiation Common	C.36.13	M
	Tomotherapeutic Delivery Device	C.36.16	M
	Tomotherapeutic Beam	C.36.17	M
	SOP Common	C.12.1	M
	Common Instance Reference	C.12.2	M
	Radiotherapy Common Instance	C.36.4	M

A.86.1.6.4 Tomotherapeutic Radiation IOD Constraints

A.86.1.6.4.1 Modality Attribute

The value of Modality (0008,0060) shall be RTRAD.

A.86.1.6.4.2 RT Delivery Device Common Module

The Equipment Frame of Reference UID (300A,0675) shall be 1.2.840.10008.1.4.3.1, which identifies the [IEC 61217] Fixed Coordinate System Frame of Reference; see Section C.36.12.2.1.

The following Code Sequence shall have a value from the identified CID:

Code Sequence	CID
Radiation Dosimeter Unit Sequence (300A,0658)	DCID 9557 “Tomotherapeutic Dosimeter Unit”

The RT Device Distance Reference Location Code Sequence (300A,0659) shall contain the value (130358, DCM, "Nominal Radiation Source Location").

A.86.1.6.4.3 RT Radiation Common Module

The value of RT Record Flag (300A,0639) shall be NO.

The following Code Sequences shall have a value from the identified CIDs:

Code Sequence	CID
RT Treatment Technique Code Sequence (3010,0080)	DCID 9512 “Tomotherapeutic Radiotherapy Procedure Technique”
Treatment Machine Special Mode Code Sequence (300A,0635)	DCID 9543 “Radiotherapy Treatment Machine Mode”

A.86.1.6.4.4 Radiotherapy Common Instance Module

The following code sequence shall have a value from the identified CID:

Code Sequence	CID
Author Identification Sequence (3010,0019)	Organizational Role Code Sequence (0044,010A) DCID 9555 “Radiotherapy Treatment Planning Person Role”

A.86.1.7 Robotic-Arm Radiation IOD

A.86.1.7.1 Robotic-Arm Radiation IOD Description

The Robotic-Arm Radiation IOD specifies the Robotic Path and collimation parameters required to describe a radiotherapy treatment on a robotic-arm delivery device. A Robotic Path is a sequence of Robotic Nodes. A Robotic Node specifies a Radiation Source location for a Robotic-Arm delivery device.

A.86.1.7.2 Robotic-Arm Radiation IOD Entity-Relationship Model

A.86.1.7.3 Robotic-Arm Radiation IOD Module Table

Table A.86.1.7-1. Robotic-Arm Radiation IOD Modules

IE	Module	Reference	Usage
Patient	Patient	C.7.1.1	M
Patient	Clinical Trial Subject	C.7.1.3	U
Study	General Study	C.7.2.1	M
	Patient Study	C.7.2.2	U
	Clinical Trial Study	C.7.2.3	U
Series	General Series	C.7.3.1	M
	Clinical Trial Series	C.7.3.2	U
	Enhanced RT Series	C.36.3	M
Equipment	General Equipment	C.7.5.1	M
Equipment	Enhanced General Equipment	C.7.5.2	M
Frame of Reference	Frame of Reference	C.7.4.1	M
RT Radiation	General Reference	C.12.4	M
	RT Delivery Device Common	C.36.12	M
	RT Radiation Common	C.36.13	M
	Robotic-Arm Delivery Device	C.36.18	M
	Robotic-Arm Path	C.36.19	M
	SOP Common	C.12.1	M
	Common Instance Reference	C.12.2	M
	Radiotherapy Common Instance	C.36.4	M

A.86.1.7.4 Robotic-Arm Radiation IOD Module Constraints

A.86.1.7.4.1 Modality Attribute

The value of Modality (0008,0060) shall be RTRAD.

A.86.1.7.4.2 RT Delivery Device Common Module

The Equipment Frame of Reference UID (300A,0675) shall be 1.2.840.10008.1.4.3.2, which identifies the Standard Robotic-Arm Coordinate System Frame of Reference; see Section C.36.12.2.2.

The following code sequences shall have a value from the identified CID:

Code Sequence	CID
Radiation Dosimeter Unit Sequence (300A,0658)	DCID 9559 “Robotic Delivery Device Dosimeter Unit”

The RT Device Distance Reference Location Code Sequence (300A,0659) shall contain the value (130358, DCM, "Nominal Radiation Source Location").

A.86.1.7.4.3 RT Radiation Common Module

The value of RT Record Flag (300A,0639) shall be NO.

The following code sequences shall have a value from the identified CID:

Code Sequence	CID
RT Treatment Technique Code Sequence (3010,0080)	DCID 9523 “Robotic Radiotherapy Procedure Technique”
Treatment Machine Special Mode Code Sequence (300A,0635)	DCID 9543 “Radiotherapy Treatment Machine Mode”

A.86.1.7.4.4 Radiotherapy Common Instance Module

The following code sequence shall have a value from the identified CID:

Code Sequence	CID
Author Identification Sequence (3010,0019)	Organizational Role Code Sequence (0044,010A) DCID 9555 “Radiotherapy Treatment Planning Person Role”

A.86.1.8 RT Radiation Record Set IOD

The RT Radiation Record Set IOD references a set of RT Radiation Record Instances of a radiotherapy treatment that has been performed using a single RT Radiation Set SOP Instance and its referenced RT Radiation Instances.

A.86.1.8.1 RT Radiation Record Set IOD Description

A.86.1.8.2 RT Radiation Record Set IOD Entity-Relationship Model

A.86.1.8.3 RT Radiation Record Set IOD Module Table

Table A.86.1.8-1. RT Radiation Record Set IOD Modules

IE	Module	Reference	Usage
Patient	Patient	C.7.1.1	M
Patient	Clinical Trial Subject	C.7.1.3	U
Study	General Study	C.7.2.1	M
	Patient Study	C.7.2.2	U
	Clinical Trial Study	C.7.2.3	U
Series	General Series	C.7.3.1	M
	Clinical Trial Series	C.7.3.2	U
	Enhanced RT Series	C.36.3	M
Equipment	General Equipment	C.7.5.1	M
Equipment	Enhanced General Equipment	C.7.5.2	M
RT Delivered Radiation	General Reference	C.12.4	M
	RT Radiation Record Set	C.36.20	M
	RT Dose Contribution Record	C.36.21	C - Required if the dose delivered is tracked.
	SOP Common	C.12.1	M
	Common Instance Reference	C.12.2	M
	Radiotherapy Common Instance	C.36.4	M

A.86.1.8.4 RT Radiation Record Set IOD Constraints

A.86.1.8.4.1 RT Dose Contribution Record

Where dose contributions are not available at the time of delivery of the radiotherapeutic treatments specified by the RT Radiation Set IOD (e.g., for emergency treatments), the RT Dose Contribution Record Module may be absent. This does not exclude retrospective dose calculation and creation of associated RT Dose Image objects.

A.86.1.9 RT Radiation Salvage Record IOD

A.86.1.9.1 RT Radiation Salvage Record IOD Description

The RT Radiation Salvage Record IOD contains the record of a complete or partial fraction of therapeutic radiation delivered using any therapeutic device where recording by the modality-specific RT Radiation Record IOD was not possible.

A device usually creates RT Radiation Record SOP Instances using modality-specific RT Radiation Record IODs and transfers these Instances to a system that captures treatment records. If this process fails (e.g. because of failed transfer operations) and the recorded SOP Instances are not recoverable from the device, the RT Radiation Salvage Record IOD may be used to represent radiation delivery captured by a manual entry of the delivered treatment. Systems providing manual entry capabilities might not be able to create a modality-specific RT Radiation Record SOP Instance covering all device-specific parameters in question and/or the user might not know all the details. Therefore, the modality-specific RT Radiation Record IODs cannot be properly populated. The RT Radiation Salvage Record IOD allows essential information to be recorded.

A.86.1.9.2 RT Radiation Salvage Record IOD Entity-Relationship Model

A.86.1.9.3 RT Radiation Salvage Record IOD Module Table

Table A.86.1.9-1. RT Radiation Salvage Record IOD Modules

IE	Module	Reference	Usage
Patient	Patient	C.7.1.1	M
Patient	Clinical Trial Subject	C.7.1.3	U
Study	General Study	C.7.2.1	M
	Patient Study	C.7.2.2	U
	Clinical Trial Study	C.7.2.3	U
Series	General Series	C.7.3.1	M
	Clinical Trial Series	C.7.3.2	U
	Enhanced RT Series	C.36.3	M
Equipment	General Equipment	C.7.5.1	M
Equipment	Enhanced General Equipment	C.7.5.2	M
Frame of Reference	Frame of Reference	C.7.4.1	U
RT Delivered Radiation	General Reference	C.12.4	M
	RT Delivery Device Common	C.36.12	M
	RT Radiation Record Common	C.36.22	M
	RT Radiation Salvage Record	C.36.23	M
	SOP Common	C.12.1	M
	Common Instance Reference	C.12.2	M
	Radiotherapy Common Instance	C.36.4	M

A.86.1.9.4 RT Radiation Salvage Record IOD Constraints

A.86.1.9.4.1 Modality Attribute

The value of Modality (0008,0060) shall be RTRAD.

A.86.1.9.4.2 RT Delivery Device Common Module

The Equipment Frame of Reference UID (300A,0675) shall have the value used by the SOP Instance referenced in the Referenced RT Instance Sequence (300A,0631) of the RT Radiation Record Common Module.

The following code sequences shall have values from the identified CIDs:

Code Sequence	CID
Radiation Dosimeter Unit Sequence (300A,0658)	Defined CID is the CID specified for the SOP Instance referenced in the Referenced RT Instance Sequence (300A,0631) of the RT Radiation Record Common Module.

A.86.1.9.4.3 RT Radiation Record Common Module

The value of RT Record Flag (300A,0639) shall be YES.

The value of Treatment Record Content Origin (300A,0709) shall be USER.

The following code sequences shall have values from the identified CIDs:

Code Sequence	CID
RT Treatment Technique Code Sequence (3010,0080)	Defined CID is the CID specified for the SOP Instance referenced in the Referenced RT Instance Sequence (300A,0631) of the RT Radiation Record Common Module.
Treatment Machine Special Mode Sequence (300A,0635)	Defined CID is the CID specified for the SOP Instance referenced in the Referenced RT Instance Sequence (300A,0631) of the RT Radiation Record Common Module.

A.86.1.9.4.4 Radiotherapy Common Instance Module

The following code sequences shall have values from the identified CIDs:

Code Sequence	CID
Author Identification Sequence (3010,0019)	For Organizational Role Code Sequence (0044,010A) DCID 9562 “Radiotherapy Treatment Delivery Person Role” shall be used.

A.86.1.9.4.5 Frame of Reference Module

The Frame of Reference UID (0020,0052) identifies the patient-based Frame of Reference while the therapeutic radiation was delivered. The Frame of Reference UID relates the geometric parameters of this SOP Instance to other SOP Instances such as Images, Segmentations, etc. If the patient moves with respect to the patient positioning device between the delivery recorded by the current SOP Instance and another SOP Instance, a new Frame of Reference UID shall be issued for any SOP Instances created after the move. See also Section C.7.4.1.

The relationship between the patient-oriented coordinate system identified by this Frame of Reference and the Equipment Coordinate System is described in Section 10.39.1.

A.86.1.10 C-Arm Photon-Electron Radiation Record IOD

A.86.1.10.1 C-Arm Photon-Electron Radiation Record IOD Description

The C-Arm Photon-Electron Radiation Record IOD contains the record of a radiotherapy treatment that has been performed using a C-Arm Photon-Electron Radiation SOP Instance.

A.86.1.10.2 C-Arm Photon-Electron Radiation Record IOD Entity-Relationship Model

A.86.1.10.3 C-Arm Photon-Electron Radiation Record IOD Module Table

Table A.86.1.10.3-1. C-Arm Photon-Electron Radiation Record IOD Modules

IE	Module	Reference	Usage
Patient	Patient	C.7.1.1	M
Patient	Clinical Trial Subject	C.7.1.3	U
Study	General Study	C.7.2.1	M
	Patient Study	C.7.2.2	U
	Clinical Trial Study	C.7.2.3	U
Series	General Series	C.7.3.1	M
	Clinical Trial Series	C.7.3.2	U
	Enhanced RT Series	C.36.3	M
Equipment	General Equipment	C.7.5.1	M
Equipment	Enhanced General Equipment	C.7.5.2	M
Frame of Reference	Frame of Reference	C.7.4.1	M
Frame of Reference	Synchronization	C.7.4.2	C - Required if time synchronization was applied
RT Delivered Radiation	General Reference	C.12.4	M
	RT Delivery Device Common	C.36.12	M
	RT Radiation Record Common	C.36.22	M
	C-Arm Photon-Electron Delivery Device	C.36.14	M
	C-Arm Photon-Electron Beam	C.36.15	M
	SOP Common	C.12.1	M
	Common Instance Reference	C.12.2	M
	Radiotherapy Common Instance	C.36.4	M

A.86.1.10.4 C-Arm Photon-Electron Radiation Record IOD Constraints

A.86.1.10.4.1 Modality Attribute

The value of Modality (0008,0060) shall be RTRAD.

A.86.1.10.4.2 RT Delivery Device Common Module

The Equipment Frame of Reference UID (300A,0675) shall be 1.2.840.10008.1.4.3.1, which identifies the [IEC 61217] Fixed Coordinate System Frame of Reference, see Section C.36.12.2.1.

The following code sequences shall have values from the identified CIDs:

Code Sequence	CID
Radiation Dosimeter Unit Sequence (300A,0658)	DCID 9552 “C-Arm Photon-Electron Dosimeter Unit”

The RT Device Distance Reference Location Code Sequence (300A,0659) shall contain the value (130358, DCM, "Nominal Radiation Source Location").

A.86.1.10.4.3 RT Radiation Record Common Module

The value of RT Record Flag (300A,0639) shall be YES. The value of RT Radiation Physical and Geometric Content Detail Flag (300A,0638) shall be IDENT_ONLY.

The following code sequences shall have a value from the identified CIDs:

Code Sequence	CID
RT Treatment Technique Code Sequence (3010,0080)	DCID 9511 “General External Radiotherapy Procedure Technique”
Treatment Machine Special Mode Sequence (300A,0635)	DCID 9543 “Radiotherapy Treatment Machine Mode”

A.86.1.10.4.4 Radiotherapy Common Instance Module

The following code sequences shall have values from the identified CIDs:

Code Sequence	CID
Author Identification Sequence (3010,0019)	For Organizational Role Code Sequence (0044,010A) DCID 9562 “Radiotherapy Treatment Delivery Person Role” shall be used.

A.86.1.10.4.5 Frame of Reference Module

See Section A.86.1.9.4.5.

A.86.1.11 Tomotherapeutic Radiation Record IOD

A.86.1.11.1 Tomotherapeutic Radiation Record IOD Description

The Tomotherapeutic Radiation Record IOD contains the record of a radiotherapy treatment that has been performed using a Tomotherapeutic Radiation SOP Instance.

A.86.1.11.2 Tomotherapeutic Radiation Record IOD Entity-Relationship Model

A.86.1.11.3 Tomotherapeutic Radiation Record IOD Module Table

Table A.86.1.11-1. Tomotherapeutic Radiation Record IOD Modules

IE	Module	Reference	Usage
Patient	Patient	C.7.1.1	M
Patient	Clinical Trial Subject	C.7.1.3	U
Study	General Study	C.7.2.1	M
	Patient Study	C.7.2.2	U
	Clinical Trial Study	C.7.2.3	U
Series	General Series	C.7.3.1	M
	Clinical Trial Series	C.7.3.2	U
	Enhanced RT Series	C.36.3	M
Equipment	General Equipment	C.7.5.1	M
Equipment	Enhanced General Equipment	C.7.5.2	M
Frame of Reference	Frame of Reference	C.7.4.1	M
Frame of Reference	Synchronization	C.7.4.2	C - Required if time synchronization was applied
RT Delivered Radiation	General Reference	C.12.4	M
	RT Delivery Device Common	C.36.12	M
	RT Radiation Record Common	C.36.22	M
	Tomotherapeutic Delivery Device	C.36.16	M
	Tomotherapeutic Beam	C.36.17	M
	SOP Common	C.12.1	M
	Common Instance Reference	C.12.2	M
	Radiotherapy Common Instance	C.36.4	M

A.86.1.11.4 Tomotherapeutic Radiation Record IOD Constraints

A.86.1.11.4.1 Modality Attribute

The value of Modality (0008,0060) shall be RTRAD.

A.86.1.11.4.2 RT Delivery Device Common Module

The Equipment Frame of Reference UID (300A,0675) shall be 1.2.840.10008.1.4.3.1, which identifies the [IEC 61217] Fixed Coordinate System Frame of Reference, see Section C.36.12.2.1.

The following code sequences shall have values from the identified CIDs:

Code Sequence	CID
Radiation Dosimeter Unit Sequence (300A,0658)	DCID 9557 “Tomotherapeutic Dosimeter Unit”

The RT Device Distance Reference Location Code Sequence (300A,0659) shall contain the value (130358, DCM, "Nominal Radiation Source Location").

A.86.1.11.4.3 RT Radiation Record Common Module

The value of RT Record Flag (300A,0639) shall be YES. The value of RT Radiation Physical and Geometric Content Detail Flag (300A,0638) shall be IDENT_ONLY.

The following code sequences shall have a value from the identified CIDs:

Code Sequence	CID
RT Treatment Technique Code Sequence (3010,0080)	DCID 9512 “Tomotherapeutic Radiotherapy Procedure Technique”
Treatment Machine Special Mode Sequence (300A,0635)	DCID 9543 “Radiotherapy Treatment Machine Mode”

A.86.1.11.4.4 Radiotherapy Common Instance Module

The following code sequences shall have values from the identified CIDs:

Code Sequence	CID
Author Identification Sequence (3010,0019)	Organizational Role Code Sequence (0044,010A) DCID 9562 “Radiotherapy Treatment Delivery Person Role”.

A.86.1.11.4.5 Frame of Reference Module

See Section A.86.1.9.4.5.

A.86.1.12 Robotic-Arm Radiation Record IOD

A.86.1.12.1 Robotic-Arm Radiation Record IOD Description

The Robotic-Arm Radiation Record IOD contains the record of a radiotherapy treatment that has been performed using a Robotic-Arm Radiation SOP Instance.

A.86.1.12.2 Robotic-Arm Radiation Record IOD Entity-Relationship Model

A.86.1.12.3 Robotic-Arm Radiation Record IOD Module Table

Table A.86.1.12-1. Robotic-Arm Radiation Record IOD Modules

IE	Module	Reference	Usage
Patient	Patient	C.7.1.1	M
Patient	Clinical Trial Subject	C.7.1.3	U
Study	General Study	C.7.2.1	M
	Patient Study	C.7.2.2	U
	Clinical Trial Study	C.7.2.3	U
Series	General Series	C.7.3.1	M
	Clinical Trial Series	C.7.3.2	U
	Enhanced RT Series	C.36.3	M
Equipment	General Equipment	C.7.5.1	M
Equipment	Enhanced General Equipment	C.7.5.2	M
Frame of Reference	Frame of Reference	C.7.4.1	M
Frame of Reference	Synchronization	C.7.4.2	C - Required if time synchronization was applied
RT Delivered Radiation	General Reference	C.12.4	M
	RT Delivery Device Common	C.36.12	M
	RT Radiation Record Common	C.36.22	M
	Robotic-Arm Delivery Device	C.36.18	M
	Robotic-Arm Path	C.36.19	M
	SOP Common	C.12.1	M
	Common Instance Reference	C.12.2	M
	Radiotherapy Common Instance	C.36.4	M

A.86.1.12.4 Robotic-Arm Radiation Record IOD Constraints

A.86.1.12.4.1 Modality Attribute

The value of Modality (0008,0060) shall be RTRAD.

A.86.1.12.4.2 RT Delivery Device Common Module

The Equipment Frame of Reference UID (300A,0675) shall be 1.2.840.10008.1.4..3.2, which identifies the Standard Robotic-Arm Coordinate System Frame of Reference, see Section C.36.12.2.2.

The following code sequences shall have values from the identified CIDs:

Code Sequence	CID
Radiation Dosimeter Unit Sequence (300A,0658)	DCID 9559 “Robotic Delivery Device Dosimeter Unit”

The RT Device Distance Reference Location Code Sequence (300A,0659) shall contain the value (130358, DCM, "Nominal Radiation Source Location").

A.86.1.12.4.3 RT Radiation Record Common Module

The value of RT Record Flag (300A,0639) shall be YES. The value of RT Radiation Physical and Geometric Content Detail Flag (300A,0638) shall be IDENT_ONLY.

The following code sequences shall have a value from the identified CIDs:

Code Sequence	CID
RT Treatment Technique Code Sequence (3010,0080)	DCID 9523 “Robotic Radiotherapy Procedure Technique”
Treatment Machine Special Mode Sequence (300A,0635)	DCID 9543 “Radiotherapy Treatment Machine Mode”

A.86.1.12.4.4 Radiotherapy Common Instance Module

The following code sequences shall have values from the identified CIDs:

Code Sequence	CID
Author Identification Sequence (3010,0019)	For Organizational Role Code Sequence (0044,010A) DCID 9562 “Radiotherapy Treatment Delivery Person Role” shall be used.

A.86.1.12.4.5 Frame of Reference Module

See Section A.86.1.9.4.5.

A.86.1.13 RT Radiation Set Delivery Instruction IOD

A.86.1.13.1 RT Radiation Set Delivery Instruction IOD Description

The RT Radiation Set Delivery Instruction IOD contains all the parameters needed to deliver a single RT Treatment Fraction of one RT Radiation Set in the scope of one RT Treatment Session. It handles either the delivery of the complete fraction of the RT Radiation Set or the continuation of a formerly treated fraction which was interrupted and not completely delivered.

A.86.1.13.2 RT Radiation Set Delivery Instruction IOD Entity-Relationship Model

A.86.1.13.3 RT Radiation Set Delivery Instruction IOD Module Table

Table A.86.1.13-1. RT Radiation Set Delivery Instruction IOD Modules

IE	Module	Reference	Usage
Patient	Patient	C.7.1.1	M
Patient	Clinical Trial Subject	C.7.1.3	U
Study	General Study	C.7.2.1	M
	Patient Study	C.7.2.2	U
	Clinical Trial Study	C.7.2.3	U
Series	General Series	C.7.3.1	M
	Clinical Trial Series	C.7.3.2	U
	Enhanced RT Series	C.36.3	M
Equipment	General Equipment	C.7.5.1	M
Equipment	Enhanced General Equipment	C.7.5.2	M
Plan	General Reference	C.12.4	M
	RT Radiation Set Delivery Instruction	C.36.24	M
	SOP Common	C.12.1	M
	Common Instance Reference	C.12.2	M
	Radiotherapy Common Instance	C.36.4	M

A.86.1.13.4 RT Radiation Set Delivery Instruction IOD Constraints

A.86.1.13.4.1 Modality Attribute

The value of Modality (0008,0060) shall be PLAN.

A.86.1.14 RT Treatment Preparation IOD

A.86.1.14.1 RT Treatment Preparation IOD Description

The RT Treatment Preparation IOD describes the setup of the patient in preparation for delivery of the therapeutic radiation within an RT Treatment Session. It may include an initial patient’s position in preparation for treatment delivery, the treatment setup positions, or setup procedures along with the use of any fixation or shielding devices.

A.86.1.14.2 RT Treatment Preparation IOD Entity-Relationship Model

A.86.1.14.3 RT Treatment Preparation IOD Module Table

Table A.86.1.14-1. RT Treatment Preparation IOD Modules

IE	Module	Reference	Usage
Patient	Patient	C.7.1.1	M
Patient	Clinical Trial Subject	C.7.1.3	U
Study	General Study	C.7.2.1	M
	Patient Study	C.7.2.2	U
	Clinical Trial Study	C.7.2.3	U
Series	General Series	C.7.3.1	M
	Clinical Trial Series	C.7.3.2	U
	Enhanced RT Series	C.36.3	M
Equipment	General Equipment	C.7.5.1	M
Equipment	Enhanced General Equipment	C.7.5.2	M
RT Treatment Preparation	General Reference	C.12.4	M
	RT Treatment Preparation	C.36.25	M
	SOP Common	C.12.1	M
	Common Instance Reference	C.12.2	M
	Radiotherapy Common Instance	C.36.4	M

A.86.1.14.4 RT Treatment Preparation IOD Constraints

A.86.1.14.4.1 Modality Attribute

The value of Modality (0008,0060) shall be PLAN.

A.86.1.15 Enhanced RT Image IOD

A.86.1.15.1 Enhanced RT Image IOD Description

The Enhanced RT Image IOD represents projection images generated before, during or after Radiotherapy treatment sessions. The projection images may be acquired directly or may be derived ("reconstructed") from volumetric data such as CT. Such images capture the patient geometry to guide, or record, the positioning of the patient on a patient support device to deliver therapeutic dose to an intended location.

A.86.1.15.2 Enhanced RT Image IOD Entity-relationship Model

A.86.1.15.3 Enhanced RT Image IOD Module Table

Table A.86.1.15-1 specifies the Modules of the Enhanced RT Image IOD.

Table A.86.1.15-1. Enhanced RT Image IOD Modules

IE	Module	Reference	Usage
Patient	Patient	C.7.1.1	M
Patient	Clinical Trial Subject	C.7.1.3	U
Study	General Study	C.7.2.1	M
	Patient Study	C.7.2.2	U
	Clinical Trial Study	C.7.2.3	U
Series	General Series	C.7.3.1	M
	Clinical Trial Series	C.7.3.2	U
	Enhanced RT Series	C.36.3	M
Frame of Reference	Frame of Reference	C.7.4.1	M
Frame of Reference	Synchronization	C.7.4.2	C - Required if time synchronization was applied.
Equipment	General Equipment	C.7.5.1	M
Equipment	Enhanced General Equipment	C.7.5.2	M
Image	General Reference	C.12.4	M
	Image Pixel	C.7.6.3	M
	Multi-frame Functional Groups	C.7.6.16	M
	Multi-frame Dimension	C.7.6.17	M
	Cardiac Synchronization	C.7.6.18.1	C - Required if cardiac synchronization was applied for image acquisition
	Respiratory Synchronization	C.7.6.18.2	C - Required if respiratory synchronization was applied for image acquisition.
	Enhanced Contrast/Bolus	C.7.6.4b	C - Required if contrast media was used
	Device	C.7.6.12	U
	Enhanced RT Image Device	C.36.26	M
	Enhanced RT Image	C.36.27	M
	SOP Common	C.12.1	M
	Common Instance Reference	C.12.2	M
	Radiotherapy Common Instance	C.36.4	M
	Frame Extraction	C.12.3	C - Required if the SOP Instance was created in response to a Frame-Level retrieve request

A.86.1.15.4 Enhanced RT Image IOD Content Constraints

A.86.1.15.4.1 Modality Attribute

The value of Modality (0008,0060) shall be RTIMAGE.

A.86.1.15.4.2 Inclusion of Modules in Standard Extended SOP Classes

The General Image Module, Overlay Plane Module, Modality LUT Module and VOI LUT Module shall not be used in a Standard Extended SOP Class of the Enhanced RT Image.

Note

The Curve Module (Retired) was previously included in the list of Modules that shall not be present, but has been retired. It is still not permitted to be present. See PS3.3-2004.

A.86.1.15.4.3 Image Pixel Module

In the Image Pixel Module, the following constraints apply:

Samples per Pixel (0028,0002) shall be 1
Photometric Interpretation (0028,0004) shall be MONOCHROME2
Bits Allocated (0028,0100) shall be 8 or 16
Bits Stored (0028,0101) shall be equal to Bits Allocated (0028,0100)
High Bit (0028,0102) shall be one less than the value of Bits Stored (0028,0101).
Pixel Representation (0028,0103) shall be 0

A.86.1.15.5 Enhanced RT Image Functional Group Macros

Table A.86.1.15-2 specifies the use of the Functional Group Macros used in the Multi-frame Functional Groups Module for the Enhanced RT Image IOD.

Table A.86.1.15-2. Enhanced RT Image Functional Group Macros

Functional Group Macro	Section	Usage
Pixel Measures	C.7.6.16.2.1	M - Shall be used as a Shared Functional Group.
Frame Content	C.7.6.16.2.2	M - May not be used as a Shared Functional Group.
Plane Position (Patient)	C.7.6.16.2.3	M
Plane Orientation (Patient)	C.7.6.16.2.4	M
Referenced Image	C.7.6.16.2.5	U
Derivation Image	C.7.6.16.2.6	C - Required if the image or frame has been derived from another SOP Instance.
Cardiac Synchronization	C.7.6.16.2.7	C - Required if Cardiac Synchronization Technique (0018,9037) equals other than NONE and if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise.
Respiratory Synchronization	C.7.6.16.2.17	C - 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.
Contrast/Bolus Usage	C.7.6.16.2.12	C - Required if Contrast/Bolus Agent Sequence (0018,0012) is used.
RT Image Frame General Content	C.36.2.4.8	M The units for Start Cumulative Meterset (3002,0106) are specified by Radiation Dosimeter Unit Sequence (300A,0658) in the Enhanced RT Image Module C.36.27.
RT Image Frame Imaging Device Position	C.36.2.4.9	M
RT Image Frame Radiation Acquisition Parameters	C.36.2.4.10	C - Required if Image Type (0008,0008) Value 1 is ORIGINAL. May be present otherwise.
RT Image Frame Context	C.36.2.4.11	C - Required if the SOP Instance was created for the purpose of controlling the treatment position of the patient.
RT Beam Limiting Device Opening Sequence	C.36.2.2.21	C - Required if all Frames or the current Frame were acquired using a Beam Limiting Device.
Frame VOI LUT	C.7.6.16.2.10	U
Real World Value Mapping	C.7.6.16.2.11	U

A.86.1.15.5.1 Pixel Spacing

The Pixel Spacing (0028,0030) is measured on the x/y plane of the Image Receptor Coordinate System at z = 0. Imager Pixel Spacing (0018,1164) shall not be used.

See Section C.7.6.16.2.1 for a description of Pixel Spacing (0028,0030).

See Section C.36.1.1.12 for a description of the Image Receptor Coordinate System.

A.86.1.16 Enhanced Continuous RT Image IOD

A.86.1.16.1 Enhanced Continuous RT Image IOD Description

The Enhanced Continuous RT Image IOD represents projection images generated before, during or after Radiotherapy treatment sessions. The projection images may be acquired directly or may be derived ("reconstructed") from volumetric data such as CT. Such images capture the patient geometry to guide, or record, the positioning of the patient on a patient support device to deliver therapeutic dose to an intended location.

This IOD limits the content to a selected set of frames in the Per-Frame Functional Group when a high number of frames are present due to a high frame rate (e.g. 25 frames / second).

A.86.1.16.2 Enhanced Continuous RT Image IOD Entity-relationship Model

A.86.1.16.3 Enhanced Continuous RT Image IOD Module Table

Table A.86.1.16-1 specifies the Modules of the Enhanced Continuous RT Image IOD.

Table A.86.1.16-1. Enhanced Continuous RT Image IOD Modules

IE	Module	Reference	Usage
Patient	Patient	C.7.1.1	M
Patient	Clinical Trial Subject	C.7.1.3	U
Study	General Study	C.7.2.1	M
	Patient Study	C.7.2.2	U
	Clinical Trial Study	C.7.2.3	U
Series	General Series	C.7.3.1	M
	Clinical Trial Series	C.7.3.2	U
	Enhanced RT Series	C.36.3	M
Frame of Reference	Frame of Reference	C.7.4.1	M
Frame of Reference	Synchronization	C.7.4.2	C - Required if time synchronization was applied.
Equipment	General Equipment	C.7.5.1	M
Equipment	Enhanced General Equipment	C.7.5.2	M
Image	General Reference	C.12.4	M
	Image Pixel	C.7.6.3	M
	Sparse Multi-frame Functional Groups	C.7.6.29	M
	Cardiac Synchronization	C.7.6.18.1	C - Required if cardiac synchronization was applied for image acquisition.
	Respiratory Synchronization	C.7.6.18.2	C - Required if respiratory synchronization was applied for image acquisition.
	Enhanced Contrast/Bolus	C.7.6.4b	C - Required if contrast media was used
	Device	C.7.6.12	U
	Enhanced RT Image Device	C.36.26	M
	Enhanced RT Image	C.36.27	M
	SOP Common	C.12.1	M
	Common Instance Reference	C.12.2	M
	Radiotherapy Common Instance	C.36.4	M

A.86.1.16.4 Enhanced Continuous RT Image IOD Content Constraints

A.86.1.16.4.1 Modality Attribute

The value of Modality (0008,0060) shall be RTIMAGE.

A.86.1.16.4.2 Inclusion of Modules in Standard Extended SOP Classes

The General Image Module, Overlay Plane Module, Modality LUT Module, VOI LUT Module and Multi-frame Dimension Module shall not be used in a Standard Extended SOP Class of the Enhanced Continuous RT Image.

Note

The Curve Module (Retired) was previously included in the list of Modules that shall not be present, but has been retired. It is still not permitted to be present. See PS3.3-2004.

A.86.1.16.4.3 Image Pixel Module

In the Image Pixel Module, the constraints specified in Section A.86.1.15.4.3 apply.

A.86.1.16.5 Enhanced Continuous RT Image Functional Group Macros

Table A.86.1.16-2 specifies the use of the Functional Group Macros used in the Sparse Multi-frame Functional Groups Module for the Enhanced Continuous RT Image IOD.

Table A.86.1.16-2. Enhanced Continuous RT Image Functional Group Macros

Functional Group Macro	Section	Usage
Pixel Measures	C.7.6.16.2.1	M - Shall be used as a Shared Functional Group.
Frame Content	C.7.6.16.2.2	M - May not be used as a Shared Functional Group.
Plane Position (Patient)	C.7.6.16.2.3	M
Plane Orientation (Patient)	C.7.6.16.2.4	M
Referenced Image	C.7.6.16.2.5	U
Derivation Image	C.7.6.16.2.6	C - Required if the image has been derived from another SOP Instance.
Cardiac Synchronization	C.7.6.16.2.7	C - Required if Cardiac Synchronization Technique (0018,9037) equals other than NONE and if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise
Respiratory Synchronization	C.7.6.16.2.17	C - 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.
Contrast/Bolus Usage	C.7.6.16.2.12	C - Required if Contrast/Bolus Agent Sequence (0018,0012) is used.
RT Image Frame General Content	C.36.2.4.8	M The units for Start Cumulative Meterset (3002,0106) are specified by Radiation Dosimeter Unit Sequence (300A,0658) in the Enhanced RT Image Module C.36.27.
RT Image Frame Imaging Device Position	C.36.2.4.9	M
RT Image Frame Radiation Acquisition Parameters	C.36.2.4.10	C - Required if Image Type (0008,0008) Value 1 is ORIGINAL. May be present otherwise.
RT Image Frame Context	C.36.2.4.11	C - Required if the SOP Instance was created for the purpose of controlling the treatment position of the patient.
RT Beam Limiting Device Opening Sequence	C.36.2.2.21	C - Required if all Frames or the current Frame was acquired using a Beam Limiting Device.
Frame VOI LUT	C.7.6.16.2.10	U
Real World Value Mapping	C.7.6.16.2.11	U

A.86.1.16.5.1 Pixel Spacing

The Pixel Spacing (0028,0030) is measured on the x/y plane of the Image Receptor Coordinate System at z = 0. Imager Pixel Spacing (0018,1164) shall not be used.

See Section C.7.6.16.2.1 for a description of Pixel Spacing (0028,0030).

See Section C.36.1.1.12 for a description of the Image Receptor Coordinate System.

A.86.1.17 RT Patient Position Acquisition Instruction IOD

A.86.1.17.1 RT Patient Position Acquisition Instruction IOD Description

The RT Patient Position Acquisition Instruction IOD contains parameters needed to acquire the actual patient position.

A.86.1.17.2 RT Patient Position Acquisition Instruction IOD Entity-relationship Model

DCID 3101 “Cardiac Procedural State Value”.

A.86.1.17.3 RT Patient Position Acquisition Instruction IOD Module Table

Table A.86.1.17-1. RT Patient Position Acquisition Instruction IOD Modules

IE	Module	Reference	Usage
Patient	Patient	C.7.1.1	M
Patient	Clinical Trial Subject	C.7.1.3	U
Study	General Study	C.7.2.1	M
	Patient Study	C.7.2.2	U
	Clinical Trial Study	C.7.2.3	U
Series	General Series	C.7.3.1	M
	Clinical Trial Series	C.7.3.2	U
	Enhanced RT Series	C.36.3	M
Equipment	General Equipment	C.7.5.1	M
Equipment	Enhanced General Equipment	C.7.5.2	M
Plan	General Reference	C.12.4	M
	RT Patient Position Acquisition Device	C.36.28	M
	RT Patient Position Acquisition Instruction	C.36.29	M
	SOP Common	C.12.1	M
	Common Instance Reference	C.12.2	M
	Radiotherapy Common Instance	C.36.4	M

A.86.1.17.4 RT Patient Position Acquisition Instruction IOD Constraints

A.86.1.17.4.1 Modality Attribute

The value of Modality (0008,0060) shall be PLAN.

A.87 Microscopy Bulk Simple Annotations IOD

A.87.1 Microscopy Bulk Simple Annotations IOD Description

The Microscopy Bulk Simple Annotations IOD encodes Microscopy Bulk Simple Annotations into a collection of points, closed polygons, open polylines and simple geometric shapes. Polygons and polylines are defined by the coordinates of each point. Simple geometric shapes are defined by parameters.

Numeric quantities and color may be associated with Annotations.

A.87.2 Microscopy Bulk Simple Annotations IOD Entity-Relationship Model

The E-R Model in Section A.1.2 depicts those components of the DICOM Information Model that directly reference the Microscopy Bulk Simple Annotations IOD.

A.87.3 Microscopy Bulk Simple Annotations IOD Module Table

Table A.87-1. Microscopy Bulk Simple Annotations IOD Modules

IE	Module	Reference	Usage
Patient	Patient	C.7.1.1	M
Patient	Clinical Trial Subject	C.7.1.3	U
Study	General Study	C.7.2.1	M
	Patient Study	C.7.2.2	U
	Clinical Trial Study	C.7.2.3	U
Series	General Series	C.7.3.1	M
	Microscopy Bulk Simple Annotations Series	C.37.1.1	M
	Clinical Trial Series	C.7.3.2	U
Frame of Reference	Frame of Reference	C.7.4.1	C - Required if Annotation Coordinate Type (006A,0001) is 3D
Equipment	General Equipment	C.7.5.1	M
Equipment	Enhanced General Equipment	C.7.5.2	M
Annotation	Microscopy Bulk Simple Annotations	C.37.1.2	M
	ICC Profile	C.11.15	U
	Specimen	C.7.6.22	U
	Common Instance Reference	C.12.2	M
	SOP Common	C.12.1	M

A.88 Inventory IOD

A.88.1 Inventory IOD Description

The Inventory IOD defines an Inventory of all Studies, Series, and SOP Instances managed by a repository, or a specified subset of those Studies, Series, and SOP Instances. It includes information about the available mechanisms to access such Studies, Series, and SOP Instances, including both DICOM and non-DICOM protocols. The Inventory provides selected Patient, Procedure, and Imaging Service Request Attribute values for the inventoried Studies.

For implementation-specific reasons, a complete Inventory may need to be divided across multiple SOP Instances. The Inventory IOD allows a SOP Instance to reference other SOP Instances whose content is logically included by such reference. A complete inventory thus consists of one root SOP Instance, with a tree of references to additional SOP Instances, the content of all of which comprises the Inventory.

Note

See additional explanatory information in Annex YYYY “Inventories (Informative)” in PS3.17, including discussion of the use of the Repository Query SOP Class or the Inventory Creation SOP Class to produce an Inventory SOP Instance.

A.88.2 Inventory IOD Entity-Relationship Model

The Inventory IOD uses the E-R Model specified in Section 7.13.6.

A.88.3 Inventory IOD Module Table

Table A.88.3-1 lists the Modules that make up the Inventory IOD.

Table A.88.3-1. Inventory IOD Modules

IE	Module	Reference	Usage
Equipment	General Equipment	C.7.5.1	M
Inventory	Inventory	C.38.1	M
Inventory	SOP Common	C.12.1	M

Note

The Attributes of the other Information Entities of the Inventory Information Model (such as Study, Series, Patient, etc.) are hierarchically encoded (within Sequence Attributes) in the Inventory Module, and thus do not appear as separate Modules in the IOD.

A.89 Photoacoustic Image IOD

A.89.1 Photoacoustic Image IOD Description

The Photoacoustic Image IOD specifies an image which has been generated by the acquisition of acoustic signals from the absorption of light at one or more optical excitation wavelengths and the optional algorithmic combination of the acquired data.

A.89.2 Photoacoustic Image IOD Description Entity-relationship Model

The Photoacoustic Image IOD uses the DICOM Composite Instance IOD Entity-Relationship Information Model defined in Section A.1.2, with the Image IE below the Series IE.

A.89.3 Photoacoustic Image IOD Module Table

Table A.89.3-1 specifies the Modules of the Photoacoustic Image IOD.

Table A.89.3-1. Photoacoustic Image IOD Modules

IE	Module	Reference	Usage
Patient	Patient	C.7.1.1	M
Patient	Clinical Trial Subject	C.7.1.3	U
Study	General Study	C.7.2.1	M
	Patient Study	C.7.2.2	U
	Clinical Trial Study	C.7.2.3	U
Series	General Series	C.7.3.1	M
	Enhanced Series	C.7.3.3	M
	Clinical Trial Series	C.7.3.2	U
Frame of Reference	Frame of Reference	C.7.4.1	M
	Ultrasound Frame of Reference	C.8.24.2	M
	Synchronization	C.7.4.2	M
Equipment	General Equipment	C.7.5.1	M
Equipment	Enhanced General Equipment	C.7.5.2	M
Image	General Image	C.7.6.1	M
	General Reference	C.12.4	U
	Image Pixel	C.7.6.3	M
	Enhanced Contrast/Bolus	C.7.6.4b	C - Required if contrast media was used in this image
	Multi-frame Functional Groups	C.7.6.16	M
	Multi-frame Dimension	C.7.6.17	M
	Device	C.7.6.12	U
	Specimen	C.7.6.22	U
	Acquisition Context	C.7.6.14	M
	Supplemental Palette Color Lookup Table	C.7.6.19	C - Required if Pixel Presentation (0008,9205) in the Photoacoustic Image Module equals COLOR
	Photoacoustic Image	C.8.34.1	M
	Photoacoustic Acquisition Parameters	C.8.34.2	M
	Photoacoustic Transducer	C.8.34.3	U
	Photoacoustic Reconstruction	C.8.34.4	U
	ICC Profile	C.11.15	C - Required if Pixel Presentation (0008,9205) in the Photoacoustic Image Module equals TRUE_COLOR or COLOR (Section A.89.3.1.2)
	SOP Common	C.12.1	M
	Common Instance Reference	C.12.2	U
	Frame Extraction	C.12.3	C - Required if the SOP Instance was created in response to a Frame-Level retrieve request

A.89.3.1 Photoacoustic Image IOD Content Constraints

A.89.3.1.1 Modality

The value of Modality (0008,0060) shall be PA.

A.89.3.1.2 Photometric Interpretation and Pixel Presentation

If Pixel Presentation (0008,9205) in the Photoacoustic Image Module equals COLOR or MONOCHROME, the Photometric Interpretation (0028,0004) shall be MONOCHROME2.

If Pixel Presentation (0008,9205) in the Photoacoustic Image Module equals TRUE_COLOR, the Photometric Interpretation (0028,0004) shall be RGB for uncompressed or lossless compressed Transfer Syntaxes that do not have defined color space transformations, YBR_ICT for irreversible JPEG2000 Transfer Syntaxes, YBR_RCT for reversible JPEG2000 Transfer Syntaxes, YBR_PARTIAL_420 for MPEG2, MPEG-4 AVC/H.264, HEVC/H.265 Transfer Syntaxes and YBR_FULL_422 for JPEG lossy compressed Transfer Syntaxes and YBR_FULL or RGB for RLE Transfer Syntaxes. See Table C.8.34.1.3-1 for combinations of parameter values.

Note

Future lossless and lossy Transfer Syntaxes may lead to the need for new definitions and choices for Photometric Interpretation.

A.89.3.1.3 ICC Profile Module

The ICC Profile Module shall be present if Pixel Presentation (0008,9205) in the Photoacoustic Image equals TRUE_COLOR or COLOR. If the color space to be used is not calibrated (i.e., a device-specific ICC Input Profile is not available), then an ICC Input Profile specifying a well-known space (such as sRGB) may be specified.

A.89.3.1.4 Ultrasound Frame of Reference

The Ultrasound Frame of Reference Module is mandatory for Photoacoustic even in cases where Ultrasound is not used as a complementary modality due to the use of the Image Position (Volume) (0020,9301) in the Photoacoustic Dimension Index.

A.89.3.1.5 Real World Value Mapping

If the Real World Value Mapping Sequence (0040,9096) is present, it shall not be inconsistent with the Image Data Type Sequence (0018,9807).

A.89.4 Photoacoustic Image Functional Group Macros

Table A.89.4-1 specifies the use of the Functional Group Macros used in the Multi-frame Functional Groups Module for the Photoacoustic IOD.

Table A.89.4-1. Photoacoustic Image Functional Group Macros

Functional Group Macro	Section	Usage
Frame Content	C.7.6.16.2.2	M - May not be used as a Shared Functional Group.
Pixel Measures	C.7.6.16.2.1	M
Plane Position (Patient)	C.7.6.16.2.3	C - Required if Ultrasound Acquisition Geometry (0020,9307) has a value of PATIENT. May be present otherwise. See Section A.59.4.1.2.
Plane Orientation (Patient)	C.7.6.16.2.4	C - Required if Ultrasound Acquisition Geometry (0020,9307) has a value of PATIENT. May be present otherwise. See Section A.59.4.1.2.
Referenced Image	C.7.6.16.2.5	U
Derivation Image	C.7.6.16.2.6	C - Required if the image or frame has been derived from another SOP Instance.
Frame VOI LUT	C.7.6.16.2.10	U - May be used only if Photometric Interpretation (0028,0004) is MONOCHROME2.
Real World Value Mapping	C.7.6.16.2.11	U - May be used only if Photometric Interpretation (0028,0004) is MONOCHROME2.
Contrast/Bolus Usage	C.7.6.16.2.12	C - Required if the Enhanced Contrast/Bolus Module is present.
Patient Orientation in Frame	C.7.6.16.2.15	U
Frame Display Shutter	C.7.6.16.2.16	U
Plane Position (Volume)	C.7.6.16.2.21	M - May not be used as a Shared Functional Group. See Section A.59.4.1.2.
Plane Orientation (Volume)	C.7.6.16.2.22	M - May not be used as a Per-Frame Functional Group. See Section A.59.4.1.2.
Temporal Position	C.7.6.16.2.23	M
Photoacoustic Excitation Characteristics	C.8.34.5.1	U
Photoacoustic Image Frame Type	C.8.34.5.2	M - May not be used as a Per-Frame Functional Group
Photoacoustic Image Data Type	C.8.34.5.3	M - May not be used as a Per-Frame Functional Group
Photoacoustic Reconstruction Algorithm Macro Attributes	C.8.34.5.4	U - May not be used as a Per-Frame Functional Group

A.90 Confocal Microscopy Image IODs

The Confocal Microscopy Image IODs specify images that are acquired by means of a confocal microscope. The confocal microscopy may be performed in-vivo or ex-vivo in reflectance or fluorescence mode.

Confocal images may be simple (non-tiled) or tiled. Separate IODs have been defined for simple confocal microscopy images and tiled pyramidal images.

Simple confocal images may be encoded according the to the Confocal Microscopy Image IOD. A SOP Instance may contain one or more frames (multi-frame). A movie acquisition may be encoded as a multi-frame cine image.

A.90.1 Confocal Microscopy Image IOD

A.90.1.1 Confocal Microscopy Image IOD Description

The Confocal Microscopy Image IOD specifies the Attributes of a simple (non-tiled) Confocal Microscopy Image.

A.90.1.2 Confocal Microscopy Image IOD Description Entity-Relationship Model

The Confocal Microscopy Image IOD uses the DICOM Composite Instance IOD Entity-Relationship Information Model defined in Section A.1.2, with only the Image IE below the Series IE.

A.90.1.3 Confocal Microscopy Image IOD Module Table

Table A.90.1.3-1 specifies the Modules of the Confocal Microscopy Image IOD.

Table A.90.1.3-1. Confocal Microscopy Image IOD Modules

IE	Module	Reference	Usage
Patient	Patient	C.7.1.1	M
Patient	Clinical Trial Subject	C.7.1.3	U
Study	General Study	C.7.2.1	M
	Patient Study	C.7.2.2	U
	Clinical Trial Study	C.7.2.3	U
Series	General Series	C.7.3.1	M
Series	Clinical Trial Series	C.7.3.2	U
Frame of Reference	Frame of Reference	C.7.4.1	M
Frame of Reference	Synchronization	C.7.4.2	C - Required if time synchronization was applied
Equipment	General Equipment	C.7.5.1	M
Equipment	Enhanced General Equipment	C.7.5.2	M
Acquisition	General Acquisition	C.7.10.1	M
Image	General Image	C.7.6.1	M
	General Reference	C.12.4	U
	Image Pixel	C.7.6.3	M
	Multi-frame Functional Groups	C.7.6.16	M
	Multi-frame Dimension	C.7.6.17	M
	Specimen	C.7.6.22	C - Required if the Imaging Subject is a Specimen
	Acquisition Context	C.7.6.14	M
	Confocal Microscopy Image	C.8.35.1	M
	Cutaneous Confocal Microscopy Image Acquisition Parameters	C.8.35.3	C - Required for cutaneous confocal microscopy
	Optical Path	C.8.12.5	M
	SOP Common	C.12.1	M
	Common Instance Reference	C.12.2	U
	Frame Extraction	C.12.3	C - Required if the SOP Instance was created in response to a Frame-Level retrieve request

A.90.1.4 Confocal Microscopy Image IOD Content Constraints

A.90.1.4.1 Modality

The value of Modality (0008,0060) shall be CFM.

A.90.1.4.2 Acquisition Context Module

The Defined TID for Acquisition Context Sequence (0040,0555) is TID 8300 “Skin Imaging Acquisition Context”.

Note

Any lesion level Attributes apply to the single lesion seen in the acquired image.

A.90.1.4.3 Referenced Image Sequence

In cutaneous confocal microscopy the Referenced Image Sequence (0008,1140) may be used to identify the SOP instance of a Dermoscopic, or Visible Light image correlated to the Confocal Microscopy acquisition in which case the value of Purpose of Reference Code Sequence (0040,A170) shall be (121311, DCM, "Localizer").

A.90.1.4.4 Anatomic Region Sequence

For dermatology applications:

For Anatomic Region Sequence (0008,2218) BCID 4029 “Dermatology Anatomic Site” may be used.
For Anatomic Region Modifier Sequence (0008,2220) BCID 245 “Laterality with Median” may be used.

A.90.1.4.5 Illumination Type

For Illumination Type Code Sequence (0022,0016) BCID 8123 “Microscopy Illumination Method” may be used.

A.90.1.5 Confocal Microscopy Image Functional Group Macros

Table A.90.1.5-1. Confocal Microscopy Image Functional Group Macros

Functional Group Macro	Section	Usage
Pixel Measures	C.7.6.16.2.1	M - Shall be used as a shared functional group
Derivation Image	C.7.6.16.2.6	C - Required if the image or frame has been derived from another SOP Instance.
Optical Path Identification	C.8.12.6.2	C - Required if Dimension Organization Type (0020,9311) is not TILED_FULL; may be present otherwise.
Referenced Image	C.7.6.16.2.5	C - Required if the image or frame has been planned on another image or frame. May be present otherwise.
Frame Content	C.7.6.16.2.2	U - Shall not be used as a shared functional group
Real World Value Mapping	C.7.6.16.2.11	U - May be used only if Photometric Interpretation (0028,0004) is MONOCHROME2.
Plane Position (Slide)	C.8.12.6.1	C - Required if the Frame of Reference is defined in the Slide Coordinate System.
Confocal Microscopy Image Frame Type	C.8.35.4.1	M
Frame Anatomy	C.7.6.16.2.8	M

A.90.2 Confocal Microscopy Tiled Pyramidal Image IOD

A.90.2.1 Confocal Microscopy Tiled Pyramidal Image IOD Description

The Confocal Microscopy Tiled Pyramidal Image IOD specifies the Attributes of Tiled Pyramidal Confocal Microscopy Images.

A.90.2.2 Confocal Microscopy Tiled Pyramidal Image IOD Description Entity-Relationship Model

The Confocal Microscopy Tiled Pyramidal Image IOD uses the DICOM Composite Instance IOD Entity-Relationship Information Model defined in Section A.1.2, with only the Image IE below the Series IE.

A.90.2.3 Confocal Microscopy Tiled Pyramidal Image IOD Module Table

Table A.90.2.3-1 specifies the Modules of the Confocal Microscopy Tiled Pyramidal Image IOD.

Table A.90.2.3-1. Confocal Microscopy Tiled Pyramidal Image IOD Modules

IE	Module	Reference	Usage
Patient	Patient	C.7.1.1	M
Patient	Clinical Trial Subject	C.7.1.3	U
Study	General Study	C.7.2.1	M
	Patient Study	C.7.2.2	U
	Clinical Trial Study	C.7.2.3	U
Series	General Series	C.7.3.1	M
Series	Clinical Trial Series	C.7.3.2	U
Frame of Reference	Frame of Reference	C.7.4.1	M
Frame of Reference	Synchronization	C.7.4.2	C - Required if time synchronization was applied.
Equipment	General Equipment	C.7.5.1	M
Equipment	Enhanced General Equipment	C.7.5.2	M
Acquisition	General Acquisition	C.7.10.1	M
Multi-Resolution Pyramid	Multi-Resolution Pyramid	C.7.11.1	U - Shall be present only if Image Type Value 3 is VOLUME or THUMBNAIL
Image	General Image	C.7.6.1	M
	General Reference	C.12.4	U
	Microscope Slide Layer Tile Organization	C.8.12.14	C - Required for slide microscopy imaging. May be present otherwise
	Image Pixel	C.7.6.3	M
	Multi-frame Functional Groups	C.7.6.16	M
	Multi-frame Dimension	C.7.6.17	M
	Specimen	C.7.6.22	C - Required if the Imaging Subject is a Specimen
	Acquisition Context	C.7.6.14	M
	Confocal Microscopy Image	C.8.35.1	M
	Confocal Microscopy Tiled Pyramidal Image	C.8.35.2	M
	Cutaneous Confocal Microscopy Image Acquisition Parameters	C.8.35.3	C - Required for cutaneous confocal microscopy
	Optical Path	C.8.12.5	M
	SOP Common	C.12.1	M
	Common Instance Reference	C.12.2	U
	Frame Extraction	C.12.3	C - Required if the SOP Instance was created in response to a Frame-Level retrieve request

A.90.2.4 Confocal Microscopy Tiled Pyramidal Image IOD Content Constraints

A.90.2.4.1 Modality

The value of Modality (0008,0060) shall be CFM.

A.90.2.4.2 Acquisition Context Module

The Defined TID for Acquisition Context Sequence (0040,0555) is TID 8300 “Skin Imaging Acquisition Context”.

Note

Any lesion level Attributes apply to the single lesion seen in the acquired image.

A.90.2.4.3 Referenced Image Sequence

A.90.2.4.4 Antomical Region Sequence

For dermatology applications:

For Anatomic Region Sequence (0008,2218) BCID 4029 “Dermatology Anatomic Site” may be used.
For Anatomic Region Modifier Sequence (0008,2220) BCID 245 “Laterality with Median” may be used.

A.90.2.4.5 Illumination Type

For Illumination Type Code Sequence (0022,0016) BCID 8123 “Microscopy Illumination Method” may be used.

A.90.2.4.6 Specimen Module

For Specimen Preparation Step Content Item Sequence (0040,0612) DTID 8301 “Specimen Staining for Cutaneous Confocal Microscopy”.

A.90.2.5 Confocal Microscopy Tiled Pyramidal Image Functional Group Macros

Table A.90.2.5-1. Confocal Microscopy Tiled Pyramidal Image Functional Group Macros

Functional Group Macro	Section	Usage
Pixel Measures	C.7.6.16.2.1	M - Shall be used as a shared functional group
Derivation Image	C.7.6.16.2.6	C - Required if the image or frame has been derived from another SOP Instance.
Optical Path Identification	C.8.12.6.2	C - Required if Dimension Organization Type (0020,9311) is not TILED_FULL; may be present otherwise.
Specimen Reference	C.8.12.6.3	U
Referenced Image	C.7.6.16.2.5	C - Required if the image or frame has been planned on another image or frame. May be present otherwise.
Frame Content	C.7.6.16.2.2	U - Shall not be used as a shared functional group
Real World Value Mapping	C.7.6.16.2.11	U - May be used only if Photometric Interpretation (0028,0004) is MONOCHROME2.
Plane Position (Slide)	C.8.12.6.1	C - Required if the Frame of Reference is defined in the Slide Coordinate System.
Confocal Microscopy Image Frame Type	C.8.35.4.1	M
Frame Anatomy	C.7.6.16.2.8	M

A.91 Height Map Segmentation IOD

A.91.1 Height Map Segmentation IOD Description

The Height Map Segmentation Information Object Definition (IOD) specifies the location of one or more layer surfaces within a 3D volume, e.g., for retinal or epithelial layers. For each coordinate of the reference plane, each layer has at most one surface point at a distance perpendicular to the reference plane. However, not all coordinates of the reference plane might have a corresponding distance specified for any particular layer.

Each frame of a Height Map Segmentation SOP Instance corresponds to a segmented layer within a referenced derivation image. Each row in a Height Map Segmentation frame corresponds to a single frame in a derivation image, and the pixel values in a row represent the height map data for a segmented layer as it intersects the derivation image frame. The Height Map Segmentation SOP Instance does not include the full set of acquisition parameters of the derivation image and frames, e.g., Plane Orientation, or Plane Position. An application rendering or processing the segmentation may need to access the referenced derivation image for such information.

Note

The frames of the derivation image may not form a regularly spaced voxel set (see concepts in CID 4272 “OPT Scan Pattern Type”). The image rows in the segmentation frame pixel set follow the orientations of the derivation image frames, and thus rendering a frame of the height map segmentation in Cartesian 3D space may require obtaining the orientation and position of each derivation image frame.

A.91.2 Height Map Segmentation IOD Entity-relationship Model

The Height Map Segmentation IOD uses the E-R Model specified in Section A.1.2, with only the Image IE below the Series IE.

A.91.3 Height Map Segmentation IOD Module Table

Table A.91-1 lists the Modules that make up the Height Map SegmentationIOD.

Table A.91-1. Height Map Segmentation IOD Modules

IE	Module	Reference	Usage
Patient	Patient	C.7.1.1	M
Patient	Clinical Trial Subject	C.7.1.3	U
Study	General Study	C.7.2.1	M
	Patient Study	C.7.2.2	U
	Clinical Trial Study	C.7.2.3	U
Series	General Series	C.7.3.1	M
	Segmentation Series	C.8.20.1	M
	Clinical Trial Series	C.7.3.2	U
Frame of Reference	Frame of Reference	C.7.4.1	M
Equipment	General Equipment	C.7.5.1	M
Equipment	Enhanced General Equipment	C.7.5.2	M
Image	General Image	C.7.6.1	M
	Multi-frame Functional Groups	C.7.6.16	M
	Multi-frame Dimension	C.7.6.17	M
	Floating Point Image Pixel	C.7.6.24	M
	Height Map Segmentation Image	C.8.20.5	M
	ICC Profile	C.11.15	U
	SOP Common	C.12.1	M
	Common Instance Reference	C.12.2	M
	Frame Extraction	C.12.3	C - Required if the SOP Instance was created in response to a Frame-Level retrieve request
	General Reference	C.12.4	U

A.91.4 Height Map Segmentation IOD Constraints

A.91.4.1 Frame of Reference UID

Frame of Reference UID (0020,0052) in this SOP Instance shall have the same value as the Frame of Reference UID (0020,0052) of the SOP Instance(s) referenced in the Derivation Image Macro.

Note

The coordinate system associated with the Frame of Reference may be deformed (e.g., see Section A.52.4.3). The height map data is defined with respect to image frames within the identified Frame of Reference.

A.91.5 Height Map Segmentation Functional Groups

Table A.91-2 specifies the use of the Functional Group Macros used in the Multi-frame Functional Groups Module for the Height Map Segmentation IOD.

Table A.91-2. Height Map Segmentation Functional Group Macros

Functional Group Macro	Section	Usage
Pixel Measures	C.7.6.16.2.1	M
Frame Content	C.7.6.16.2.2	M - May not be used as a Shared Functional Group.
Plane Position (Patient)	C.7.6.16.2.3	C - Required if value of Rows is greater than 1, may be present otherwise
Plane Orientation (Patient)	C.7.6.16.2.4	C - Required if value of Rows is greater than 1, may be present otherwise
Referenced Image	C.7.6.16.2.5	U
Derivation Image	C.7.6.16.2.6	M
Real World Value Mapping	C.7.6.16.2.11	M
Segmentation	C.8.20.3.1	M

A.91.5.1 Height Map Segmentation Functional Groups Description

A.91.5.1.1 Derivation Image

The Derivation Image Macro shall identify one or more Image SOP Instances that are the source for the volumetric space to which the Height Map Segmentation frame applies. Referenced derivation images shall have the same Frame of Reference UID (0020,0052).

Each Item of the Derivation Image Sequence (0008,9124) shall specify a number of frames equal to the value of Rows (0028,0010) in the Height Map Segmentation SOP Instance. The Derivation Image Macro for a Height Map Segmentation frame with multiple rows shall enumerate the referenced frame for each row in Referenced Frame Number (0008,1160). Alternatively, if the Functional Group references a single derivation image with a number of frames equal to the number of Height Map Segmentation rows, the Referenced Frame Number (0008,1160) Attribute may be omitted, and the Height Map Segmentation rows shall correspond to the derivation image frames in their storage order in the pixel data.

The value of Purpose of Reference Code Sequence (0040,A170) in Source Image Sequence (0008,2112) in Derivation Image Sequence (0008,9124) shall be (121322, DCM, "Source Image for Image Processing Operation"). The value of Derivation Code Sequence (0008,9215) in Derivation Image Sequence (0008,9124) shall be (113076, DCM, "Segmentation").

Note

The referenced derivation image is the source of the pixel/voxel matrix extent in which the Height Map Segmentation is defined. It might technically not be a source image from which the segmentation is derived, e.g., if both the referenced image and the segmentation are derived from a raw acquisition data set. Use of (121322, DCM, "Source Image for Image Processing Operation") is specified to maintain consistency with the Segmentation IOD (see Section A.51.5.1). Other source data SOP Instances can be identified in the Referenced Image Macro.

A.91.5.1.2 Pixel Measures

Pixel Spacing (0028,0030) in the Pixel Measures Macro specifies the real-world physical distance in the imaging target (patient) as row spacing and column spacing in mm (see Section C.7.6.16.2.1 and Section 10.7.1.3). The pixel spacing of the Height Map Segmentation is determined by the pixel measures of the referenced derivation image (see Figure A.91.5-1). As each height map row corresponds to a derivation image frame with the same number of columns, value 2 (column spacing) of Pixel Spacing (0028,0030) in the Height Map Segmentation will equal value 2 of Pixel Spacing (0028,0030) in the referenced derivation image.

Height Map Segmentation frames with more than one row correspond to a set of parallel derivation image frames, i.e., whose Image Orientation (Patient) (0020,0037) values are identical. As the height map frame is orthogonal to those derivation image frames, value 1 (row spacing) of Pixel Spacing (0028,0030) in the Height Map Segmentation will equal the spacing between derivation image frames, computed from differences in Image Position (Patient) (0020,0032) of the referenced derivation image frames.

Note

As specified in Section 10.7.1.3, if there is only a single row in the Height Map Segmentation frames, the row spacing value may be zero.
Height Map Segmentation is defined only for cases where the rows of height map data correspond to the top rows of derivation image frames, and the columns of the Height Map Segmentation correspond to the frames of the derivation image. It is not defined for cases where the derivation image frames are parallel to the Height Map Segmentation frame, or for the 90 degree rotation with the Height Map Segmentation columns corresponding to the derivation image rows, or for the Height Map Segmentation to be aligned to the bottom of the derivation image frames.
The value of Spacing Between Slices (0018,0088) in the derivation image might be used to determine the row spacing of the Height Map Segmentation, but that Attribute is Type 1C in the Ophthalmic Tomography Image IOD, and might not be present. Even if present, it would not be valid if decimated frames of the derivation image are referenced.

Figure A.91.5-1. Height Map Pixel Spacing from Derivation Image Attributes

A.91.5.1.3 Plane Position and Plane Orientation

The Plane Position (Patient) and Plane Orientation (Patient) Functional Groups shall be present in a Height Map Segmentation with multiple rows. The values of Image Position (Patient) (0020,0032) and Image Orientation (Patient) (0020,0037) are derived from the values in the derivation image.

Note

The value of Image Position (Patient) (0020,0032) will be equal to the value of Image Position (Patient) (0020,0032) in the first referenced frame of the Derivation Image. The value of Image Orientation (Patient) (0020,0037) will have row direction cosines equal to the row direction cosines of the referenced derivation image, and column direction cosines equal to the cross product of the column direction cosines and row direction cosines of the referenced derivation image. If the coordinate system associated with the Frame of Reference is deformed (e.g., see Section A.52.4.3), then the orientation will be the nominal real world orientation.

Image Position (Patient) (0020,0032) and Image Orientation (Patient) (0020,0037) might not be present in the derivation image, in particular for non-volumetric (e.g., circular) scans, where the derivation image is located in space by reference to points on a localizer image rather than by Plane Position and Plane Orientation.

Figure A.91.5-2. 2D Height Map Plane Position and Orientation from Derivation Image Attributes

A.91.5.1.4 Real World Value Mapping

The Real World Value Mapping Functional Group shall provide the mapping of Height Map Segmentation pixel values to real world distance in the volume defined by the derivation image. Height Map values are floating point numbers representing vertical pixel distances with sub-pixel resolution in the pixel matrix of the derivation image. The value of Measurement Units Code Sequence (0040,08EA) shall be (mm, UCUM, "mm"). Values in the pixel padding range, i.e., between the values of Float Pixel Padding Value (0028,0122) and Float Pixel Padding Range Limit (0028,0124), shall not be mapped.

Note

The value of Real World Value Slope (0040,9225) will typically be equal to first value (row spacing) of the Pixel Spacing (0028,0030) Attribute in the Pixel Measures Functional Group of the referenced derivation image. If the coordinate system associated with the Frame of Reference is deformed (e.g., see Section A.52.4.3), then the value mapping will be the nominal real world distance.

The value of Real World Value First Value Mapped (0040,9216) or Double Float Real World Value First Value Mapped (0040,9214) will typically be 0. The value of Real World Value Last Value Mapped (0040,9211) or Double Float Real World Value Last Value Mapped (0040,9213) will typically be equal to the number of rows in the derivation image.

B Normalized Information Object Definitions (Normative)

B.7 Basic Film Session IOD

B.7.1 IOD Description

The Basic Film Session IOD describes the presentation parameters that are common for all the films of a film session (e.g., number of films, film destination).

B.7.2 IOD Modules

Table B.7-1. Basic Film Session IOD Modules

Module	Reference	Module Description
SOP Common	C.12.1	Contains SOP Common information
Basic Film Session Presentation	C.13.1	Contains Film Session presentations information
Basic Film Session Relationship	C.13.2	References to related SOP Classes

B.8 Basic Film Box IOD

B.8.1 IOD Description

The Basic Film Box IOD is an abstraction of the presentation of one film of the film session. The Basic Film Box IOD describes the presentation parameters that are common for all images on a given sheet of film.

B.8.2 IOD Modules

Table B.8-1. Basic Film Box IOD Modules

Module	Reference	Module Description
SOP Common	C.12.1	Contains SOP Common information
Basic Film Box Presentation	C.13.3	Contains Film Box presentation information
Basic Film Box Relationship	C.13.4	References to related SOP Classes

B.9 Basic Image Box IOD

B.9.1 IOD Description

The Basic Image Box IOD is an abstraction of the presentation of an image and image related data in the image area of a film. The Basic Image Box IOD describes the presentation parameters and image pixel data that apply to a single image of a sheet of film.

B.9.2 IOD Modules

Table B.9-1. Basic Image Box IOD Modules

Module	Reference	Module Description
SOP Common	C.12.1	Contains SOP Common information
Image Box Pixel Presentation	C.13.5	Contains Image Box presentation information

Note

The Image Box Relationship Module (Retired) was previously defined in DICOM. It is now retired. See PS3.3-1998.

B.10 Basic Annotation Box IOD

B.10.1 IOD Description

The Basic Annotation Box IOD is an abstraction of the presentation of an annotation (e.g., text string) on a film. The Basic Annotation Box IOD describes the most used text related presentation parameters.

B.10.2 IOD Modules

Table B.10-1. Basic Annotation Box IOD Modules

Module	Reference	Module Description
SOP Common	C.12.1	Contains SOP Common information
Basic Annotation Presentation	C.13.7	Contains annotation presentation information

B.11 Print Job IOD

B.11.1 IOD Description

The Print Job IOD is an abstraction of the print job transaction and is the basic information entity to monitor the execution of the print process. A print job contains one film or multiple films, all belonging to the same film session.

B.11.2 IOD Modules

Table B.11-1. Print Job IOD Modules

Module	Reference	Module Description
SOP Common	C.12.1	Contains SOP Common information
Print Job	C.13.8	Contains print job transaction information

B.12 Printer IOD

B.12.1 IOD Description

The Printer IOD is an abstraction of the hardcopy printer and is the basic information entity to monitor the status of the printer.

B.12.2 IOD Modules

Table B.12-1. Printer IOD Modules

Module	Reference	Module Description
SOP Common	C.12.1	Contains SOP Common information
Printer	C.13.9	Contains status information to monitor the printer

B.13 VOI LUT Box IOD (Retired)

Retired. See PS3.3-1998 .

B.14 Image Overlay Box IOD (Retired)

Retired. See PS3.3-1998 .

B.15 Storage Commitment IOD

B.15.1 Storage Commitment IOD Description

The Storage Commitment IOD describes the Attributes that may be present in a Storage Commitment Request or Response. The SOP Instances referenced by the Storage Commitment IOD are not restricted to images and may include other SOP Instances.

B.15.2 Storage Commitment IOD Modules

Table B.15-1 identifies and defines the Modules that comprise this IOD. The requirements for whether Attributes in these Modules are mandatory or optional are as specified in PS3.4.

Table B.15-1. Storage Commitment IOD Modules

Module	Reference	Module Description
SOP Common	C.12.1	Contains SOP common information
Storage Commitment	C.14	Contains references to the SOP Instances and associated information that are contained in Storage Commitment.

B.16 Print Queue IOD (Retired)

Retired. See PS3.3-2004.

B.17 Modality Performed Procedure Step IOD

B.17.1 IOD Description

A "Modality Performed Procedure Step IOD" is an abstraction of the information that describes the activities, conditions and results of an imaging procedure performed on a modality. It contains information about the Modality Performed Procedure Step (MPPS) and its relations to other Information Entities of the DICOM real-world model as introduced in this Part.

A Modality Performed Procedure Step is related to the actual imaging procedure carried out at the modality. Other types of Performed Procedure Steps, e.g., reporting or image processing, are not covered by the Modality Performed Procedure Step IOD. The information gathered includes data about the performance of the procedure itself, and data for billing and material management. The Modality Performed Procedure Step IOD includes general PPS Modules and image acquisition specific ones, such as Image Acquisition Results, and Billing and Material Management.

B.17.2 IOD Modules

Table B.17.2-1 lists the Modules that make up the Modality Performed Procedure Step IOD.

Table B.17.2-1. Modality Performed Procedure Step IOD Modules

Module	Reference	Module Description
SOP Common	C.12.1	Contains SOP common information
Performed Procedure Step Relationship	C.4.13	References the related SOPs and IEs.
Performed Procedure Step Information	C.4.14	Includes identifying and status information as well as place and time
Image Acquisition Results	C.4.15	Identifies Series and Images related to this PPS and specific image acquisition conditions.
Billing and Material Management Code	C.4.17	Contains codes for billing and material management.

Note

The Radiation Dose Module (Retired) has been retired. See PS3.3-2017c.

B.18 Presentation LUT IOD

B.18.1 IOD Description

The Presentation LUT Information Object is an abstraction of a Presentation LUT. The objective of the Presentation LUT is to realize image display tailored for specific modalities, applications, and user preferences. It is used to prepare image pixel data for display on devices that conform to the Grayscale Standard Display Function defined in PS3.14.

The output of the Presentation LUT is Presentation Values (P-Values). P-Values are approximately related to human perceptual response. They are intended to facilitate common input for both hardcopy and softcopy display devices. P-Values are intended to be independent of the specific class or characteristics of the display device.

B.18.2 IOD Modules

Table B.18.2-1. Presentation LUT IOD Modules

Module	Reference	Module Description
SOP Common	C.12.1
Presentation LUT	C.11.4

B.19 Pull Print Request IOD (Retired)

Retired. See PS3.3-2004.

B.20 Printer Configuration IOD

B.20.1 IOD Description

The Printer Configuration IOD describes key imaging characteristics of the printer.

B.20.2 IOD Modules

Table B.20-1. Printer Configuration IOD Modules

Module	Reference	Module Description
SOP Common	C.12.1	Contains SOP Common Information
Printer	C.13.9	Contains information about the printer
Printer Configuration	C.13.13	Contains Printer Configuration Information

B.21 Basic Print Image Overlay Box IOD (Retired)

Retired. See PS3.3-2004.

B.22 General Purpose Scheduled Procedure Step IOD (Retired)

Retired. See PS3.3-2011.

B.23 General Purpose Performed Procedure Step IOD (Retired)

Retired. See PS3.3-2011.

B.24 Instance Availability Notification IOD

B.24.1 IOD Description

An Instance Availability Notification IOD is a summary of the information that describes the availability of a set of Composite Instances.

B.24.2 IOD Modules

Table B.24.2-1 lists the Modules that make up the Instance Availability Notification IOD.

Table B.24.2-1. Instance Availability Notification IOD Modules

Module	Reference	Module Description
SOP Common	C.12.1	Contains SOP common information
Instance Availability Notification	C.4.23	References the related SOPs and IEs.

B.25 Media Creation Management IOD

B.25.1 IOD Description

A Media Creation Management IOD is an abstraction of the information that describes the Attributes and the status of a media creation request.

B.25.2 IOD Modules

Table B.25.2-1 lists the Modules that make up the Media Creation Management IOD.

Table B.25.2-1. Media Creation Management IOD Modules

Module	Reference	Module Description
SOP Common	C.12.1	Contains SOP common information
Media Creation Management	C.22.1	Contains references to the SOP Instances to be used for this media creation request, and the information about its status.

B.26 Unified Procedure Step IOD

B.26.1 IOD Description

A Unified Procedure Step (UPS) describes the details of a procedure step that has been scheduled, the progress details during performance, and the details of the procedure step actually performed in response.

B.26.2 IOD Modules

Table B.26.2-1 lists the Modules that make up the Unified Procedure Step IOD.

Table B.26.2-1. Unified Procedure Step IOD Modules

Module	Reference	Module Description
SOP Common	C.12.1	Contains SOP common information
Unified Procedure Step Relationship	C.30.4	References the related SOPs and IEs
Unified Procedure Step Scheduled Procedure Information	C.30.2	Describes the UPS task to be performed including information about place, time, priority and input data
Unified Procedure Step Progress Information	C.30.1	Describes the progress of a UPS task
Unified Procedure Step Performed Procedure Information	C.30.3	Describes the work performed including information about status, place, time and result data
Patient Demographic	C.2.3	Describes the Patient at the time of scheduling
Patient Medical	C.2.4	Describes the Patient's medical state or history
Visit Identification	C.3.2	Attributes relevant to identifying a Visit
Visit Status	C.3.3	Attributes relevant to the Patient's stay with the healthcare provider
Visit Admission	C.3.4	Attributes relevant to admitting a Patient during a Visit

B.27 RT Conventional Machine Verification IOD

B.27.1 IOD Description

The RT Conventional Machine Verification IOD describes the Attributes that are required by an external Machine Parameter Verifier (MPV) when performing verification of a conventional (photon or electron) radiation therapy treatment, prior to delivery.

B.27.2 IOD Modules

Table B.27.2-1. RT Conventional Machine Verification IOD Modules

Module	Reference	Module Description
SOP Common	C.12.1	Contains SOP Common Information
RT General Machine Verification	C.31.1	Contains general delivery verification information
RT Conventional Machine Verification	C.31.2	Contains delivery verification information specific to conventional (photon or electron) machines

B.28 RT Ion Machine Verification IOD

B.28.1 IOD Description

The RT Ion Machine Verification IOD describes the Attributes that are required by an external Machine Parameter Verifier (MPV) when performing verification of an ion radiation therapy treatment, prior to delivery.

B.28.2 IOD Modules

Table B.28.2-1. RT Ion Machine Verification IOD Modules

Module	Reference	Module Description
SOP Common	C.12.1	Contains SOP Common Information
RT General Machine Verification	C.31.1	Contains general delivery verification information
RT Ion Machine Verification	C.31.3	Contains delivery verification information specific to ion machines

B.29 Display System IOD

B.29.1 IOD Description

An Instance of the Display System IOD describes all of the Display Subsystems in a given Display System.

Display Subsystems are described in terms of their equipment identification, display performance (luminance, uniformity, etc.) and the corresponding configurations. Although a variety of components (controllers, cables, display devices, etc.) contribute to the performance of the Display Subsystem to which they belong, these details are not exposed in the abstraction of the Display Subsystem. Similarly, each Display Subsystem is addressed independently even though one controller might drive display devices in multiple Display Subsystems or multiple controllers might drive a single display device. Effectively, the Display Subsystem represents the display device and any components involved behind it.

The IOD only describes emissive display systems.

Note

Hanging Protocols manage Screens based on their physical location and arrangement. This IOD does not describe the spatial positioning of Display Devices. There is usually a 1:1 relationship between a Display Subsystem in this IOD and a Hanging Protocol Screen.

Table B.29-1. Display System IOD Modules

Module	Reference	Module Description
SOP Common	C.12.1	Contains SOP Common information.
Display System	C.32.1	Describes the Display System. The Display System has one or more Display Subsystem. A Display Subsystem corresponds to one Display Device.
Target Luminance Characteristics	C.32.2	Describes the target luminance characteristics of the Display Subsystem(s)
QA Results	C.32.3	Describes the results of QA performed on the Display Subsystem(s).

B.30 Inventory Creation IOD

B.30.1 Inventory Creation IOD Description

The Inventory Creation IOD describes the Attributes that may be present in an Inventory Creation Request or Response.

B.30.2 Inventory Creation IOD Module Table

Table B.30.2-1. Inventory Creation IOD Modules

Module	Reference	Description
Inventory Creation	C.38.3	Contains parameters for initiation of inventory production
SOP Common	C.12.1	Contains SOP common information

C Information Module Definitions (Normative)

C.1 Elements of a Module Definition

A Module Definition is composed of the following Sections

Module Description
Module Definition
Attribute Description (Optional)

Section C.1.1, Section C.1.2 and Section 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:

Attribute Name (see Section C.1.2.1)
Data Element Tag (see Section C.1.2.2)
Type Designation (see Section C.1.2.3)
Attribute Definition (see Section 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 PS3.6.

C.1.2.2 Attribute Tag

Each Attribute has a Data Element Tag that uniquely identifies the Attribute (also used for encoding into a Data Set - see PS3.5). This tag also serves as an index into the Data Dictionary of PS3.6.

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. PS3.5 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. PS3.4 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 specifies the Attributes of the Patient Relationship Module, which reference SOP Instances related to this SOP Class.

Table C.2-1. Patient Relationship Module Attributes

Attribute Name	Tag	Attribute Description
Referenced Study Sequence	(0008,1110)	Uniquely identifies the Studies associated with the Patient. One or more Items shall be included in this Sequence. See Section 10.6.1.
>Include Table 10-11 “SOP Instance Reference Macro Attributes”
Referenced Visit Sequence	(0008,1125)	Uniquely identifies the Visits associated with this Patient. One or more Items shall be included in this Sequence.
>Include Table 10-11 “SOP Instance Reference Macro Attributes”

C.2.2 Patient Identification Module

Table C.2-2 specifies the Attributes of the Patient Identification Module, which define the Attributes relevant to identifying a Patient.

Table C.2-2. Patient Identification Module Attributes

Attribute Name	Tag	Attribute Description
Patient's Name	(0010,0010)	Patient's full name.
Patient ID	(0010,0020)	Primary identifier for the Patient. Note In the case of imaging a group of small animals simultaneously, the single value of this identifier corresponds to the identification of the entire group. See also Section C.7.1.4.1.1.
Include Table 10-18 “Issuer of Patient ID Macro Attributes”
Type of Patient ID	(0010,0022)	The type of identifier in the Patient ID (0010,0020). Defined Terms: TEXT RFID BARCODE Note The identifier is coded as a string regardless of the type, not as a binary value. When this Attribute has a value of BARCODE, Patient ID (0010,0020) may or may not have the same value as Barcode Value (2200,0005) in the Scheduled Procedure Step Module, if present.
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. One or more Items are permitted in this Sequence. Note This Attribute replaces the use of Other Patient IDs (0010,1000), which did not specify an issuer for each other identifier, and which has been retired.
>Patient ID	(0010,0020)	An identifier for the Patient.
>Include Table 10-18 “Issuer of Patient ID Macro Attributes”
>Type of Patient ID	(0010,0022)	The type of identifier in the Patient ID (0010,0020) 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. When this Attribute has a value of BARCODE, Patient ID (0010,0020) may or may not have the same value as Barcode Value (2200,0005) in the Scheduled Procedure Step Module, if present.
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.
Referenced Patient Photo Sequence	(0010,1100)	A photo to confirm the identity of a Patient. Only a single Item is permitted in this Sequence. See C.2.2.1.1.
>Include Table 10-3b “Referenced Instances and Access Macro Attributes”
Include Table C.7.1.4-1 “Patient Group Macro Attributes”

Note

Previously, Other Patient IDs (0010,1000) and Medical Record Locator (0010,1090) were included in this table. These Attributes have been retired. See PS3.3-2017a.

C.2.2.1 Patient Identification Module Attribute Descriptions

C.2.2.1.1 Referenced Patient Photo Sequence

A Patient Photo may be provided as an additional means to confirm the identity of the Patient.

When the Referenced SOP Sequence (0008,1199) is present, the Referenced SOP Class UID (0008,1150) shall be either VL Photographic Image Storage (1.2.840.10008.5.1.4.1.1.77.1.4) or Secondary Capture Image Storage (1.2.840.10008.5.1.4.1.1.7).

When the WADO Retrieval Sequence (0040,E023) or WADO-RS Retrieval Sequence (0040,E025) is present, the Retrieve URI (0040,E010) shall refer to a JPEG image if the referenced server is not WADO-compliant.

C.2.3 Patient Demographic Module

Table C.2-3 specifies the Attributes of the Patient Demographic Module, which generally describe the Patient at a specific point in time, e.g., at the time of admission.

Table C.2-3. Patient 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 Patient's 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
Quality Control Subject	(0010,0200)	Indicates whether or not the subject is a quality control phantom. Enumerated Values: YES NO If this Attribute is absent, then the subject may or may not be a phantom. This Attribute describes a characteristic of the Imaging Subject. It is distinct from Quality Control Image (0028,0300) in the General Image Module, which is used to describe an image acquired.
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 Table 8.8-1 “Code Sequence Macro Attributes”		No Baseline CID 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 Items are ordered by preference (most preferred language to least preferred language).
>Include Table 8.8-1 “Code Sequence Macro Attributes”		BCID 5000 “Language”.
>Patient's Primary Language Modifier Code Sequence	(0010,0102)	A modifier 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 Table 8.8-1 “Code Sequence Macro Attributes”		BCID 5001 “Country”.
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 Table 8.8-1 “Code Sequence Macro Attributes”		BCID 7039 “Pediatric Size Category” 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.
Patient's Telecom Information	(0010,2155)	The Patient's personal telecommunication contact information, including telephone, email, or other telecom addresses. Note This Attribute may have internal format or structure in accordance with local agreement or profile. It is recommended that this Attribute be treated as equivalent to HL7v2 fields PID-13 and PID-14, or PID-40 (v2.7 and later), and be formatted in accordance with the HL7v2 XTN data type (without escapes for HL7 message structure reserved characters).
Ethnic Group	(0010,2160)	Ethnic group or race of Patient.
Ethnic Group Code Sequence	(0010,2161)	Ethnic group or race of Patient. One or more Items are permitted in this Sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes”		BCID 6099 “Racial Group”.
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 or welfare 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 or welfare decision making authority for the Patient.
Patient Species Description	(0010,2201)	The taxonomic rank value (e.g., genus, subgenus, species or subspecies) of the Patient. See Section C.7.1.1.1.3.
Patient Species Code Sequence	(0010,2202)	The taxonomic rank value (e.g., genus, subgenus, species or subspecies) of the Patient. See Section C.7.1.1.1.3. Only a single Item shall be included in this Sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes”		DCID 7454 “Animal Taxonomic Rank Value”.
Patient Breed Description	(0010,2292)	The breed of the Patient. See Section C.7.1.1.1.1.
Patient Breed Code Sequence	(0010,2293)	The breed of the Patient. See Section C.7.1.1.1.1. Zero or more Items shall be included in this Sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes”		DCID 7480 “Breed”.
Breed Registration Sequence	(0010,2294)	Information identifying a non-human organism within a breed registry. Zero or more Items shall be included in this Sequence.
>Breed Registration Number	(0010,2295)	Identification number of a non-human organism within the registry.
>Breed Registry Code Sequence	(0010,2296)	Identification of the organization with which a non-human organism is registered. Only a single Item shall be included in this Sequence.
>>Include Table 8.8-1 “Code Sequence Macro Attributes”		DCID 7481 “Breed Registry”.
Strain Description	(0010,0212)	The strain of the Patient. See Section C.7.1.1.1.4.
Strain Nomenclature	(0010,0213)	The nomenclature used for Strain Description (0010,0212). See Section C.7.1.1.1.4.
Strain Code Sequence	(0010,0219)	A coded identification of the strain of the Patient. See Section C.7.1.1.1.4. One or more Items are permitted in this Sequence. If more than one Item is present, each Item represents the same information but encoded using a different coding scheme (rather than post-coordinated modifiers).
>Include Table 8.8-1 “Code Sequence Macro Attributes”		No Baseline CID is defined.
Strain Additional Information	(0010,0218)	Additional information about the strain of the Patient that is not encoded in the formal nomenclature used in Strain Description (0010,0212). See Section C.7.1.1.1.4.
Strain Stock Sequence	(0010,0216)	Information identifying a non-human organism within a strain stock. Only a single Item is permitted in this Sequence.
>Strain Stock Number	(0010,0214)	The stock number of the strain of the Patient issued by the organization identified by Strain Source (0010,0217). See Section C.7.1.1.1.4.
>Strain Source	(0010,0217)	Identification of the organization that is the source of the non-human organism, issued by the registry identified by Strain Source Registry Code Sequence (0010,0215). See Section C.7.1.1.1.4.
>Strain Source Registry Code Sequence	(0010,0215)	Identification of the organization that is the registry of sources of non-human organisms. See Section C.7.1.1.1.4. Only a single Item is permitted in this Sequence.
>>Include Table 8.8-1 “Code Sequence Macro Attributes”		DCID 7490 “Research Animal Source Registry”.
Genetic Modifications Sequence	(0010,0221)	The genetic modifications of the Patient. One or more Items are permitted in this Sequence. See Section C.7.1.1.1.4.
>Genetic Modifications Description	(0010,0222)	The genetic modifications of the Patient described using a specific nomenclature.
>Genetic Modifications Nomenclature	(0010,0223)	The nomenclature used for Genetic Modifications Description (0010,0222).
>Genetic Modifications Code Sequence	(0010,0229)	A coded identification of the genetic modifications of the Patient. One or more Items are permitted in this Sequence. If more than one Item is present, each Item represents the same information but encoded using a different coding scheme (rather than post-coordinated modifiers).
>>Include Table 8.8-1 “Code Sequence Macro Attributes”		No Baseline CID is defined.

Note

The language codes specified in CID 5000 “Language”, 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 releases of the Standard.

C.2.4 Patient Medical Module

Table C.2-4 specifies the Attributes of the Patient Medical Module, which describe a Patient's medical state or history.

Table C.2-4. Patient 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 Values: ALTERED Altered/Neutered UNALTERED Unaltered/intact
Patient's Body Mass Index	(0010,1022)	Body Mass Index of the Patient in kg/m2.
Measured AP Dimension	(0010,1023)	The thickness in mm of the body part being scanned, in the antero-posterior dimension (per AAPM Report 204). Note These values are normally derived from a scanned image, but might also be obtained using physical calipers, e.g., for children.
Measured Lateral Dimension	(0010,1024)	The side-to-side (left to right) dimension in mm of the body part being scanned (per AAPM Report 204). Note These values are normally derived from a scanned image, but might also be obtained using physical calipers, e.g., for children.
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 Table 10-11 “SOP Instance Reference Macro Attributes”
>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 Table 8.8-1 “Code Sequence Macro Attributes”		No Baseline CID is defined.
>Document Title	(0042,0010)	Title of the referenced document.
Pertinent Resources Sequence	(0038,0101)	List of resources that contain information considered pertinent for the Patient medical condition. Zero or more Items shall be included in this Sequence.
>Retrieve URI	(0040,E010)	Retrieval access path to resource. Includes fully specified scheme, authority, path, and query in accordance with [RFC3986]. Note The VR of this Data Element has changed from UT to UR.
>Resource Description	(0038,0102)	Description or title of the resource.
Patient Clinical Trial Participation Sequence	(0038,0502)	Sequence of identifiers for clinical trials or research 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 or research 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 or research protocol.
>Clinical Trial Site ID	(0012,0030)	The identifier, issued by the Clinical Trial Sponsor, of the site responsible for submitting clinical trial or research data.
>Clinical Trial Site Name	(0012,0031)	Name of the site responsible for submitting clinical trial or research data.
>Clinical Trial Subject ID	(0012,0040)	The assigned identifier for the Patient as a clinical trial or research subject.
>Clinical Trial Subject Reading ID	(0012,0042)	Identifies the Patient as a clinical trial or research subject for blinded evaluations.

Note

The Patient Clinical Trial Participation Sequence (0038,0502) identifies potentially multiple trials or research projects 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 specifies the Attributes of the Visit Relationship Module, which reference SOP Instances related to this SOP Class.

Table C.3-1. Visit Relationship Module Attributes

Attribute Name	Tag	Attribute Description
Referenced Study Sequence	(0008,1110)	Uniquely identifies the Studies associated with the Visit. One or more Items shall be included in this Sequence. See Section 10.6.1.
>Include Table 10-11 “SOP Instance Reference Macro Attributes”
Referenced Patient Sequence	(0008,1120)	Uniquely identifies the Patient that relates to the Visit. Only a single Item shall be included in this Sequence.
>Include Table 10-11 “SOP Instance Reference Macro Attributes”

C.3.2 Visit Identification Module

Table C.3-2 specifies the Attributes of the Visit Identification Module, which identify a Visit.

Table C.3-2. Visit 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 Table 8.8-1 “Code Sequence Macro Attributes”		No Baseline CID is defined.
Institutional Department Name	(0008,1040)	The Department, Unit or Service within the healthcare facility.
Institutional Department Type Code Sequence	(0008,1041)	A coded description of the type of Department or Service within the healthcare facility. Note This might be obtained from a corresponding HL7v2 message containing PV1:10 Hospital Service. Only a single Item is permitted in this Sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes”		BCID 7030 “Institutional Department/Unit/Service”.
Admission ID	(0038,0010)	Identification number of the Visit as assigned by the healthcare provider Note Visit and Admission are used interchangeably here. In the broader sense, an admission is a type of visit at an institution where there is an admission process for patients.
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 Table 10-17 “HL7v2 Hierarchic Designator Macro Attributes”
Reason for Visit	(0032,1066)	Reason(s) for this visit by the patient to the facility or provider.
Reason for Visit Code Sequence	(0032,1067)	Coded reason(s) for this visit by the patient to the facility or provider. Note If an HL7 message is available with a PV2 segment corresponding to this visit, potential codes may be found in Admit Reason PV2-3. One or more Items are permitted in this Sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes”		No Baseline CID is defined.
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 Table 10-17 “HL7v2 Hierarchic Designator Macro Attributes”
Service Episode Description	(0038,0062)	Description of the type of service episode.

C.3.3 Visit Status Module

Table C.3-3 specifies the Attributes of the Visit Status Module, which are relevant to the Patient's stay with the healthcare provider.

Table C.3-3. Visit 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 specifies the Attributes of the Visit Admission Module, which are relevant to admitting the Patient during the Visit.

Table C.3-4. Visit 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 Table 10-1 “Person Identification Macro Attributes”		Note The Person's Telecom Information (0040,1104) Attribute in this Sequence may be treated as equivalent to HL7v2 field ROL-12 associated with the referring physician identified in PV1-8.
Consulting Physician's Name	(0008,009C)	Consulting physician(s) for this Patient Visit.
Consulting Physician Identification Sequence	(0008,009D)	Identification of the consulting physician(s). One or more Items are permitted in this Sequence. If more than one Item, the number and order shall correspond to the value of Consulting Physician's Name (0008,009C), if present.
>Include Table 10-1 “Person Identification Macro Attributes”		Note The Person's Telecom Information (0040,1104) Attribute in this Sequence may be treated as equivalent to HL7v2 field ROL-12 associated with the consulting physician.
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 Table 8.8-1 “Code Sequence Macro Attributes”		No Baseline CID 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.4.10 Scheduled Procedure Step Module

Table C.4-10. Scheduled 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.
>Referenced Defined Protocol Sequence	(0018,990C)	Defined Procedure Protocol Instance(s) specified for the Scheduled Procedure Step.
>>Referenced SOP Class UID	(0008,1150)	Uniquely identifies the referenced SOP Class.
>>Referenced SOP Instance UID	(0008,1155)	Uniquely identifies the referenced SOP Instance.
>Referenced Performed Protocol Sequence	(0018,990D)	Prior Performed Procedure Protocol Instance(s) that is to be repeated for the Scheduled Procedure Step.
>>Referenced SOP Class UID	(0008,1150)	Uniquely identifies the referenced SOP Class.
>>Referenced SOP Instance UID	(0008,1155)	Uniquely identifies the referenced SOP Instance.
>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 Table 10-1 “Person Identification Macro Attributes”
>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 Table 8.8-1 “Code Sequence Macro Attributes”		No Baseline CID is defined.
>>Protocol Context Sequence	(0040,0440)	Sequence that specifies the context for the Scheduled Protocol Code Sequence (0040,0008) Item. One or more Items shall be included in this Sequence. See Section C.4.10.1.
>>>Include Table 10-2 “Content Item Macro Attributes”		No Baseline TID 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 Table 10-2 “Content Item Macro Attributes”		No Baseline TID 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 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)	Type of device, process or method for which the Scheduled Procedure Step is scheduled. 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
>Treatment Session UID	(300A,0700)	A unique identifier of the RT Treatment Session to which Instances created during this Procedure Step will belong.
Scheduled Specimen Sequence	(0040,0500)	Sequence of Items identifying specimens to be imaged in the identified Scheduled Procedure Step(s), with their characteristics.
>Include Table C.7.6.22-2 “Specimen Macro Attributes”
Barcode Value	(2200,0005)	Barcode interpreted from a scanned label. Note In the case of a scanned patient label, this may be the same as Patient ID (0010,0020), but it is included in the Scheduled Procedure Step Module rather than the Patient Identification Module since barcodes may also be used to identify lower level entities and/or different forms of patient identifier may be in use. In the case of a scanned slide label, this may be the same as Container Identifier (0040,0512).

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.4-11. Requested 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 Table 8.8-1 “Code Sequence Macro Attributes”		No Baseline CID is defined.
Requested Procedure Code Sequence	(0032,1064)	A Sequence that conveys the Requested Procedure of one Procedure Type. Only a single Item shall be included in this Sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes”		BCID 101 “Imaging Procedure”.
Requested Laterality Code Sequence	(0032,1065)	Laterality of body part subject of procedure. Only a single Item shall be included in this Sequence. If present, shall not conflict with any pre-coordinated laterality in Requested Procedure Code Sequence (0032,1064).
>Include Table 8.8-1 “Code Sequence Macro Attributes”		DCID 244 “Laterality”.
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 Studies associated with this SOP Instance. One or more Items shall be included in this Sequence. See Section 10.6.1.
>Include Table 10-11 “SOP Instance Reference Macro Attributes”
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 Table 10-1 “Person Identification Macro Attributes”

Note

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

C.4.12 Imaging Service Request Module

Table C.4-12. Imaging Service Request Module Attributes

Attribute Name	Tag	Attribute Description
Imaging Service Request Comments	(0040,2400)	User-defined comments on the Imaging Service Request. Note This 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 Table 10-1 “Person Identification Macro Attributes”		Note The Person's Telecom Information (0040,1104) Attribute in this Sequence may be treated as equivalent to HL7v2 field ROL-12 associated with the requesting physician identified in ORC-12 or OBR-16.
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 Table 10-1 “Person Identification Macro Attributes”		Note The Person's Telecom Information (0040,1104) Attribute in this Sequence may be treated as equivalent to HL7v2 field ROL-12 associated with the referring physician identified in PV1-8.
Requesting Service	(0032,1033)	Institutional department, unit or service where the request initiated. See Note 3.
Requesting Service Code Sequence	(0032,1034)	Institutional department, unit or service where the request initiated. Equivalent to HL7 v2.x ORC-17. See Note 3. Only a single Item shall be included in this Sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes”		DCID 7030 “Institutional Department/Unit/Service”.
Accession Number	(0008,0050)	A departmental Information System 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 Table 10-17 “HL7v2 Hierarchic Designator Macro Attributes”
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 Table 10-17 “HL7v2 Hierarchic Designator Macro Attributes”
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 Table 10-17 “HL7v2 Hierarchic Designator Macro Attributes”
Order Entered By	(0040,2008)	The person who entered the Imaging Service Request into an Information System. Note This Attribute may be treated as equivalent to HL7v2 field ORC-10.
Order Enterer's Location	(0040,2009)	The location at which the Imaging Service Request was entered. Note This Attribute may be treated as equivalent to HL7v2 field ORC-13.
Order Callback Phone Number	(0040,2010)	Telephone Number at which additional information can be retrieved.
Order Callback Telecom Information	(0040,2011)	The telecommunication contact information, including telephone, email, or other telecom addresses, at which additional information about the order can be retrieved. Note This Attribute may have internal format or structure in accordance with local agreement or profile. It is recommended that this Attribute be treated as equivalent to HL7v2 fields ORC-12 and OBR-17, and be formatted in accordance with the HL7v2 XTN data type (without escapes for HL7 message structure reserved characters).
Admission ID	(0038,0010)	Identification number of the Visit as assigned by the healthcare provider Note Visit and Admission are used interchangeably here. In the broader sense, an admission is a type of visit at an institution where there is an admission process for patients.
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 Table 10-17 “HL7v2 Hierarchic Designator Macro Attributes”
Reason for Visit	(0032,1066)	Reason(s) for this visit by the patient to the facility or provider.
Reason for Visit Code Sequence	(0032,1067)	Coded reason(s) for this visit by the patient to the facility or provider. Note If an HL7 message is available with a PV2 segment corresponding to this visit, potential codes may be found in Admit Reason PV2-3. One or more Items are permitted in this Sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes”		No Baseline CID is defined.

Note

Placer Order Number / Imaging Service Request (0040,2016) and Filler Order Number / Imaging Service Request (0040,2017) are intended to convey the corresponding order numbers as defined in HL7, in the case where interoperability with an HL7 environment is the objective.
Attributes (0040,2001), (0040,2006) and (0040,2007) were previously defined in DICOM. They are now retired (see PS3.3-1998 ).
Both Requesting Service (0032,1033) and Requesting Service Code Sequence (0032,1034) are defined in this table; the latter is preferred, but the former may be copied from an HL7 message whether or not there is also 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 Module

Table C.4-13 specifies the Attributes of the Performed Procedure Step Relationship Module, which are 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 identifier for the Patient. Note In the case of imaging a group of small animals simultaneously, the single value of this identifier corresponds to the identification of the entire group. See also Section C.7.1.4.1.1.
Include Table 10-18 “Issuer of Patient ID Macro Attributes”
Patient's Birth Date	(0010,0030)	Date of birth of the named Patient.
Patient's Birth Date in Alternative Calendar	(0010,0033)	Date of birth of the named Patient in the Alternative Calendar (0010,0035). Note No format is specified for alternative calendar dates so none should be assumed.
Patient's Death Date in Alternative Calendar	(0010,0034)	Date of death of the named Patient in the Alternative Calendar (0010,0035). Note No format is specified for alternative calendar dates so none should be assumed.
Patient's Alternative Calendar	(0010,0035)	The Alternative Calendar used for Patient's Birth Date in Alternative Calendar (0010,0033) and Patient's Death Date in Alternative Calendar (0010,0034). See Section C.7.1.5 for Defined Terms. Required if either Patient's Birth Date in Alternative Calendar (0010,0033) or Patient's Alternative Death Date in Calendar (0010,0034) is present.
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. Only a single Item shall be included in this Sequence.
>Include Table 10-11 “SOP Instance Reference Macro Attributes”
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 Table 10-17 “HL7v2 Hierarchic Designator Macro Attributes”
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 Table 10-17 “HL7v2 Hierarchic Designator Macro Attributes”
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 associated with this Scheduled Procedure Step. Only a single Item shall be included in this Sequence. See Section 10.6.1.
>>Include Table 10-11 “SOP Instance Reference Macro Attributes”
>Accession Number	(0008,0050)	A departmental Information System 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 Table 10-17 “HL7v2 Hierarchic Designator Macro Attributes”
>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 Table 10-17 “HL7v2 Hierarchic Designator Macro Attributes”
>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 Table 10-17 “HL7v2 Hierarchic Designator Macro Attributes”
>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 Table 8.8-1 “Code Sequence Macro Attributes”		No Baseline CID 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 Table 8.8-1 “Code Sequence Macro Attributes”		No Baseline CID is defined.
>>Protocol Context Sequence	(0040,0440)	Sequence that specifies the context for the Scheduled Protocol Code Sequence (0040,0008) Item. One or more Items shall be included in this Sequence. See Section C.4.10.1.
>>>Include Table 10-2 “Content Item Macro Attributes”		No Baseline TID 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 Table 10-2 “Content Item Macro Attributes”		No Baseline TID is defined.

Note

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.
Placer Order Number / Imaging Service Request (0040,2016) and Filler Order Number / Imaging Service Request (0040,2017) are intended to convey the corresponding order numbers as defined in HL7, in the case where interoperability with an HL7 environment is the objective.
Attributes (0040,2006) and (0040,2007) were previously defined in DICOM. They are now retired (see PS3.3-1998 ).
Placer Order Number / Procedure (0040,1006) and Filler Order Number / Procedure (0040,1007) were previously defined in DICOM. They are now retired (see PS3.3-1998 ).

C.4.14 Performed Procedure Step Information Module

Table C.4-14 specifies the Attributes of the Performed Procedure Step Information Module, which 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 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 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 Table 8.8-1 “Code Sequence Macro Attributes”		BCID 101 “Imaging Procedure”.
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 Table 8.8-1 “Code Sequence Macro Attributes”		No Baseline CID 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 Table 8.8-1 “Code Sequence Macro Attributes”		DCID 9300 “Procedure Discontinuation Reason”.

C.4.15 Image Acquisition Results Module

Table C.4-15 specifies the Attributes of the Image Acquisition Results Module, which 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 device, process or method that originally acquired the data used to create the Instances associated with this Modality Performed Procedure Step. See Section 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 Table 8.8-1 “Code Sequence Macro Attributes”		No Baseline CID is defined.
>Protocol Context Sequence	(0040,0440)	Sequence that specifies the context for the Performed Protocol Code Sequence (0040,0260) Item. One or more Items shall be included in this Sequence. See Section C.4.10.1.
>>Include Table 10-2 “Content Item Macro Attributes”		No Baseline TID 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 Table 10-2 “Content Item Macro Attributes”		No Baseline TID 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 Table 10-1 “Person Identification Macro Attributes”
>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 Table 10-1 “Person Identification Macro Attributes”
>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 included in this Sequence.
>>Include Table 8.8-1 “Code Sequence Macro Attributes”		No Baseline CID 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. Enumerated Values: 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 Table 10-11 “SOP Instance Reference Macro Attributes”
>>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 Table 10-11 “SOP Instance Reference Macro Attributes”

C.4.16 Radiation Dose Module (Retired)

Retired. See PS3.3-2017c

C.4.17 Billing and Material Management Code Module

Table C.4-17 specifies the Attributes of the Billing and Material Management Code Module, which 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.4-17. Billing 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 Table 8.8-1 “Code Sequence Macro Attributes”		No Baseline CID 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 Table 8.8-1 “Code Sequence Macro Attributes”		No Baseline CID 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 Table 8.8-1 “Code Sequence Macro Attributes”		BCID 82 “Measurement Unit”.

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. Note This may refer to a different PPS than that encoded in the Composite Instances themselves. It is typically used for notification about Instances created as a consequence of some scheduled activity.
>Include Table 10-11 “SOP Instance Reference Macro Attributes”
>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 Table 8.8-1 “Code Sequence Macro Attributes”		BCID 9231 “Workitem Definition”.
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 Table 10-11 “SOP Instance Reference Macro Attributes”
>>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)	Fully specified URI/URL (see [RFC3986]) the location of the referenced Instance. Note The VR of this Data Element has changed from UT to UR.
>>Retrieve URL	(0008,1190)	URL specifying the location of the referenced Instance(s). See Section 10.4 “Retrieve Transaction” in PS3.18.
>>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

Enumerated Values:

ONLINE: The Instances are immediately available from the Retrieve AE Title (0008,0054), and if a C-MOVE were to be requested, it would succeed in a reasonably short time.
NEARLINE: The Instances need to be retrieved from relatively slow media such as optical disk or tape, and if a C-MOVE were to be requested from the Retrieve AE Title (0008,0054), it would succeed, but may take a considerable time.
OFFLINE: A manual intervention is needed before the Instances may be retrieved, and if a C-MOVE were to be requested from the Retrieve AE Title (0008,0054), it would fail (e.g., by timeout) without such manual intervention.
UNAVAILABLE: The Instances cannot be retrieved from the Retrieve AE Title (0008,0054), and if a C-MOVE were to be requested, it would fail.

Note

SOP Instances that are unavailable from this AE may be available from other AEs, or may have an alternate representation that is available from this AE.

C.5 Results Modules (Retired)

Retired. See PS3.3-2004.

C.6 Interpretation Modules (Retired)

Retired. See PS3.3-2004.

C.7 Common Composite IOD Modules

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

C.7.1 Common Patient IE Modules

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

C.7.1.1 Patient Module

Table C.7-1 specifies the Attributes of the Patient Module, which identify and describe the Patient who is the subject of the Study. This Module contains Attributes of the Patient that are needed for interpretation of the Composite Instances and are common for all Studies performed on the Patient. It contains Attributes that are also included in the Section C.2 Patient Modules.

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 identifier for the Patient. Note In the case of imaging a group of small animals simultaneously, the single value of this identifier corresponds to the identification of the entire group. See also Section C.7.1.4.1.1.
Include Table 10-18 “Issuer of Patient ID Macro Attributes”
Type of Patient ID	(0010,0022)	3	The type of identifier in the Patient ID (0010,0020). Defined Terms: TEXT RFID BARCODE Note The identifier is coded as a string regardless of the type, not as a binary value. When this Attribute has a value of BARCODE, Patient ID (0010,0020) may or may not have the same value as Barcode Value (2200,0005) in the SOP Common Module, if present.
Patient's Birth Date	(0010,0030)	2	Birth date of the Patient.
Patient's Birth Date in Alternative Calendar	(0010,0033)	3	Date of birth of the named Patient in the Alternative Calendar (0010,0035). Note No format is specified for alternative calendar dates so none should be assumed.
Patient's Death Date in Alternative Calendar	(0010,0034)	3	Date of death of the named Patient in the Alternative Calendar (0010,0035). Note No format is specified for alternative calendar dates so none should be assumed.
Patient's Alternative Calendar	(0010,0035)	1C	The Alternative Calendar used for Patient's Birth Date in Alternative Calendar (0010,0033) and Patient's Death Date in Alternative Calendar (0010,0034). See Section C.7.1.5 for Defined Terms. Required if either Patient's Birth Date in Alternative Calendar (0010,0033) or Patient's Alternative Death Date in Calendar (0010,0034) is present.
Patient's Sex	(0010,0040)	2	Sex of the named Patient. Enumerated Values: M male F female O other
Referenced Patient Photo Sequence	(0010,1100)	3	A photo to confirm the identity of a Patient. Only a single Item is permitted in this Sequence. See C.2.2.1.1.
>Include Table 10-3b “Referenced Instances and Access Macro Attributes”
Quality Control Subject	(0010,0200)	3	Indicates whether or not the subject is a quality control phantom. Enumerated Values: YES NO If this Attribute is absent, then the subject may or may not be a phantom. This Attribute describes a characteristic of the Imaging Subject. It is distinct from Quality Control Image (0028,0300) in the General Image Module, which is used to describe an image acquired.
Referenced Patient Sequence	(0008,1120)	3	A Sequence that provides reference to a Patient. Only a single Item is permitted in this Sequence.
>Include Table 10-11 “SOP Instance Reference Macro Attributes”
Patient's Birth Time	(0010,0032)	3	Birth time of 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. Note This Attribute replaces the use of Other Patient IDs (0010,1000), which did not specify an issuer for each other identifier, and which has been retired.
>Patient ID	(0010,0020)	1	An identifier for the Patient. Note In the case of imaging a group of small animals simultaneously, the single value of this identifier corresponds to the identification of the entire group. See also Section C.7.1.4.1.1.
>Include Table 10-18 “Issuer of Patient ID Macro Attributes”
>Type of Patient ID	(0010,0022)	1	The type of identifier in the Patient ID (0010,0020) 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. When this Attribute has a value of BARCODE, Patient ID (0010,0020) may or may not have the same value as Barcode Value (2200,0005) in the SOP Common Module, if present.
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.
Ethnic Group Code Sequence	(0010,2161)	3	Ethnic group or race of Patient. One or more Items are permitted in this Sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes”			BCID 6099 “Racial Group”.
Patient Comments	(0010,4000)	3	User-defined additional information about the Patient.
Patient Species Description	(0010,2201)	1C	The taxonomic rank value (e.g., genus, subgenus, species or subspecies) of the Patient. See Section C.7.1.1.1.3. Required if the Patient is a non-human organism and if Patient Species Code Sequence (0010,2202) is not present. May be present otherwise.
Patient Species Code Sequence	(0010,2202)	1C	The taxonomic rank value (e.g., genus, subgenus, species or subspecies) of the Patient. See Section C.7.1.1.1.3. Only a single Item shall be included in this Sequence. Required if the Patient is a non-human organism and if Patient Species Description (0010,2201) is not present. May be present otherwise.
>Include Table 8.8-1 “Code Sequence Macro Attributes”			DCID 7454 “Animal Taxonomic Rank Value”.
Patient Breed Description	(0010,2292)	2C	The breed of the Patient. See Section C.7.1.1.1.1. Required if the Patient is a non-human organism 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 Section C.7.1.1.1.1. Zero or more Items shall be included in this Sequence. Required if the Patient is a non-human organism.
>Include Table 8.8-1 “Code Sequence Macro Attributes”			DCID 7480 “Breed”.
Breed Registration Sequence	(0010,2294)	2C	Information identifying a non-human organism within a breed registry. Zero or more Items shall be included in this Sequence. Required if the Patient is a non-human organism.
>Breed Registration Number	(0010,2295)	1	Identification number of a non-human organism within the registry.
>Breed Registry Code Sequence	(0010,2296)	1	Identification of the organization with which a non-human organism is registered. Only a single Item shall be included in this Sequence.
>>Include Table 8.8-1 “Code Sequence Macro Attributes”			DCID 7481 “Breed Registry”.
Strain Description	(0010,0212)	3	The strain of the Patient. See Section C.7.1.1.1.4.
Strain Nomenclature	(0010,0213)	3	The nomenclature used for Strain Description (0010,0212). See Section C.7.1.1.1.4.
Strain Code Sequence	(0010,0219)	3	A coded identification of the strain of the Patient. See Section C.7.1.1.1.4. One or more Items are permitted in this Sequence. If more than one Item is present, each Item represents the same information but encoded using a different coding scheme (rather than post-coordinated modifiers).
>Include Table 8.8-1 “Code Sequence Macro Attributes”			No Baseline CID is defined.
Strain Additional Information	(0010,0218)	3	Additional information about the strain of the Patient that is not encoded in the formal nomenclature used in Strain Description (0010,0212). See Section C.7.1.1.1.4.
Strain Stock Sequence	(0010,0216)	3	Information identifying a non-human organism within a strain stock. Only a single Item is permitted in this Sequence.
>Strain Stock Number	(0010,0214)	1	The stock number of the strain of the Patient issued by the organization identified by Strain Source (0010,0217). See Section C.7.1.1.1.4.
>Strain Source	(0010,0217)	1	Identification of the organization that is the source of the non-human organism, issued by the registry identified by Strain Source Registry Code Sequence (0010,0215). See Section C.7.1.1.1.4.
>Strain Source Registry Code Sequence	(0010,0215)	1	Identification of the organization that is the registry of sources of non-human organisms. See Section C.7.1.1.1.4. Only a single Item is permitted in this Sequence.
>>Include Table 8.8-1 “Code Sequence Macro Attributes”			DCID 7490 “Research Animal Source Registry”.
Genetic Modifications Sequence	(0010,0221)	3	The genetic modifications of the Patient. One or more Items are permitted in this Sequence. See Section C.7.1.1.1.4.
>Genetic Modifications Description	(0010,0222)	1	The genetic modifications of the Patient described using a specific nomenclature.
>Genetic Modifications Nomenclature	(0010,0223)	1	The nomenclature used for Genetic Modifications Description (0010,0222).
>Genetic Modifications Code Sequence	(0010,0229)	3	A coded identification of the genetic modifications of the Patient. One or more Items are permitted in this Sequence. If more than one Item is present, each Item represents the same information but encoded using a different coding scheme (rather than post-coordinated modifiers).
>>Include Table 8.8-1 “Code Sequence Macro Attributes”			No Baseline CID is defined.
Responsible Person	(0010,2297)	2C	Name of person with medical or welfare decision making authority for the Patient. Required if the Patient is a non-human organism. 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 or welfare decision making authority for the Patient. Required if Patient is a non-human organism. 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. Note 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). 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 Table 8.8-1 “Code Sequence Macro Attributes”			DCID 7050 “De-identification Method”.
Include Table C.7.1.4-1 “Patient Group Macro Attributes”

Note

Previously, Other Patient IDs (0010,1000) was included in this table. This Attribute has been retired. See PS3.3-2017a.

C.7.1.1.1 Patient Module Attribute Descriptions

C.7.1.1.1.1 Patient Breed Description and Code Sequence

The breed of a non-human organism, 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:

described in plain text in Patient Breed Description (0010,2292), e.g., "Border Collie American Bulldog mix", or just "Mixed", or
coded as multiple specific breeds by composing the mix as multiple Items of Patient Breed Code Sequence (0010,2293), e.g., (132561000, SCT, "Border Collie dog breed") followed by (132534000, SCT, "American Bulldog breed"), or
encoded non-specifically with a code that means "mixed breed" of the appropriate species, as defined in CID 7486 “Mixed Breed”, which is included in CID 7480 “Breed”, e.g., (132619000, SCT, "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

Defined Terms:

OWNER
PARENT
CHILD
SPOUSE
SIBLING
RELATIVE
GUARDIAN
CUSTODIAN
AGENT
INVESTIGATOR
VETERINARIAN

C.7.1.1.1.3 Patient Species (Taxonomic Rank Value)

If the species is not known then the Patient Species Description (0010,2201) or Patient Species Code Sequence (0010,2202) may describe a more general taxonomic rank value, such as a genus or subgenus, family or subfamily.

Note

E.g., "Mus" rather than "Mus musculus".

If the subspecies is known then the Patient Species Description (0010,2201) or Patient Species Code Sequence (0010,2202) may describe the subspecies.

Note

E.g., "Canis lupus familiaris" rather than "Canis lupus".

C.7.1.1.1.4 Patient Strain and Genetic Modifications

The strain of a non-human organism (group of non-human organisms that is genetically uniform), if known, may be encoded in Strain Description (0010,0212). The nomenclature used may be encoded in Strain Nomenclature (0010,0213). A precoordinated code identifying the strain may be encoded in Strain Code Sequence (0010,0219).

Defined Terms for Strain Nomenclature (0010,0213) and Genetic Modifications Nomenclature (0010,0223):

MGI_2013: International Committee on Standardized Genetic Nomenclature for Mice, Rat Genome and Nomenclature Committee. MGI-Guidelines for Nomenclature of Mouse and Rat Strains. 2013/10. Available from: http://www.informatics.jax.org/mgihome/nomen/strains.shtml

Note

A pair of text and nomenclature Attributes are used, since standard nomenclatures typically define values that are constructed from multiple components, and do not distinguish between value and meaning. These are distinct from the precoordinated codes used in Strain Code Sequence (0010,0219).
Some strain and genetic modification nomenclatures make use of superscripts. To encode these superscripts consistently in an unformatted string, the convention of enclosing the superscript text in "<" and ">" pairs may be used. E.g., "D2.B6-Ahr^b-1/J" would be encoded as "D2.B6-Ahr<b-1>/J".
Relevant information that is not encoded in the formal description of the strain (i.e., not defined in the nomenclature used), such as the number of transgenes, may be encoded as plain text in Strain Additional Information (0010,0218).

The strain of a non-human organism may be more specifically identified by the Attributes within Strain Stock Sequence (0010,0216).

Note

The MGI-Guidelines for Nomenclature of Mouse and Rat Strains recommends the use of the laboratory codes assigned by the Institute of Laboratory Animal Research (ILAR). See the International Laboratory Code Registry (ILCR) http://dels.nas.edu/global/ilar/lab-codes.
Because allele names are closely tied to gene names/symbols it is necessary to have a unique and permanent code for any allele that is part of a genotype of interest. For mice, MGI is the authoritative source of the nomenclature for genes and alleles and maintains unique, permanent codes for these entities. The MGI provides a report of all precoordinated MGI codes that are assigned to specific strains at http://www.informatics.jax.org/downloads/reports/MGI_Strain.rpt. These may be used in Strain Code Sequence (0010,0219) and Genetic Modifications Code Sequence (0010,0229) with a coding scheme of "MGI".
Another source of pre-coordinated codes for strains is the NCI Thesaurus, which includes a snapshot of strains from the International Mouse Strain Resource (IMSR), as children of (C14421, NCIt, "Inbred Mouse Strains"). See http://ncit.nci.nih.gov/ncitbrowser/pages/concept_details.jsf?dictionary=NCI_Thesaurus&code=C14421.
For example, a C57BL/6J mouse strain from The Jackson Laboratory might be identified as:
- Strain Description (0010,0212) = "C57BL/6J"
- Strain Nomenclature (0010,0213) = "MGI_2013"
- Strain Code Sequence (0010,0219)
  - >Code Value (0008,0100) = "3028467"
  - >Coding Scheme Designator (0008,0102) = "MGI"
  - >Code Meaning (0008,0104) = "C57BL/6J"
- Strain Stock Sequence (0010,0216)
  - >Strain Stock Number (0010,0214) = "000664"
  - >Strain Source (0010,0217) = "Jrep"
  - >Strain Source Registry Code Sequence (0010,0215)
    
    >>Code Value (0008,0100) = 126850
    
    >>Coding Scheme Designator (0008,0102) = "DCM"
    
    >>Code Meaning (0008,0104) = "ILCR"
For example, a FVB/N mouse with a Tg(MMTV-Erbb2*)NDL2-5Mul transgene might be identified as:
- Strain Description (0010,0212) = "FVB/N-Tg(MMTV-Erbb2*)NDL2-5Mul"
- Strain Nomenclature (0010,0213) = "MGI_2013"
- Genetic Modifications Sequence (0010,0221)
  - >Genetic Modifications Description (0010,0222) = "Tg(MMTV-Erbb2*)NDL2-5Mul"
  - >Genetic Modifications Nomenclature (0010,0223) = "MGI_2013"
  - >Genetic Modifications Code Sequence (0010,0229)
    
    >>Code Value (0008,0100) = "3793949"
    
    >>Coding Scheme Designator (0008,0102) = "MGI"
    
    >>Code Meaning (0008,0104) = "Tg(MMTV-Erbb2*)NDL2-5Mul"
In this example, a precoordinated code for the genetic modification is defined in MGI, but not for the mouse strain.

C.7.1.2 Specimen Identification Module (Retired)

Retired. See PS3.3-2008.

Note

The functionality of the Specimen Identification Module (Retired) has been replaced by the Specimen Module. See Section C.7.6.22.

C.7.1.3 Clinical Trial Subject Module

Table C.7-2b specifies the Attributes of the Clinical Trial Subject Module, which identify a Patient as a clinical trial or research 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 or research sponsor. See Section C.7.1.3.1.1.
Clinical Trial Protocol ID	(0012,0020)	1	Identifier for the protocol. See Section C.7.1.3.1.2.
Issuer of Clinical Trial Protocol ID	(0012,0022)	3	Identifier of the Assigning Authority that issued the Clinical Trial Protocol ID (0012,0020).
Other Clinical Trial Protocol IDs Sequence	(0012,0023)	3	Identification numbers or codes used to identify the protocol. One or more Items are permitted in this Sequence.
>Clinical Trial Protocol ID	(0012,0020)	1	Identifier for the protocol. See Section C.7.1.3.1.2.
>Issuer of Clinical Trial Protocol ID	(0012,0022)	1	Identifier of the Assigning Authority that issued the Clinical Trial Protocol ID (0012,0020).
Clinical Trial Protocol Name	(0012,0021)	2	The name of the clinical trial or research protocol. See Section C.7.1.3.1.3.
Clinical Trial Site ID	(0012,0030)	2	The identifier of the site responsible for submitting clinical trial or research data. See Section C.7.1.3.1.4.
Issuer of Clinical Trial Site ID	(0012,0032)	3	Identifier of the Assigning Authority that issued the Clinical Trial Site ID (0012,0030).
Clinical Trial Site Name	(0012,0031)	2	Name of the site responsible for submitting clinical trial or research data. See Section C.7.1.3.1.5
Clinical Trial Subject ID	(0012,0040)	1C	The assigned identifier for the clinical trial or research subject. See Section C.7.1.3.1.6. Shall be present if Clinical Trial Subject Reading ID (0012,0042) is absent. May be present otherwise.
Issuer of Clinical Trial Subject ID	(0012,0041)	3	Identifier of the Assigning Authority that issued the Clinical Trial Subject ID (0012,0040).
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 Section C.7.1.3.1.7.
Issuer of Clinical Trial Subject Reading ID	(0012,0043)	3	Identifier of the Assigning Authority that issued the Clinical Trial Subject Reading ID (0012,0042).
Clinical Trial Protocol Ethics Committee Name	(0012,0081)	1C	Name of the Ethics Committee or Institutional Review Board (IRB) or Institutional Animal Care and Use Committees (IACUC) responsible for approval of the Clinical Trial or research. 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 Module Attribute Descriptions

Identification of subjects in clinical trials or research generally requires a combination of the following four Attributes:

Clinical Trial Sponsor Name (0012,0010),
Clinical Trial Protocol ID (0012,0020),
Clinical Trial Subject ID (0012,0040) (or Clinical Trial Subject Reading ID (0012,0042) for blinded evaluations), and
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 or research 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.

Note

If there is a need to record more than one identifier for the protocol, one may be conveyed Clinical Trial Protocol ID (0012,0020) in the top level dataset and the others included in Other Clinical Trial Protocol IDs Sequence (0012,0023), and the source of each distinguished by their Issuer of Clinical Trial Protocol ID (0012,0022).

Here is an example of identifying a completed trial whose data has been shared and assigned a digital object identifier:

Clinical Trial Protocol ID (0012,0020) = "TCGA-GBM"
Issuer of Clinical Trial Protocol ID (0012,0022) = "NCI"
Other Clinical Trial Protocol IDs Sequence (0012,0023)
- >Clinical Trial Protocol ID (0012,0020) = "doi:10.7937/K9/TCIA.2016.RNYFUYE9"
- >Issuer of Clinical Trial Protocol ID (0012,0022) = "DOI"

Here is an example of identifying a clinical trial that is potentially ongoing and not yet published or shared, and has multiple (primary and secondary) identifiers from the same issuer (which are enumerated but not otherwise distinguished from each other):

Clinical Trial Protocol ID (0012,0020) = "D6940C00002"
Issuer of Clinical Trial Protocol ID (0012,0022) = "NCI"
Other Clinical Trial Protocol IDs Sequence (0012,0023)
- >Clinical Trial Protocol ID (0012,0020) = "NCI-2018-00805"
- >Issuer of Clinical Trial Protocol ID (0012,0022) = "NCI"
- >Clinical Trial Protocol ID (0012,0020) = "135803"
- >Issuer of Clinical Trial Protocol ID (0012,0022) = "NCI"
- >Clinical Trial Protocol ID (0012,0020) = "2017-002451-28"
- >Issuer of Clinical Trial Protocol ID (0012,0022) = "NCI"
- >Clinical Trial Protocol ID (0012,0020) = "NCT03423628"
- >Issuer of Clinical Trial Protocol ID (0012,0022) = "ClinicalTrials.gov"

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 or research 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 or research 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 or research 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).

Note

The Clinical Trial Subject ID (0012,0040) may, but is not required to be, the same as Patient ID (0010,0020).

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.7.1.4 Patient Group Macro

Table C.7.1.4-1 specifies the Attributes of the Patient Group Macro, which describe multiple imaging subjects (such as small animals for pre-clinical research) imaged at the same time as a group. This Macro may be included in the Section C.2.2 Patient Identification Module and the Section C.7.1.1 Patient Module.

Table C.7.1.4-1. Patient Group Macro Attributes

Attribute Name	Tag	Type	Attribute Description
Source Patient Group Identification Sequence	(0010,0026)	3	A Sequence containing the value used for Patient ID (0010,0020) and related Attributes in the source Composite Instances that contained a group of subjects whose data was acquired at the same time, from which this Composite Instance was extracted. See Section C.7.1.4.1.1. Only a single Item is permitted in this Sequence.
>Patient ID	(0010,0020)	1	Primary identifier for the group of subjects.
>Include Table 10-18 “Issuer of Patient ID Macro Attributes”
Group of Patients Identification Sequence	(0010,0027)	3	A Sequence containing the identifiers and locations of the individual subjects whose data was acquired at the same time (as a group) and encoded in this Composite Instance. See Section C.7.1.4.1.1. One or more Items are permitted in this Sequence.
>Patient ID	(0010,0020)	1	Primary identifier for an individual subject.
>Include Table 10-18 “Issuer of Patient ID Macro Attributes”
>Subject Relative Position in Image	(0010,0028)	3	The position in the image pixel data of the individual subject identified in this Sequence relative to the other subjects. See Section C.7.1.4.1.1.1.
>Patient Position	(0018,5100)	3	Patient position descriptor relative to the equipment. See Section C.7.1.4.1.1.1. See Section C.7.3.1.1.2 for Defined Terms and further explanation.

C.7.1.4.1 Patient Group Macro Attribute Descriptions

C.7.1.4.1.1 Groups of Subjects

It is common to image multiple small non-human organisms for pre-clinical research as a group at the same time.

In such cases, the single value of Patient ID (0010,0020) corresponds to the identification of the entire group. The same applies to related Attributes, if present, such as Issuer of Patient ID (0010,0021). Other Attributes of the Patient Module that are present shall be those shared by the entire group of non-human organisms, otherwise they shall be absent or empty (e.g., Patient's Sex (0010,0040)). Any acquisition-related Attributes that are Patient-specific (e.g., injected contrast or radiopharmaceutical dose) shall also be absent or empty (and the information may be communicated in separate acquisition context Instances).

The Group of Patients Identification Sequence (0010,0027) provides a means of describing the identifiers and locations of the individual subjects, if known at the time of acquisition, regardless of whether or not the group images are later segmented into individual images.

It is also common to segment the acquired images of the group of non-human organisms and extract the image pixel data for each non-human organism into separate images.

The Source Patient Group Identification Sequence (0010,0026) provides a "backward reference" within the segmented (individual subject) images to the Patient ID (0010,0020) used to identify the whole group.

Note

Individual derived SOP Instances may reference the source image explicitly by its SOP Instance UID. Additional objects, such as Segmentations, may be created to encode the regions segmented for individual non-human organisms, and referenced from the derived images. See also Annex VVV “Segmentation of Images of Groups of Animals (Informative)” in PS3.17.
For example, an image of a group of 6 mice in a 3 column, 2 row single longitudinal plane array might be described as:
- Patient ID (0010,0020) = "Inv234_Exp_56_Group78"
- Issuer of Patient ID (0010,0021) = "MyMouseLab"
- Group of Patients Identification Sequence (0010,0027)
- >Patient ID (0010,0020) = "Inv234_Exp_56_Group78_Mouse01"
- >Issuer of Patient ID (0010,0021) = "MyMouseLab"
- >Subject Relative Position in Image (0010,0028) = 1\1\1
- ...
- >Patient ID (0010,0020) = "Inv234_Exp_56_Group78_Mouse06"
- >Issuer of Patient ID (0010,0021) = "MyMouseLab"
- >Subject Relative Position in Image (0010,0028) = 3\2\1
In this example, the optional Issuer of Patient ID (0010,0021) is shown to emphasize that if it is needed, it should be repeated; i.e., there is no "inheritance" of the issuer from the Data Set enclosing the Sequence.

The naming of the group and the individual non-human organisms in the identifier is purely illustrative; it is not meant to imply preference for one local convention or another, or for using a discrete identifier for the group as opposed to, say, a concatenated list of individual non-human organism identifiers used as the group identifier.

See Figure C.7.1.4-1.
For example, segmented images of an individual non-human organism derived from the group image might be described as:
- Patient ID (0010,0020) = "Inv234_Exp_56_Group78_Mouse04"
- Issuer of Patient ID (0010,0021) = "MyMouseLab"
- Source Patient Group Identification Sequence (0010,0026)
- >Patient ID (0010,0020) = "Inv234_Exp_56_Group78"
- >Issuer of Patient ID (0010,0021) = "MyMouseLab"

C.7.1.4.1.1.1 Subject Relative Position in Image and Patient Position

Subject Relative Position in Image (0010,0028) shall be encoded as a 3D ordinal position in machine-relative orthogonal dimensions, such that when facing the front of the machine (gantry):

the first value starts at one for the left most subject holder and monotonically increases by one for each successive subject holder towards the right,
the second value starts at one for the top most subject holder and monotonically increases by one for each successively lower subject holder,
the third value starts at one for the outer most subject holder and monotonically increases by one for each successive subject holder inwards (i.e., increasing values from the front to the back of the gantry along the direction orthogonal to the first two dimensions, usually the long axis of the table).

Note

The order and sign of the machine-relative directions is consistent with the Axis Definition in [ACR-NEMA 300-1985].
Image-relative positions are not used, since there may be multiple acquisitions in different orientations. The machine-relative positions are applicable regardless of whether acquired images are cross-sections or projections.
Patient-relative positions are not used, since the non-human organisms may not be arranged in the same direction (e.g., a pair of non-human organisms may be arranged head-to-head).
There is no requirement that there be the same number of non-human organisms in each dimension. E.g., one in the top "row"and two below, in one longitudinal plane, would be represented as 1\1\1, 1\2\1, 2\1\1.
The goal is to describe only the relative locations of non-human organisms in any form of multiple non-human organism holder ("mouse hotel"), without attempting to specify the exact physical dimensions or absolute locations, regardless of whether the holder is regular or symmetric in any particular dimension or not (e.g., to include "revolver-like" and hexagonal arrangements). Nor is the "distance" between each non-human organism described.
The position is defined in terms of subject holders rather than subjects, since some holders may be empty or unused but still partially or completely visible in some of the images. In such cases the relative positions need to be consistently encoded by the acquisition device and recognized by automated segmentation algorithms. E.g., if the top row of in a two row holder is unoccupied, then the non-human organisms in the bottom row will be identified with a row position of 2, not 1.
Due to field of view and anatomical region of interest considerations, adjacent non-human organisms may sometimes be partially overlapped (e.g., Cheng TE et al. A rat head holder for simultaneous scanning of two rats in small animal PET scanners: Design, construction, feasibility testing and kinetic validation. Journal of Neuroscience Methods. 2009 Jan 15;176(1):24–33. http://dx.doi.org/10.1016/j.jneumeth.2008.08.031 and Xu S et al. In vivo multiple-mouse imaging at 1.5 T. Magnetic Resonance in Medicine. 2003;49(3):551–7. http://dx.doi.org/10.1002/mrm.10397); such cases may be described as a either a single plane or two planes of non-human organisms, as long as there is sufficient information to identify which non-human organism is which.

See Figure C.7.1.4-3.
The description of the physical relative locations of the non-human organisms does not account for any spatial distortion that may occur in the images due to the acquisition technique used (e.g., aliasing in MRI).

Patient Position (0018,5100) may be used to describe the machine-relative position of each non-human organism when the non-human organisms are not all arranged in the same direction.

Note

Patient Position (0018,5100) is used rather than Patient Orientation Code Sequence (0054,0410) because Patient Position (0018,5100) is present in the IODs for those modalities most commonly used for small animal imaging in preclinical research.
For example, a pair of prone non-human organisms arranged head-to-head longitudinally along the bore of the machine would be described as:
- Subject Relative Position in Image = 1\1\1 and Patient Position = HFP
  
  Subject Relative Position in Image = 1\1\2 and Patient Position = FFP
See Figure C.7.1.4-2.

The presence of Subject Relative Position in Image (0010,0028) and Patient Position (0018,5100) within Group of Patients Identification Sequence (0010,0027) within the Patient Module implies that the relative locations and orientations of multiple non-human organisms within a group cannot change over time. I.e., a "group", identified by a particular Patient ID (0010,0020) (the unique key of the Patient entity in the Information Model), is defined not only by the non-human organisms that comprise it but also their relative locations and positioning. If the same non-human organisms are imaged together but in a different arrangement, a different Patient ID (0010,0020) for the group shall be used.

Example of Subject Relative Position in Image for group of 6 mice in a 3 column, 2 row single longitudinal plane array, all feet first prone

Figure C.7.1.4-1. Example of Subject Relative Position in Image for group of 6 mice in a 3 column, 2 row single longitudinal plane array, all feet first prone

Figure C.7.1.4-2. Example of Subject Relative Position in Image and differing Patient Position for group of 2 mice head-to-head

Figure C.7.1.4-3. Example of Subject Relative Position in Image and overlapping narrow field of view group of 2 mice head-to-head

C.7.1.5 Patient's Alternative Calendar

Enumerated Values:

PROLEPTIC GREGN
JULIAN
PROLEPTIC JULIAN
EGYPTIAN REGNAL
HEBREW
HIJRI

C.7.2 Common Study IE Modules

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

C.7.2.1 General Study Module

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

Table C.7-3. General 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 Table 10-1 “Person Identification Macro Attributes”
Consulting Physician's Name	(0008,009C)	3	Consulting physician(s) for this Patient Visit.
Consulting Physician Identification Sequence	(0008,009D)	3	Identification of the consulting physician(s). One or more Items are permitted in this Sequence. If more than one Item, the number and order shall correspond to the value of Consulting Physician's Name (0008,009C), if present.
>Include Table 10-1 “Person Identification Macro Attributes”
Study ID	(0020,0010)	2	User or equipment generated Study identifier.
Accession Number	(0008,0050)	2	A departmental Information System generated number that identifies the Imaging Service Request.
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 Table 10-17 “HL7v2 Hierarchic Designator Macro Attributes”
Study Description	(0008,1030)	3	Institution-generated description or classification of the Study 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 Table 10-1 “Person Identification Macro Attributes”
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 Table 10-1 “Person Identification Macro Attributes”
Requesting Service	(0032,1033)	3	Institutional department, unit or service where the request initiated. See Note 1 and Note 2.
Requesting Service Code Sequence	(0032,1034)	3	Institutional department, unit or service where the request initiated. Only a single Item is permitted in this Sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes”			DCID 7030 “Institutional Department/Unit/Service”.
Referenced Study Sequence	(0008,1110)	3	A Sequence that provides reference to a Study. One or more Items are permitted in this Sequence. See Section 10.6.1.
>Include Table 10-11 “SOP Instance Reference Macro Attributes”
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 Table 8.8-1 “Code Sequence Macro Attributes”			BCID 101 “Imaging Procedure”.
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 Table 8.8-1 “Code Sequence Macro Attributes”			No Baseline CID is defined.

Note

Both Requesting Service (0032,1033) and Requesting Service Code Sequence (0032,1034) are defined in this table; the latter is preferred, but the former may be copied from an HL7 message whether or not there is also the ability to map it to a coded form (e.g., with only ORC-17 component 1 valued).
Requesting Service (0032,1033) and/or Requesting Service Code Sequence (0032,1034) may be used in the absence of a specific request or order, to describe the service involved or associated with acquiring the Study.

C.7.2.1.1 General Study Module Attribute Descriptions

C.7.2.1.1.1 Referring Physician, Physician of Record, Physician Reading Study, Consulting Physician

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. Figure C.7.2-1 shows some of the relationships and information flows between physician roles that might be present in some healthcare business models.

Figure C.7.2-1. Functions 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 specifies the Attributes of the Patient Study Module, which provide information about the Patient at the time the Study started.

Note

In the case of imaging a group of small non-human organisms simultaneously, the Attributes in this Module can only have values that apply to the entire group, otherwise they are absent (e.g., Patient's Weight (0010,1030)) or empty (e.g., Patient's Sex Neutered (0010,2203).

Table C.7-4a. Patient 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 Table 8.8-1 “Code Sequence Macro Attributes”			No Baseline CID 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 Body Mass Index	(0010,1022)	3	Body Mass Index of the Patient in kg/m2.
Measured AP Dimension	(0010,1023)	3	The thickness in mm of the body part being scanned, in the antero-posterior dimension (per AAPM Report 204). Note These values are normally derived from a scanned image, but might also be obtained using physical calipers, e.g., for children.
Measured Lateral Dimension	(0010,1024)	3	The side-to-side (left to right) dimension in mm of the body part being scanned (per AAPM Report 204). Note These values are normally derived from a scanned image, but might also be obtained using physical calipers, e.g., for children.
Patient's Size Code Sequence	(0010,1021)	3	Patient's size category code One or more Items are permitted in this Sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes”			BCID 7039 “Pediatric Size Category” for pediatric patients BCID 7041 “Calcium Scoring Patient Size Category” for CT calcium scoring
Medical Alerts	(0010,2000)	3	Conditions to which medical staff should be alerted (e.g., contagious condition, drug allergies, etc.).
Allergies	(0010,2110)	3	Description of prior reaction to contrast agents, or other patient allergies or adverse reactions.
Smoking Status	(0010,21A0)	3	Indicates whether Patient smokes. Enumerated Values: YES NO UNKNOWN
Pregnancy Status	(0010,21C0)	3	Describes pregnancy state of Patient. Enumerated Values: 0001 not pregnant 0002 possibly pregnant 0003 definitely pregnant 0004 unknown
Last Menstrual Date	(0010,21D0)	3	Date of onset of last menstrual period.
Patient State	(0038,0500)	3	Description of Patient state (comatose, disoriented, vision impaired, etc.).
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 Note Visit and Admission are used interchangeably here. In the broader sense, an admission is a type of visit at an institution where there is an admission process for patients.
Issuer of Admission ID Sequence	(0038,0014)	3	Identifier of the Assigning Authority that issued Admission ID (0038,0010). Only a single Item is permitted in this Sequence.
>Include Table 10-17 “HL7v2 Hierarchic Designator Macro Attributes”
Reason for Visit	(0032,1066)	3	Reason(s) for this visit by the patient to the facility or provider.
Reason for Visit Code Sequence	(0032,1067)	3	Coded reason(s) for this visit by the patient to the facility or provider. Note If an HL7 message is available with a PV2 segment corresponding to this visit, potential codes may be found in Admit Reason PV2-3. One or more Items are permitted in this Sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes”			No Baseline CID is defined.
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 Table 10-17 “HL7v2 Hierarchic Designator Macro Attributes”
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 Values: 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 a non-human organism. May be present otherwise.

C.7.2.3 Clinical Trial Study Module

Table C.7-4b specifies the Attributes of the Clinical Trial Study Module, which identify a Study in the context of a clinical trial or research.

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 or research. See Section C.7.2.3.1.1.
Issuer of Clinical Trial Time Point ID	(0012,0055)	3	Identifier of the Assigning Authority that issued the Clinical Trial Time Point ID.
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 or research. See Section C.7.2.3.1.1.
Clinical Trial Time Point Type Code Sequence	(0012,0054)	3	A pre-defined type of a set of one or more Studies that are grouped together to represent a clinical time point or submission in a clinical trial or research. See Section C.7.2.3.1.1. One or more Items are permitted in this Sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes”			BCID 6146 “Time Point Type”.
Longitudinal Temporal Offset from Event	(0012,0052)	3	An offset in days from a particular event of significance. May be fractional. In the context of a clinical trial, this is often the days since enrollment, or the baseline imaging Study.
Longitudinal Temporal Event Type	(0012,0053)	1C	The type of event to which Longitudinal Temporal Offset from Event (0012,0052) is relative. Defined Terms: ENROLLMENT Relative to enrollment of the subject in the research activity or clinical trial. BASELINE Relative to the baseline imaging Study. Required if Longitudinal Temporal Offset from Event (0012,0052) is present.
Consent for Clinical Trial Use Sequence	(0012,0083)	3	A Sequence that conveys information about consent for Clinical Trial or research use of the Composite Instances within this Study. One or more Items are permitted in this Sequence. See Section 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 Section 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.
>Issuer of Clinical Trial Protocol ID	(0012,0022)	3	Identifier of the Assigning Authority that issued the Clinical Trial Protocol ID.
>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 Section 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 Module 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 or research. 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. Clinical Trial Time Point Type Code Sequence (0012,0054) can be used to specify one or more pre-defined type of time point from a standard lexicon; more than one type is permitted, e.g., a time point may be "posttreatment" as well as "unscheduled" or "nadir", etc.

C.7.2.3.1.2 Consent For Clinical Trial Use Sequence

For applications such as clinical trials or research, 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 following purposes:

Defined Terms:

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

Note

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.
There is no identification of an individual responsible for the approval or granting consent, since in the case of a clinical trial or research subject granting informed consent, the presence of this information would breach de-identification requirements.
Multiple Sequence Items may be present; for example a Study may be approved for distribution for conducting multiple explicitly named protocols.
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 Annex E “Attribute Confidentiality Profiles (Normative)” in PS3.15.
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 or research.

C.7.3 Common Series IE Modules

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

C.7.3.1 General Series Module

Table C.7-5a specifies the Attributes of the General Series Module, which identify and describe general information about the Series within a Study.

Table C.7-5a. General Series Module Attributes

Attribute Name	Tag	Type	Attribute Description
Modality	(0008,0060)	1	Type of device, process or method that originally acquired or produced the data used to create the Instances in this Series. See Section 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) or Measurement Laterality (0024,0113) are not present. 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. There is no value for both left and right, for which Image Laterality (0020,0062) at the Image level or Frame Laterality (0020,9072) may be used instead. There is no value for median, for which Primary Anatomic Structure Modifier Sequence (0008,2230) or Anatomic Region Modifier Sequence (0008,2220) may be used instead.
Series Date	(0008,0021)	3	Date the Series started.
Series Time	(0008,0031)	3	Time the Series started.
Performing Physician's 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 Physician's Name (0008,1050), if present.
>Include Table 10-1 “Person Identification Macro Attributes”
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 protocol described in the Performed Protocol Code Sequence (0040,0260) in the Performed Protocol Code Sequence (0040,0260) in Table 10-16 “Performed Procedure Step Summary Macro Attributes”.
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 Table 8.8-1 “Code Sequence Macro Attributes”			No Baseline CID 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 Table 10-1 “Person Identification Macro Attributes”
Referenced Performed Procedure Step Sequence	(0008,1111)	3	Uniquely identifies the Performed Procedure Step SOP Instance to which the Series is related. Only a single Item is permitted in this Sequence.
>Include Table 10-11 “SOP Instance Reference Macro Attributes”
Related Series Sequence	(0008,1250)	3	Identification of Series significantly related to this Series. One or more Items are permitted in this Sequence. Note 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. The related Series may have different Frames of Reference and hence require some sort of registration before spatial coordinates can be directly compared. 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 Table 8.8-1 “Code Sequence Macro Attributes”			DCID 7210 “Related Series Purpose of Reference”.
Body Part Examined	(0018,0015)	3	Text description of the part of the body examined. See Annex L “Correspondence of Anatomic Region Codes and Body Part Examined Defined Terms” in PS3.16 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 Section 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 Table 10-9 “Request Attributes Macro Attributes”			No Baseline CID is defined.
Include Table 10-16 “Performed Procedure Step Summary Macro Attributes”			No Baseline CID is 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 a non-human organism and the anatomical Frame of Reference is not bipedal. May be present otherwise. See Section C.7.6.1.1.1 and Section 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-Based Coordinate System of cross-sectional images.
Treatment Session UID	(300A,0700)	3	A unique identifier of the RT Treatment Session to which Instances in this Series belong.

Note

If any 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.
If the Storage SCU does not conform to any 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 Module Attribute Descriptions

C.7.3.1.1.1 Modality

Defined Terms:

ANN: Annotation
AR: Autorefraction
ASMT: Content Assessment Results
AU: Audio
BDUS: Bone Densitometry (ultrasound)
BI: Biomagnetic imaging
BMD: Bone Densitometry (X-Ray)
CFM: Confocal Microscopy
CR: Computed Radiography
CT: Computed Tomography
CTPROTOCOL: CT Protocol (Performed)
DMS: Dermoscopy
DG: Diaphanography
DOC: Document
DX: Digital Radiography
ECG: Electrocardiography
EEG: Electroencephalography
EMG: Electromyography
EOG: Electrooculography
EPS: Cardiac Electrophysiology
ES: Endoscopy
FID: Fiducials
GM: General Microscopy
HC: Hard Copy
HD: Hemodynamic
IO: Intra-Oral Radiography
IOL: Intraocular Lens Data
IVOCT: Intravascular Optical Coherence Tomography
IVUS: Intravascular Ultrasound
KER: Keratometry
KO: Key Object Selection
LEN: Lensometry
LS: Laser surface scan
MG: Mammography
MR: Magnetic Resonance
M3D: Model for 3D Manufacturing
NM: Nuclear Medicine
OAM: Ophthalmic Axial Measurements
OCT: Optical Coherence Tomography (non-Ophthalmic)
OP: Ophthalmic Photography
OPM: Ophthalmic Mapping
OPT: Ophthalmic Tomography
OPTBSV: Ophthalmic Tomography B-scan Volume Analysis
OPTENF: Ophthalmic Tomography En Face
OPV: Ophthalmic Visual Field
OSS: Optical Surface Scan
OT: Other
PA: Photoacoustic
PLAN: Plan

Note

The term "PLAN" denotes Series describing planned activities. It is not be confused with radiotherapy treatment plans.
POS: Position Sensor
PR: Presentation State
PT: Positron emission tomography (PET)
PX: Panoramic X-Ray
REG: Registration
RESP: Respiratory
RF: Radio Fluoroscopy
RG: Radiographic imaging (conventional film/screen)
RTDOSE: Radiotherapy Dose
RTIMAGE: Radiotherapy Image
RTINTENT: Radiotherapy Intent
RTPLAN: Radiotherapy Plan
RTRAD: RT Radiation
RTRECORD: RT Treatment Record
RTSEGANN: Radiotherapy Segment Annotation
RTSTRUCT: Radiotherapy Structure Set
RWV: Real World Value Map
SEG: Segmentation
SM: Slide Microscopy
SMR: Stereometric Relationship
SR: SR Document
SRF: Subjective Refraction
STAIN: Automated Slide Stainer
TEXTUREMAP: Texture Map
TG: Thermography
US: Ultrasound
VA: Visual Acuity
XA: X-Ray Angiography
XAPROTOCOL: XA Protocol (Performed)
XC: External-camera Photography

Retired Defined Terms:

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

Note

The XA modality incorporates the retired modality DS.
The RF modality incorporates the retired modalities CF, DF, VF.
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 X-Ray Angiographic Image IOD may list the RF modality when an RF implementation produces an XA object.
The MR modality incorporates the retired modalities MA and MS.
The US modality incorporates the retired modalities EC, CD, and DD.
The NM modality incorporates the retired modality ST.

C.7.3.1.1.2 Patient Position

Patient Position (0018,5100) specifies the positioning 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. The information in Patient Position (0018,5100) is more formally modeled in the Enhanced Patient Orientation Module. See Section C.7.6.30 for additional detail, guidance, and discussion of vertical gantry cases.

When multiple subjects are present in the same image, and arranged with different positions, then the Patient Position (0018,5100) in the General Series Module is nominal, does not apply to each subject, but does define the relationship of the nominal Patient-Based Coordinate System to the machine.

Note

In conjunction with the Patient Position (0018,5100) in each Item of the Group of Patients Identification Sequence (0010,0027), Patient Position (0018,5100) in the General Series Module may be helpful to compute patient-relative spatial information for each subject from the Attributes of the Image Plane Module.

When facing the front of the imaging equipment:

HF: Head First is defined as the patient's head being positioned toward the front of the imaging equipment (i.e., head entering the front of the equipment).
FF: Feet First is defined as the patient's feet being positioned toward the front of the imaging equipment (i.e., feet entering the front of the equipment).
LF: Left First is defined as the patient's left side being positioned towards the front of the imaging equipment (i.e., patient's left side entering the front of the equipment).
RF: Right First is defined as the patient's right being positioned towards the front of the imaging equipment (i.e., patient's right side entering the front of the equipment).
AF: Anterior First is defined as the patient's anterior being positioned towards the front of the imaging equipment (i.e., patient's anterior side entering the front of the equipment).
PF: Posterior First is defined as the patient's posterior being positioned towards the front of the imaging equipment (i.e., patient's posterior side entering the front of the equipment).
P: Prone is defined as the patient's face being positioned in a downward (gravity) direction.
S: Supine is defined as the patient's face being in an upward direction.
DR: Decubitus Right is defined as the patient's right side being in a downward direction.
DL: Decubitus Left is defined as the patient's left side being in a downward direction.
V: Vertical is defined as the patient's feet being positioned in a downward (gravity) direction.
I: Inverted is defined as the patient's head being positioned in a downward (gravity) direction.

Defined Terms:

HFP: Head First-Prone
HFS: Head First-Supine
HFDR: Head First-Decubitus Right
HFDL: Head First-Decubitus Left
HFV: Head First-Vertical
HFI: Head First-Inverted
FFDR: Feet First-Decubitus Right
FFDL: Feet First-Decubitus Left
FFP: Feet First-Prone
FFS: Feet First-Supine
FFV: Feet First-Vertical
FFI: Feet First-Inverted
LFP: Left First-Prone
LFS: Left First-Supine
LFDR: Left First-Decubitus Right
LFDL: Left First-Decubitus Left
RFP: Right First-Prone
RFS: Right First-Supine
RFDR: Right First-Decubitus Right
RFDL: Right First-Decubitus Left
AFP: Anterior First-Prone
AFS: Anterior First-Supine
AFDR: Anterior First-Decubitus Right
AFDL: Anterior First-Decubitus Left
PFP: Posterior First-Prone
PFS: Posterior First-Supine
PFDR: Posterior First-Decubitus Right
PFDL: Posterior First-Decubitus Left

Note

For quadrupeds, separate concepts for ventral and dorsal are not introduced, rather it is expected that anterior and posterior will be considered synonymous as they are when applied to the trunk.
In previous releases of the standard, imaging equipment that is aligned vertically with respect to gravity was not addressed. Doing so introduced additional prone, supine, and decubitus variants, as well as vertical and inverted concepts. Older implementations might not recognize or have appropriate behaviors for those Defined Terms. See Section C.7.6.30 for relevant examples.

The Figure C.7.3.1.1.2-1 illustrates some of 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.

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

Figure C.7.3.1.1.2-2. Example of Right First-Prone (RFP) Patient Position Relative to the Gantry and Table for a Small Animal

C.7.3.2 Clinical Trial Series Module

Table C.7-5b specifies the Attributes of the Clinical Trial Series Module, which identify a Series in the context of a clinical trial or research.

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 or research. See Section 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 or research. See Section C.7.3.2.1.2.
Issuer of Clinical Trial Series ID	(0012,0073)	3	Identifier of the Assigning Authority that issued the Clinical Trial Series ID.
Clinical Trial Series Description	(0012,0072)	3	A description of the Series in the context of a clinical trial or research. See Section C.7.3.2.1.2.

C.7.3.2.1 Clinical Trial Series Module 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 or research.

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 or research without requiring the replacement of the values in 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 specifies the Attributes of the Enhanced Series Module, which 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.7-5c. Enhanced Series Module Attributes

Attribute Name

Tag

Type

Attribute Description

Series Number

(0020,0011)

A number that identifies this Series.

Note

The value of this Attribute should be unique for all Series in a Study created on the same equipment.
Because Series can be created on more than one equipment, it can not be guaranteed that the value of Series Number (0020,0011) is unique in a Study.

Referenced Performed Procedure Step Sequence

(0008,1111)

Uniquely identifies the Performed Procedure Step SOP Instance to which the Series is related.

Only a single Item shall be included in this Sequence.

Required if a Performed Procedure Step SOP Class was involved in the creation of this Series.

>Include Table 10-11 “SOP Instance Reference Macro Attributes”

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 of the Frame of Reference Module, which are necessary to uniquely identify a Frame of Reference that ensures 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 releases 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.7-6. Frame 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 Section 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 Section C.7.4.1.1.2 for further explanation.

C.7.4.1.1 Frame of Reference Module 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.

Note

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.
A common Frame of Reference UID may be used to spatially relate localizer images with a set of transverse images. However, in some cases (e.g., 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 costal margin, or external auditory meatus, or a fiducial marker placed on the patient. The Patient-Based Coordinate System is described in Section C.7.6.2.1.1.

For a slide-related Frame of Reference, this is the slide corner as specified in Section 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 Section C.8.12.2.1.

For a Corneal Coordinate System, the Frame of Reference is based upon the corneal vertex. The corneal vertex is determined by the measuring instrument and shall be identified in this Attribute with the value CORNEAL_VERTEX_R (for the right eye) or CORNEAL_VERTEX_L (for the left eye). The Corneal Coordinate System is described in Section C.8.30.3.1.4.

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 encoded as 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 of the Synchronization Module, which are 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 Section 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 Section 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 Section 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. Enumerated Values: NTP Network Time Protocol IRIG Inter Range 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 Module 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 (0020,0200). All SOP Instances that share the same Synchronization Frame of Reference UID (0020,0200) shall be temporally related to each other. If a Synchronization Frame of Reference UID (0020,0200) 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).

Note

The Synchronization Frame of Reference UID (0020,0200) 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 (0020,0200), but be clinically unrelated (e.g., apply to different Patients).
When a synchronization environment is recalibrated, a new Synchronization Frame of Reference UID (0020,0200) must be issued.
The method of distributing the Synchronization Frame of Reference UID (0020,0200) 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

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 Waveform Sequence (5400,0100) (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) specifies whether Acquisition DateTime (0008,002A) 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) specifies whether Observation DateTime (0040,A032) of Items in Content Sequence (0040,A730) of the SR Document Content Module represents an accurate synchronized timestamp for the Item.

For IODs that include the RT Radiation Record Common Module, the Acquisition Time Synchronized (0018,1800) specifies whether the following Attributes represent a synchronized timestamp.

Recorded RT Control Point DateTime (300A,073A)
Interlock DateTime (300A,0741)

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 of the General Equipment Module, which identify and describe the piece of equipment that produced Composite Instances.

Table C.7-8. General 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. Note This Attribute represents the organizational context only for the Equipment IE, and should not be construed to be a substitute for Issuer of Patient ID (0010,0021) or Issuer of Accession Number (0008,0051).
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.
Institutional Department Type Code Sequence	(0008,1041)	3	A coded description of the type of Department or Service within the healthcare facility. Note This might be obtained from a corresponding HL7v2 message containing PV1:10 Hospital Service. Only a single Item is permitted in this Sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes”			BCID 7030 “Institutional Department/Unit/Service”.
Manufacturer's Model Name	(0008,1090)	3	Manufacturer's model name of the equipment that produced the Composite Instances.
Manufacturer's Device Class UID	(0018,100B)	3	Manufacturer's Unique Identifier (UID) for the class of the device. A class is a manufacturer-specific grouping concept with no DICOM-defined scope or criteria. A class is independent from a marketing-defined make, model or version. A class allows grouping of devices with a similar set of capabilities. This Attribute may be multi-valued if this device is a member of more than one class.
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.
UDI Sequence	(0018,100A)	3	Unique Device Identifier (UDI) of the entire equipment. For example, the entire CT Scanner. Note Multiple Items may be present if the entire equipment has UDIs issued by different Issuing Authorities. Multiple Items may be present if multiple pieces of equipment were involved in the creation of this Instance, e.g., the DR plate and the DR reader. This is not intended to contain the UDIs of the components of the equipment, such as the X-Ray tube of the CT scanner. Such information is stored elsewhere and accessible using the UDI of the entire equipment and a date. One or more Items are permitted in this Sequence.
>Include Table 10.29-1 “UDI Macro Attributes”
Device UID	(0018,1002)	3	Unique identifier of the equipment that produced the Composite Instances. Note If present in an SR object, the value is expected to be the same as the (121012, DCM, "Device Observer UID") in TID 1004 “Device Observer Identifying Attributes”. There is no requirement that the Device UID (0018,1002) be the same as the Instance Creator UID (0008,0014) in the SOP Common Module, though they may be.
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 Manufacture	(0018,1204)	3	The date the equipment that produced the Composite Instances was originally manufactured or re-manufactured (as opposed to refurbished).
Date of Installation	(0018,1205)	3	The date the equipment that produced the Composite Instances was installed in its current location. The equipment may or may not have been used prior to installation in its current location.
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 Section 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 Section 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 or that may be rendered "transparently" when superimposing images. See Section 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. Note The Value Representation of this Attribute is determined by the value of Pixel Representation (0028,0103). This Attribute is not used in Presentation State Instances; there is no means in a Presentation State to "override" any Pixel Padding Value (0028,0120) specified in the referenced images. This Attribute does apply to RT Dose and Segmentation Instances, since they include Pixel Data. This Attribute does not apply when Float Pixel Data (7FE0,0008) or Double Float Pixel Data (7FE0,0009) are used instead of Pixel Data (7FE0,0010); Float Pixel Padding Value (0028,0122) or Double Float Pixel Padding Value (0028,0123), respectively, are used instead, and defined at the Image, not the Equipment, level. Only a single Value is allowed for this Attribute, so it only applies to images with Samples per Pixel (0028,0002) of 1, i.e., images with a Photometric Interpretation (0028,0004) of MONOCHROME1, MONOCHROME2 or PALETTE COLOR. See Section C.7.5.1.1.2 for details.

C.7.5.1.1 General Equipment Module 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 typically used to pad grayscale images (those with a Photometric Interpretation (0028,0004) of MONOCHROME1 or MONOCHROME2), or color images with a Photometric interpretation (0028,0004) of PALETTE COLOR, 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 rendering pipeline for other reasons, such as suppression of background air. Pixel Padding Range Limit (0028,0121) is defined in the Image Pixel Module.

Note

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, i.e., which is not to be suppressed, or e.g., is that part of a pseudo-colored image that might be superimposed on top of another image. For other mechanisms, see Section N.2.6 “Advanced Blending Transformations” in PS3.4.
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
No pixels in the native image will have a value equal to Pixel Padding Value (0028,0120).

Pixel Padding Value (0028,0120) specifies either a single value of this padding, 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).

The Pixel Padding Value shall correspond to a value in the original stored pixel data, before the Modality LUT Transformation or any other transformations are applied.

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 or PALETTE COLOR, 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).

Note

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^{Bits Stored} - 1 if Photometric Interpretation (0028,0004) is MONOCHROME1.
and when the image is signed:
- -2^{Bits Stored-1} if Photometric Interpretation (0028,0004) is MONOCHROME2.
- 2^{Bits Stored-1} - 1 if Photometric Interpretation (0028,0004) is MONOCHROME1.
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 present.

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 Section C.7.6.11.
The conditional requirement for the Pixel Padding 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.
The range of values to be suppressed between Pixel Padding Value (0028,0120) and Pixel Padding Range Limit (0028,0121) is specified as being inclusive, that is the values themselves as well as all values between are suppressed.
When Pixel Padding 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.
For Segmentations with a Segmentation Type (0062,0001) of LABELMAP, Pixel Padding Value (0028,0120) may be used to indicate that a particular pixel value is to be treated as background. Only a single pixel value is so indicated, and Pixel Padding Range Limit (0028,0121) is not used; see Section A.51.4. Typically the Pixel Padding Value (0028,0120) will be 0, but it can be another value, or may not be specified at all.

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.

Note

For example, if a CT image containing signed values from -1024 to 3191 and a Pixel Padding Value (0028,0120) of -2000 and a Rescale Intercept (0028,1052) of 0 is converted to an unsigned image with a Rescale Intercept (0028,1052) 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.
If the modification involves lossy compression, which may result in changes to the pixel values, then the application of Pixel Padding Value (0028,0120) and Pixel Padding Range Limit (0028,0121) 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 of the Enhanced General Equipment Module, which identify and describe the piece of equipment that produced Composite Instances.

Note

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.
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.7-8b. Enhanced 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 of the General Image Module, which identify and describe an image within a particular Series.

Table C.7-9. General 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 previous releases 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) or if image does not require Image Orientation (Slide) (0048,0102). May be present otherwise. See Section C.7.6.1.1.1 for further explanation. Note IODs 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 Section C.7.6.1.1.2 for Defined Terms and further explanation.
Image Comments	(0020,4000)	3	User-defined comments about the image.
Quality Control Image	(0028,0300)	3	Indicates whether or not quality control material (such as calibration or control material, or a phantom) is present in this image. Enumerated Values: YES the image contains only quality control material NO the image does not contain quality control material BOTH the image contains both subject (patient) and quality control information If this Attribute is absent, then the image may or may not be a quality control or phantom image. The phantom device or quality control material in the image can be described using the Device Module. See Section C.7.6.12. Note Examples of the presence of both subject and quality control information include: presence of objects of known density in radiographic images for calibration presence of control material for immunohistochemistry within slide images
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 (at a point in its lifetime). Enumerated Values: 00 Image has not been subjected to lossy compression. 01 Image has been subjected to lossy compression. Once this value has been set to "01" it shall not be reset. See Section 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 Section C.7.6.1.1.5.2.
Lossy Image Compression Method	(0028,2114)	3	A label for the lossy compression method(s) that have been applied to this image. See Section C.7.6.1.1.5.1.
Icon Image Sequence	(0088,0200)	3	This icon image is representative of the Image. Only a single Item is permitted in this Sequence.
>Include Table C.7-11b “Image Pixel Macro Attributes”			See Section 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: 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.
Real World Value Mapping Sequence	(0040,9096)	3	The mapping of stored values to associated Real World values. One or more Items are permitted in this Sequence.
>Include Table C.7.6.16-12b “Real World Value Mapping Item Macro Attributes”
Image Laterality	(0020,0062)	3	Laterality of (possibly paired) body part (as described in Anatomic Region Sequence (0008,2218)) examined. Enumerated Values: R right L left U unpaired B both left and right Shall be consistent with any laterality information contained in Primary Anatomic Structure Modifier Sequence (0008,2230) and/or Laterality (0020,0060), if present. Note Laterality (0020,0060) is a Series level Attribute and must be the same for all Images in the Series, hence it must be absent if Image Laterality (0020,0062) has different values for Images in the same Series.
Include Table 10-7 “General Anatomy Optional Macro Attributes”			Anatomic Region Sequence BCID 4031 “Common Anatomic Region” for humans. Anatomic Region Sequence BCID 7483 “Common Anatomic Regions for Animal” for non-human organisms.

Note

Previous releases 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 Module Attribute Descriptions

C.7.6.1.1.1 Patient Orientation

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:

A (anterior)
P (posterior)
R (right)
L (left)
H (head)
F (foot)

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

LE (Le or Left)
RT (Rt or Right)
D (Dorsal)
V (Ventral)
CR (Cr or Cranial)
CD (Cd or Caudal)
R (Rostral)
M (Medial)
L (Lateral)
PR (Pr or Proximal)
DI (Di or Distal)
PA (Pa or Palmar)
PL (Pl or Plantar)

Note

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 Patient Orientation (0020,0020), lowercase letters cannot be used.
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 non-human organism domains will be reduced. Hanging protocols may need to account for the difference by checking for the correct species.
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.
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.
For non-human organisms 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.

Note

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.
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 columns are directed both downwards and medially, which for a left breast is towards the right, though the downwards direction is the principal column orientation.
E.g., a right dorsal-left ventral oblique view of a quadruped's abdomen might be encoded with Patient Orientation values of "LEV\CD", rather than "LE\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 "LEV", "LE" and "CD", correspond to the designations in Smallwood et al of "LeV", "Le" and "Cd", respectively

C.7.6.1.1.2 Image Type

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

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
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
Modality Specific Characteristics
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:

Value 1 shall identify the Pixel Data Characteristics

Enumerated Values:

ORIGINAL

identifies an Original Image

DERIVED

identifies a Derived Image
Value 2 shall identify the Patient Examination Characteristics

Enumerated Values:

PRIMARY

identifies a Primary Image

SECONDARY

identifies a Secondary Image
Value 3 shall identify any Image IOD specific specialization (optional)
Other Values that are implementation specific (optional)

Any of the optional values (value 3 and beyond) may be encoded 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 SOP Instance UID (0008,0018) different than all the source images.

C.7.6.1.1.3 Derivation Description

See Section C.12.4.1.1.

C.7.6.1.1.4 Source Image Sequence

Source Image Sequence (0008,2112) was formerly used in this Module but has been moved to the General Reference Module. See Section C.12.4.1.2 “Source Image Sequence”.

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 Lossy Image Compression (0028,2110) 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

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 Section C.12.4.1.1).
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).

C.7.6.1.1.5.1 Lossy Image Compression Method

Lossy Image Compression Method (0028,2114) may be multi-valued if successive lossy compression steps have been applied; the value order shall correspond to the values of Lossy Image Compression Ratio (0028,2112), if present.

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

ISO_10918_1: JPEG Lossy Compression [ISO/IEC 10918-1]
ISO_14495_1: JPEG-LS Near-lossless Compression [ISO/IEC 14495-1]
ISO_15444_1: JPEG 2000 Irreversible Compression [ISO/IEC 15444-1]
ISO_15444_15: High-Throughput JPEG 2000 Irreversible Compression [ISO/IEC 15444-15]
ISO_18181_1: JPEG XL Image Coding System - Part 1 Core Coding System [ISO/IEC 18181-1]
ISO_13818_2: MPEG2 Compression [ISO/IEC 13818-2]
ISO_14496_10: MPEG-4 AVC/H.264 Compression [ISO/IEC 14496-10]
ISO_23008_2: HEVC/H.265 Lossy Compression [ISO/IEC 23008-2]

C.7.6.1.1.5.2 Lossy Image Compression Ratio

The value of the "compression ratio" is encoded as a numeric value that represents the numerator of an implicit ratio in which the denominator is always one, consistent with the traditional representation in the literature.

Note

For example, a compression ratio of 30:1 would be described with a value of 30.

The value may be an estimate (e.g., the nominal value that is supplied to the compressor), or it may be a measured value (e.g., computed by dividing the uncompressed pixel data size by the size of the compressed bit stream).

Lossy Image Compression Ratio (0028,2112) may be multi-valued if successive lossy compression steps have been applied; if so, the value order shall correspond to the multiple values of Lossy Image Compression Method (0028,2114), if present.

Note

For historical reasons, the lossy compression ratio should also be described in Derivation Description (0008,2111).

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 Section C.7.6.3.2 Image Pixel Macro. Unless otherwise specified in the Module or Macro table where the Icon Image Sequence (0088,0200) is used, the following restrictions shall apply on the Image Pixel Macro usage:

Only monochrome and palette color images shall be used. Samples per Pixel (0028,0002) shall have a Value of 1, Photometric Interpretation (0028,0004) shall have a Value of either MONOCHROME 1, MONOCHROME 2 or PALETTE COLOR, Planar Configuration (0028,0006) shall not be present.

Note

True color icon images are not supported. This is due to the fact that the reduced size of the Icon Image makes the quality of a palette color image (with 256 colors) sufficient in most cases.
There is no explicit limitation on the size of an Icon Image specified by Rows (0028,0010) and Columns (0028,0011).
Pixel samples shall have a Value of either 1 or 8 for Bits Allocated (0028,0100) and Bits Stored (0028,0101). High Bit (0028,0102) shall have a Value of one less than the Value used in Bit Stored.
Pixel Representation (0028,0103) shall specify an unsigned integer representation (Value 0000H).
the pixels shall be square (i.e., their aspect ratio shall be 1:1) and therefore Pixel Aspect Ratio (0028,0034) shall not be present.
If a Palette Color lookup Table is used, Bits Allocated (0028,0100) shall have a Value of 8.

C.7.6.1.1.7 Irradiation Event UID

See Section C.7.10.1.1.1.

C.7.6.2 Image Plane Module

Table C.7-10 specifies the Attributes of the Image Plane Module, which define the transmitted pixel array of a two dimensional image plane in a three dimensional space.

Note

In previous versions of the Standard ([ACR-NEMA 300-1985], [ACR-NEMA 300-1988]), 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.7-10. Image 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 Section 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 Section 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 Section C.7.6.2.1.1 for further explanation.
Slice Thickness	(0018,0050)	2	Nominal slice thickness, in mm.
Spacing Between Slices	(0018,0088)	3	Spacing between adjacent slices, in mm. The spacing is measured from the center-to-center of each slice. If present, shall not be negative, unless specialized to define the meaning of the sign in a specialized IOD, e.g., as in the Section C.8.4.15.
Slice Location	(0020,1041)	3	Relative position of the image plane expressed in mm. See Section C.7.6.2.1.2 for further explanation.

C.7.6.2.1 Image Plane Module Attribute Descriptions

C.7.6.2.1.1 Image Position and Image Orientation

Image Position (Patient) (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 (Patient) (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

x-axis is increasing to the left (as opposed to right) side of the patient
the y-axis is increasing towards
- the dorsal (as opposed to ventral) side of the patient for the neck, trunk and tail,
- the dorsal (as opposed to ventral) side of the patient for the head,
- the dorsal (as opposed to plantar or palmar) side of the distal limbs,
- the cranial (as opposed caudal) side of the proximal limbs, and
the z-axis is increasing towards
- the cranial (as opposed to caudal) end of the patient for the neck, trunk and tail,
- the rostral (as opposed to caudal) end of the patient for the head, and
- the proximal (as opposed to distal) end of the limbs

Note

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.
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 Image Position (Patient) (0020,0032) specifies the origin of the image with respect to the Patient-Based Coordinate System. RCS and Image Orientation (Patient) (0020,0037) values specify the orientation of the image frame rows and columns. The mapping of an integer (entire) pixel location (i,j) to the RCS is calculated as follows:

Equation C.7.6.2.1-1.

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 Image Position (Patient) (0020,0032). It is the location in mm from the origin of the RCS.
X_xyz The values from the row (X) direction cosine of Image Orientation (Patient) (0020,0037).
Y_xyz The values from the column (Y) direction cosine of Image Orientation (Patient) (0020,0037).
i Column integer index to the image plane. The first (entire) column is index zero.
Δ_i Column pixel resolution of Pixel Spacing (0028,0030) in units of mm.
j Row integer index to the image plane. The first (entire) row index is zero.
Δ_j Row pixel resolution of Pixel Spacing (0028,0030) in units of mm.

Note

The integer entire row and column indices (i,j) that are the input to this equation start from zero, which is a common mathematical convention. Many DICOM Attributes define such indices as starting from one, e.g., those affected by Bounding Box Annotation Units (0070,0003) for PIXEL and MATRIX in Section C.10.5 Graphic Annotation Module. This needs to be accounted for when applying this equation literally.

The mapping of a sub-pixel resolution image or total pixel matrix relative location (c,r), such as used in Spatial Coordinates Macro, to the RCS is calculated as follows

Equation C.7.6.2.1-2.

Where:

P_xyz The coordinates of the voxel (c,r) in the frame's image plane in units of mm.
S_xyz The three values of Image Position (Patient) (0020,0032). It is the location in mm from the origin of the RCS.
X_xyz The values from the row (X) direction cosine of Image Orientation (Patient) (0020,0037).
Y_xyz The values from the column (Y) direction cosine of Image Orientation (Patient) (0020,0037).
c Column sub-pixel resolution index to the image plane. The left pixel edge of the first column of the frame or total pixel matrix is index zero.
Δ_c Column pixel resolution of Pixel Spacing (0028,0030) in units of mm.
r Row sub-pixel resolution index to the image plane. The top pixel edge of the first row of the frame or total pixel matrix index is zero.
Δ_r Row pixel resolution of Pixel Spacing (0028,0030) in units of mm.

Additional constraints apply:

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

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 specifies the Attributes of the Image Pixel Module.

Table C.7-11a. Image Pixel Module Attributes

Attribute Name	Tag	Type	Attribute Description
Include Table C.7-11c “Image Pixel Description Macro Attributes”			Required if the IOD is not being transferred in a STOW-RS Request and is not encoded as metadata and compressed bulk pixel data. May be present otherwise. See Section 10.5 “Store Transaction” in PS3.18. Note When the IOD is encoded as metadata in a STOW-RS Request and the bulk pixel data is compressed, the STOW-RS origin server is required to be able to derive appropriate values for the Image Pixel Macro Attributes from the compressed bit stream.
Pixel Data	(7FE0,0010)	1C	A data stream of the pixel samples that comprise the Image. See Section C.7.6.3.1.4 for further explanation. Required if Pixel Data Provider URL (0028,7FE0) is not present.
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) Note The VR of this Data Element has changed from UT to UR.
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 Section 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. Note The Value Representation of this Attribute is determined by the value of Pixel Representation (0028,0103). Pixel Padding Value (0028,0120) is also required when this Attribute is present.
Extended Offset Table	(7FE0,0001)	3	Byte offsets of the Item Tags of the Frames in the Sequence of Items in Encapsulated Pixel Data encoded in Pixel Data (7FE0,0010). See Section C.7.6.3.1.8. May only be present when: Pixel Data (7FE0,0010) is present, and the Transfer Syntax uses Encapsulated Format for the Pixel Data (7FE0,0010), and the Transfer Syntax encodes Frames in separate Fragments, and the Basic Offset Table is not present (i.e., the first Item of Pixel Data (7FE0,0010) has zero length), and each Frame is entirely contained within one Fragment. Note Unlike a Basic Offset Table, an Extended Offset Table, if the Attribute is present, is not permitted to be empty. If this Instance is part of a Concatenation, only the offset and lengths of the frames encoded in the Pixel Data (7FE0,0010) of this Instance are indexed in the Extended Offset Table (7FE0,0001) and Extended Offset Table Lengths (7FE0,0002) in this Instance, not those of the entire Concatenation. I.e., the Values of these two Attributes are specific to each Instance. See also Section C.7.6.16.2.2.4. If the Data Set is re-encoded (such as in a different Transfer Syntax) any Extended Offset Table may need to be recomputed or removed.
Extended Offset Table Lengths	(7FE0,0002)	1C	Byte lengths of the Frames in the Sequence of Items in Encapsulated Pixel Data encoded in Pixel Data (7FE0,0010). See Section C.7.6.3.1.8. Required if Extended Offset Table (7FE0,0001) is present. Note This Attribute is only sent when each Frame is entirely contained within one Fragment as a single contiguous span of bytes so that it is not necessary to assemble the Frame from Fragments with delimiters. The length encoded in this Attribute may be an odd number if the compressed bitstream for the Frame is an odd length; i.e., it does not include any trailing padding required to make the Item an even length.

C.7.6.3.1 Image Pixel Module 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).

Note

Downsampled chrominance planes of a color Photometric Interpretation are a special case, e.g., for a Photometric Interpretation (0028,0004) of YBR_FULL_422. In such cases, Samples per Pixel (0028,0002) describes the nominal number of channels (i.e., 3), and does not reflect that two chrominance samples are shared between four luminance samples. For YBR_FULL_422, Rows (0028,0010) and Columns (0028,0011) describe the size of the luminance plane, not the downsampled chrominance planes.

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 PS3.5 for additional restrictions imposed by compressed Transfer Syntaxes.

See Section 8.2.13 in PS3.5 for constraints that apply when using DICOM Real-Time Video.

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

Defined Terms:

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 PS3.4. This value may be used only when Samples per Pixel (0028,0002) has a value of 1. May be used for pixel data in a Native (uncompressed) or Encapsulated (compressed) format; see Section 8.2 in PS3.5 .

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 PS3.4. This value may be used only when Samples per Pixel (0028,0002) has a value of 1. May be used for pixel data in a Native (uncompressed) or Encapsulated (compressed) format; see Section 8.2 in PS3.5 .

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. May be used for pixel data in a Native (uncompressed) or Encapsulated (compressed) format; see Section 8.2 in PS3.5 . 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. Planar Configuration (0028,0006) may be 0 or 1. May be used for pixel data in a Native (uncompressed) or Encapsulated (compressed) format; see Section 8.2 in PS3.5 .

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. May be used for pixel data in a Native (uncompressed) or Encapsulated (compressed) format; see Section 8.2 in PS3.5 . Planar Configuration (0028,0006) may be 0 or 1.

This Photometric Interpretation is primarily used with RLE compressed bit streams, for which the Planar Configuration (0028,0006) may be 0 or 1; see Section 8.2.2 in PS3.5 and Section G.2 in PS3.5 . When used in the US Image Module, the Planar Configuration (0028,0006) is required to be 1; see Section C.8.5.6.1.16 “Planar Configuration”.

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 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.

Planar Configuration (0028,0006) shall be 0. May be used for pixel data in a Native (uncompressed) or Encapsulated (compressed) format; see Section 8.2 in PS3.5 .

Note

This Photometric Interpretation is primarily used with JPEG compressed bit streams, but is also occasionally used for pixel data in a Native (uncompressed) format.
Though the chrominance channels are downsampled, there are still nominally three channels, hence Samples per Pixel (0028,0002) has a value of 3, not 2. I.e., for pixel data in a Native (uncompressed) format, the Value Length of Pixel Data (7FE0,0010) is not:

Rows (0028,0010) * Columns (0028,0011) * Number of Frames (0028,0008) * Samples per Pixel (0028,0002) * (⌊(Bits Allocated (0028,0100)-1)/8⌋+1)

padded to an even length, as it would otherwise be, but rather is:

Rows (0028,0010) * Columns (0028,0011) * Number of Frames (0028,0008) * 2 * (⌊(Bits Allocated (0028,0100)-1)/8⌋+1)

padded to an even length.
When used to describe JPEG compressed bit streams, the chrominance sub-sampling in the JPEG bit stream may differ from this description. E.g., though many JPEG codecs produce only horizontally sub-sampled chrominance components (4:2:2), some sub-sample vertically as well (4:2:0). Though inaccurate, the use of YBR_FULL_422 to describe both has proven harmless. For a discussion of the sub-sampling notation, see [Poynton 2008].

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 sited on the even luminance pixels is often referred to as cosited sampling. The cositing applies when describing pixel data in a Native (uncompressed) form. When used to describe compressed bit streams, the siting depends on the compression scheme. E.g., for JPEG according to JFIF [ISO/IEC 10918-5], the siting is midway between luminance samples, whereas for MPEG2 [ISO/IEC 13818-2], the sampling is cosited with the even luminance pixels. See also [Poynton 2008].

YBR_PARTIAL_422

Retired. See PS3.3-2017b.

YBR_PARTIAL_420

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. 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.

Planar Configuration (0028,0006) shall be 0. Shall only be used for pixel data in an Encapsulated (compressed) format; see Section 8.2 in PS3.5 .

Note

This Photometric Interpretation is primarily used with MPEG compressed bit streams. For a discussion of the sub-sampling notation and siting, see [Poynton 2008].

Luminance and chrominance values are represented as follows:

black corresponds to Y = 16;
Y is restricted to 220 levels (i.e., the maximum value is 235);
CB and CR each has a minimum value of 16;
CB and CR are restricted to 225 levels (i.e., the maximum value is 240);
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_420 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.

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. Planar Configuration (0028,0006) shall be 0. Shall only be used for pixel data in an Encapsulated (compressed) format; see Section 8.2 in PS3.5 .

Note

This Photometric Interpretation is primarily used with JPEG 2000 compressed bit streams.

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

Note

The above is based on [ISO/IEC 15444-1] (JPEG 2000).
In a JPEG 2000 bit stream, 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).
In JPEG 2000, spatial down-sampling of the chrominance components, if performed, is signaled in the JPEG 2000 bit stream.

YBR_RCT

Reversible Color Transformation:

Pixel data represent a color image described by one luminance (Y) and two chrominance planes (CB and CR).

Note

This Photometric Interpretation is primarily used with JPEG 2000 compressed bit streams.

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

Note

The above is based on [ISO/IEC 15444-1] (JPEG 2000).
In a JPEG 2000 bit stream, 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).
This photometric interpretation is a reversible approximation to the YUV transformation used in PAL and SECAM.

XYB

Pixel data represent a color image described by XYB, the long/medium/short wavelength (LMS) based color model inspired by the human visual system, facilitating perceptually uniform quantization. It uses a gamma of 3 for computationally efficient decoding. The exact details of the XYB encoding are defined as part of a specific image being encoded in order to optimize image fidelity. Images in XYB transcoded to other Transfer Syntaxes will use RGB or the appropriate equivalent (e.g., YBR_FULL_422 for JPEG).

Note

This is a possible color space used in JPEG XL [ISO/IEC 18181-1].

C.7.6.3.1.3 Planar Configuration

Planar Configuration (0028,0006) indicates whether the color pixel data are encoded 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 encoded shall be R1, G1, B1, R2, G2, B2, …, etc.
1: Each color plane shall be encoded contiguously. For RGB images, this means the order of the pixel values encoded 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 present, then an appropriate value to use may be specified in the description of the Transfer Syntax in PS3.5, 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 encoded for each image plane is left to right, top to bottom, i.e., the upper left pixel (labeled 1,1) is encoded 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 three 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 Palette Color Lookup Table Descriptor 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 Palette Color Lookup Table Descriptor 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 Palette Color Lookup Table Descriptor 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.

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 the Segmentation 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 or 16.

Note

A value of 16 indicates the Lookup Table Data will range from (0,0,0) minimum intensity to (65535,65535,65535) maximum intensity.
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 example pixel size shown in Figure C.7.6.3.1.7-1

Figure C.7.6.3.1.7-1. Example of Pixel Size and Aspect Ratio

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

C.7.6.3.1.8 Extended Offset Table

The Extended Offset Table (7FE0,0001) Value shall contain byte offsets to the first byte of the Item Tag of the one and only Fragment for every Frame in the Pixel Data (7FE0,0010) Sequence of this Instance.

The byte offsets are measured from the first byte of the first Item Tag following the empty (zero length) Basic Offset Table item, i.e., the Item Tag of the one and only Fragment of the first Frame.

Note

The offset is to the first byte of the Item Tag itself, not the first byte of the Value Field within the Item. See also the example of the Basic Offset Table in Table A.4-2 in PS3.5 .

If present, the first entry will always be 0000000000000000H.

Note

The offset table is only present when the Pixel Data (7FE0,0010) is encoded in Encapsulated Format, since the position of uncompressed frames encoded in Native Format can be computed from their known fixed length (i.e., derived from Rows (0028,0010), Columns (0028,0011), Samples per Pixel (0028,0002) and Bits Allocated (0028,0100)).

C.7.6.3.2 Image Pixel Macro

Table C.7-11b specifies the Attributes of the Section C.7.6.3.2 Image Pixel Macro, which describe and encode the pixel data of the image.

Table C.7-11b. Image Pixel Macro Attributes

Attribute Name	Tag	Type	Attribute Description
Include Table C.7-11c “Image Pixel Description Macro Attributes”
Pixel Data	(7FE0,0010)	1	A data stream of the pixel samples that comprise the Image. See Section C.7.6.3.1.4 for further explanation.

C.7.6.3.3 Image Pixel Description Macro

Table C.7-11c specifies the Attributes of the Section C.7.6.3.3 Image Pixel Description Macro, which are the common Attributes that describe the pixel data of the image.

Table C.7-11c. Image Pixel Description Macro Attributes

Attribute Name	Tag	Type	Attribute Description
Samples per Pixel	(0028,0002)	1	Number of samples (planes) in this image. See Section C.7.6.3.1.1 for further explanation.
Photometric Interpretation	(0028,0004)	1	Specifies the intended interpretation of the pixel data. See Section C.7.6.3.1.2 for further explanation.
Rows	(0028,0010)	1	Number of rows in the image. Shall be an exact multiple of the vertical downsampling factor if any of the samples (planes) are encoded downsampled in the vertical direction for pixel data encoded in a Native (uncompressed) format. E.g., required to be an even value for a Photometric Interpretation (0028,0004) of YBR_FULL_422.
Columns	(0028,0011)	1	Number of columns in the image. Shall be an exact multiple of the horizontal downsampling factor if any of the samples (planes) are encoded downsampled in the horizontal direction for pixel data encoded in a Native (uncompressed) format. E.g., required to be an even value for a Photometric Interpretation (0028,0004) of YBR_FULL_422.
Bits Allocated	(0028,0100)	1	Number of bits allocated for each pixel sample. Each sample shall have the same number of bits allocated. Bits Allocated (0028,0100) shall be either 1, or a multiple of 8. See PS3.5 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 PS3.5 for further explanation.
High Bit	(0028,0102)	1	Most significant bit for pixel sample data. Each sample shall have the same high bit. High Bit (0028,0102) shall be one less than Bits Stored (0028,0101). See PS3.5 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
Planar Configuration	(0028,0006)	1C	Indicates whether the pixel data are encoded color-by-plane or color-by-pixel. Required if Samples per Pixel (0028,0002) has a value greater than 1. See Section 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 Section 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 Section 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 Section 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 Section 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 Section 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 Section 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 Section 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 Pixel Data (7FE0,0010) at the same level of the Data Set and not to any icons nested within Sequences, which may or may not have their own ICC profile specified.
Color Space	(0028,2002)	3	A label that identifies the well-known color space of the image. Shall be consistent with any ICC Profile (0028,2000) that is also present. See Section C.11.15.1.2.

C.7.6.4 Contrast/Bolus Module

Table C.7-12 specifies the Attributes of the Contrast/Bolus Module, which describe the contrast /bolus used in the acquisition of the Image.

Table C.7-12. Contrast/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 Table 8.8-1 “Code Sequence Macro Attributes”			BCID 12 “Imaging Contrast Agent”.
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 Table 8.8-1 “Code Sequence Macro Attributes”			BCID 11 “Administration Route”.
>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 Table 8.8-1 “Code Sequence Macro Attributes”			No Baseline CID 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

Flow duration is an alternate method of specifying stop time
Flow rate allows for stepped injections by being capable of multiple values (1,N) instances.
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 of the Enhanced Contrast/Bolus Module, which describe the contrast/bolus used in the acquisition of the Image.

Table C.7-12b. Enhanced 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 Table 8.8-1 “Code Sequence Macro Attributes”			BCID 12 “Imaging Contrast Agent”.
>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 Table 8.8-1 “Code Sequence Macro Attributes”			BCID 11 “Administration Route”.
>Contrast/Bolus Ingredient Code Sequence	(0018,9338)	2	Active ingredient of agent. Zero or more Items shall be included in this Sequence.
>>Include Table 8.8-1 “Code Sequence Macro Attributes”			BCID 13 “Imaging Contrast Agent Ingredient”.
>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/Bolus T1 Relaxivity	(0018,0013)	3	T1 Relaxivity of the MR Contrast/Bolus used specified in s^-1*mmol^-1 specified at body temperature in human blood plasma.
>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 Attribute Descriptions

C.7.6.4b.1.1 Contrast/Bolus Ingredient Opaque for X-Ray Equipment

Contrast/Bolus Ingredient Opaque (0018,9425) specifies the type of relative X-Ray absorption of the contrast/bolus ingredient, compared to the X-Ray absorption of water.

Enumerated Values:

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.

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

C.7.6.5 Cine Module

Table C.7-13 specifies the Attributes of the Cine Module, which describe a Multi-frame Cine Image.

Table C.7-13. Cine 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 Section 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 Section 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 Systems (see [ISO/IEC 13818-1]).
>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 Table 8.8-1 “Code Sequence Macro Attributes”			DCID 3000 “Audio Channel Source”.

C.7.6.5.1 Cine Module 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:

where Δt_i is the i^th 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 Items.

C.7.6.6 Multi-frame Module

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

Table C.7-14. Multi-frame Module Attributes

Attribute Name	Tag	Type	Attribute Description
Number of Frames	(0028,0008)	1	Number of frames in a Multi-frame Image. See Section 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 Section C.7.6.6.1.2 for further explanation.
Stereo Pairs Present	(0022,0028)	3	The multi-frame pixel data consists of left and right stereoscopic pairs. See Section C.7.6.6.1.3 for further explanation. Enumerated Values: YES NO
Encapsulated Pixel Data Value Total Length	(7FE0,0003)	3	The length of the pixel data bit stream encapsulated in Pixel Data (7FE0,0010), in bytes, when all the fragments have been combined, not including any trailing padding to even length in the last Fragment added for encapsulation. Note This value will depend on the Transfer Syntax in which the Pixel Data (7FE0,0010) is encoded, and may need to be updated depending on the Transfer Syntax negotiated and selected for a particular transfer. See PS3.5 Section 8.2 “Native or Encapsulated Format Encoding”.

C.7.6.6.1 Multi-frame Module 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 Section 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). Number of Frames (0028,0008) shall have a value greater than zero.

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 Data Set 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).

When the IOD permits the use of Multi-frame Functional Groups as a Standard or Standard Extended SOP Class, Frame Increment Pointer may contain the single value of Per-Frame Functional Groups Sequence (5200,9230) to indicate that the Functional Groups contain the descriptors of the frames.

Note

For example, the Multi-frame Grayscale Word Secondary Capture Image IOD requires the Multi-frame Module but also permits the Multi-frame Functional Groups, for example, to describe the plane position of each frame.

C.7.6.6.1.3 Stereoscopic Pairs Present

Stereo Pairs Present (0022,0028) shall have the value of YES when frames within a Multi-frame Image are encoded as left and right stereoscopic pairs.

When Stereoscopic Pairs are present, and the pixel data is uncompressed, or compressed with a Transfer Syntax that does not explicitly convey the semantics of stereo pairs, the first and subsequent odd frames (frames numbered from 1) are the left frame of each pair, and the second and subsequent even frames are the right frame of each pair.

If the pixel data is compressed with a Transfer Syntax that does explicitly convey the semantics of stereo pairs, then the identification of the left and right frames in the compressed pixel data will be as defined in the compressed bit stream.

Note

For example, the MPEG-4 AVC/H.264 Supplemental Enhancement Information (SEI) frame packing arrangement (FPA) field defines various methods of encoding stereo pairs. See PS3.5 Section 8.2.8 “MPEG-4 AVC/H.264 High Profile / Level 4.2 Video Compression”. Videos encoded with this Transfer Syntax are used for what is colloquially referred to as "3D Television" applications. PS3.5 Section 8.2.9 “MPEG-4 AVC/H.264 Stereo High Profile / Level 4.2 Video Compression” defines a method of encoding stereo pairs without frame packing and with 2D backwards compatibility.
The presence of Stereo Pairs Present (0022,0028) is independent of the use of Instances of the Stereometric Relationship IOD. In particular, no further description of the method of acquisition of the stereoscopic pairs is required, such as might be present in Attributes of the Stereo Pairs Sequence (0022,0020) of the Stereometric Relationship IOD. The definition of the references to left and right pairs in that IOD prohibit the encoding of the left and right pairs in the same Instance, as distinct for the usage here.
Not all multi-frame IODs are sufficiently generic in their description to permit the presence of stereoscopic pairs. E.g., the Video Endoscopic Image IOD, Video Microscopic IOD and Video Photographic IODs are, since they do not specify any conflicting constraints on the meaning of the frames.

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 the Frame Pointers Module.

Table C.7-15. Frame 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: 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

Note

Frame numbers begin at 1.
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 of the Mask Module, which describe mask operations for a Multi-frame Image.

Table C.7-16. Mask 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 Section 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 Section 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 Section 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 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. Enumerated Values: 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 encoded. 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 Module Attribute Descriptions

C.7.6.10.1.1 Mask Operation

Mask Operation (0028,6101) specifies a type of mask operation to be performed.

Defined Terms:

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 TID Offset (0028,6120) from the first frame within the Applicable Frame Range, TID Offset (0028,6120) +2 from the second frame within the Applicable Frame Range, 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)

Where:

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

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

Figure C.7.6.10-1. Example of TID Offset

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.7-17. Display Shutter Module Attributes

Attribute Name	Tag	Type	Attribute Description
Include Table C.7-17a “Display Shutter Macro Attributes”

Table C.7-17a. Display 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 Section C.10.7.1.1.

Figure C.7-1, Figure C.7-2, Figure C.7-3, Figure C.7-4 and Figure C.7-4b illustrate the values of coordinate Attributes for 1:1 aspect and 2:1 aspect ratio images with rectangular and circular display shutters applied.

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

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

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

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

Figure C.7-4b illustrates the combined application of rectangular and circular display shutters to show the least amount of visible image.

Figure C.7-4b. Combined Rectangular and Circular Display Shutter

C.7.6.12 Device Module

Table C.7-18 specifies the Attributes of the Device Module, which identifies and describes devices or calibration objects (e.g., catheters, markers, baskets) or other quality control materials that are associated with a Study and/or image.

Table C.7-18. Device 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 Table 8.8-1 “Code Sequence Macro Attributes”			BCID 4051 “General Device”.
>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.
>Date of Manufacture	(0018,1204)	3	The date the device was originally manufactured or re-manufactured (as opposed to refurbished).
>Device ID	(0018,1003)	3	User-supplied identifier for the device.
>Device Length	(0050,0014)	3	Length in mm of device. See Section C.7.6.12.1.1.
>Device Diameter	(0050,0016)	3	Unit diameter of device. See Section 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 Section C.7.6.12.1.1.
>Inter-Marker Distance	(0050,0019)	3	Distance in mm between markers on calibrated device. See Section 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 Module Attribute Descriptions

C.7.6.12.1.1 Device Type and Size

Depending on the type of device specified by Code Value (0008,0100) in an Item of 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 specifies the Attributes of the Intervention Module, which describes therapies (e.g., interventions during an angiographic procedure) that are associated with a Study and/or image.

Table C.7-19. Intervention Module Attributes

Attribute Name	Tag	Type	Attribute Description
Intervention Sequence	(0018,0036)	3	Sequence describing interventional therapies or procedures. One or more Items are permitted in this Sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes”			BCID 9 “Image Guided Therapeutic Procedure”.
>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 Table 8.8-1 “Code Sequence Macro Attributes”			BCID 10 “Interventional Drug”.
>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 Table 8.8-1 “Code Sequence Macro Attributes”			BCID 11 “Administration Route”.
>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 previous releases, but its use has been retired. See PS3.3-2003.

C.7.6.14 Acquisition Context Module

Table C.7.6.14-1 specifies the Attributes of the Acquisition Context Module, which describes 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.

Note

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. Previously, Referenced Frame Numbers (0040,A136) was used to enumerate which frames were described, but its length was limited, so it has been replaced by Referenced Frame Number (0008,1160). Similarly, applicability to a subset of Segments or Waveform Channels may be specified.

Table C.7.6.14-1. Acquisition Context Module Attributes

Attribute Name

Tag

Type

Attribute Description

Acquisition Context Sequence

(0040,0555)

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.

>Include Table 10.2.1-1 “Content Item with Modifiers Macro Attributes”

Acquisition Context Description

(0040,0556)

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 Section 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 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 Section C.11.7.

Table C.7.6.15-1. Bitmap Display Shutter Module Attributes

Attribute Name	Tag	Type	Attribute Description
Shutter Shape	(0018,1600)	1	Shape of the shutter defined for display. Enumerated Values: 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 Section 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 Section 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.7.6.16-1. Multi-frame Functional Groups Module Attributes

Attribute Name	Tag	Type	Attribute Description
Shared Functional Groups Sequence	(5200,9229)	1	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. Only a single 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. The Item may be empty if the requirements for inclusion of the Functional Groups are not satisfied.
Per-Frame Functional Groups Sequence	(5200,9230)	1C	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. Required if for any frame, there are Per-Frame Functional Groups that are not empty.
>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. An Item may be empty if the requirements for inclusion of the Functional Groups for the corresponding frame are not satisfied.
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 Section C.7.6.6.1.1 for further explanation.
Stereo Pairs Present	(0022,0028)	3	The multi-frame pixel data consists of left and right stereoscopic pairs. See Section C.7.6.6.1.3 for further explanation. Enumerated Values: YES NO
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 Section 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 Section C.7.6.16.2.2.4 for further specification. The first Instance in a concatenation (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. If present, shall have a value greater than one, unless an IOD overrides this constraint to enumerate a value of 1 to prevent the use of Concatenations (e.g., see Section C.8.17.7 and Section C.8.17.16).
Encapsulated Pixel Data Value Total Length	(7FE0,0003)	3	The length of the pixel data bit stream encapsulated in Pixel Data (7FE0,0010), in bytes, when all the fragments have been combined, not including any trailing padding to even length in the last Fragment added for encapsulation. Note This value will depend on the Transfer Syntax in which the Pixel Data (7FE0,0010) is encoded, and may need to be updated depending on the Transfer Syntax negotiated and selected for a particular transfer. See PS3.5 Section 8.2 “Native or Encapsulated Format Encoding”.

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 by editorial convention in Macros. Those Functional Groups that apply to all frames are included in the Shared Functional Groups Sequence (5200,9229). Functional Groups whose Attribute values may vary from frame to frame are included in the Per-Frame Functional Groups Sequence (5200,9230).

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

Note

In the case of a SOP Instance containing a single frame, some Functional Groups 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).
Even if there are no Functional Groups in the Per-Frame Functional Groups Sequence (5200,9230) an empty Item is encoded for every frame, which an IOD is permitted to specify for a Type 1 Sequence, as described in PS3.5, unless all Items for all frames are empty, in which case the Per-Frame Functional Groups Sequence (5200,9230) may be entirely omitted.

It may happen that the Data Set for the Item of a Functional Group Sequence Attribute does not contain any Attributes (e.g., a condition for a single Type 1C Attribute in the Sequence is not met). In this case, the Item is included but is empty.

Note

PS3.5 describes that an empty Item is permitted for a Type 1 or Type 2 Sequence depending on what the IOD in PS3.3 defines for the Data Set that is defined for that Sequence Item.

It may happen that a Functional Group Sequence Attribute is not required for a particular frame (e.g., an optional Functional Group). In this case the Functional Group Sequence Attribute is not included in the Per-Frame Functional Groups Sequence (5200,9230) Item for that frame.

Note

The absence of the Sequence Attribute corresponding to a particular Functional Group 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.

Figure C.7.6.16-1. A 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 Concatenation UID (0020,9161) because a SOP Instance can be divided into concatenations only during exchange and there can be more than one concatenation with different Concatenation UIDs of an original SOP Instance; see Figure C.7.6.16-1a.

Figure C.7.6.16-1a. 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 Macro, which is used as a Functional Group Macro.

Table C.7.6.16-2. Pixel 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 Section 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. In the case of Enhanced RT Image ("1.2.840.10008.5.1.4.1.1.481.23") or Enhanced Continuous RT Image ("1.2.840.10008.5.1.4.1.1.481.24") the pixel spacing is defined on the x/y plane at z = 0 of the Image Receptor Coordinate System. In the case of Ophthalmic Tomography Image ("1.2.840.10008.5.1.4.1.1.77.1.5.4") or Ophthalmic Optical Coherence Tomography B-scan Volume Analysis ("1.2.840.10008.5.1.4.1.1.77.1.5.8") the pixel spacing is specified as nominal because the physical distance may vary across the field of the images. Required if: Volumetric Properties (0008,9206) is other than DISTORTED or SAMPLED, and Image Type (0008,0008) Value 3 is not LABEL or OVERVIEW, or SOP Class UID is Segmentation Storage ("1.2.840.10008.5.1.4.1.1.66.4") and Frame of Reference UID (0020,0052) is present, or SOP Class UID is Ophthalmic Tomography Image Storage ("1.2.840.10008.5.1.4.1.1.77.1.5.4") and Ophthalmic Volumetric Properties Flag (0022,1622) is YES, or SOP Class UID is Ophthalmic Optical Coherence Tomography B-scan Volume Analysis Storage ("1.2.840.10008.5.1.4.1.1.77.1.5.8"), or SOP Class UID is Enhanced RT Image ("1.2.840.10008.5.1.4.1.1.481.23"), or SOP Class UID is Enhanced Continuous RT Image ("1.2.840.10008.5.1.4.1.1.481.24"). 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 Section 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 Section C.8.12.4). Required if: Volumetric Properties (0008,9206) is VOLUME or SAMPLED, and Image Type (0008,0008) Value 3 is not LABEL or OVERVIEW, or SOP Class UID is Segmentation Storage ("1.2.840.10008.5.1.4.1.1.66.4") and Frame of Reference UID (0020,0052) is present, or SOP Class UID is Ophthalmic Tomography Image Storage ("1.2.840.10008.5.1.4.1.1.77.1.5.4") and Ophthalmic Volumetric Properties Flag (0022,1622) is YES, or SOP Class UID is Ophthalmic Optical Coherence Tomography B-scan Volume Analysis Storage ("1.2.840.10008.5.1.4.1.1.77.1.5.8"). May be present otherwise, if SOP Class UID is not Enhanced RT Image ("1.2.840.10008.5.1.4.1.1.481.23"), and SOP Class UID is not Enhanced Continuous RT Image ("1.2.840.10008.5.1.4.1.1.481.24").
>Spacing Between Slices	(0018,0088)	1C	Spacing between adjacent slices, in mm. The spacing is measured from the center-to-center of each slice, and if present shall not be negative. Required if Dimension Organization Type (0020,9311) is TILED_FULL and Total Pixel Matrix Focal Planes (0048,0303) is greater than 1. May be present otherwise. Note In the case of Whole Slide Images, Spacing Between Slices (0018,0088) describes the spacing of focal planes separately encoded, and is distinct from Distance Between Focal Planes (0048,0014), which describes in what manner different focal planes were combined into a single encoded plane (focus stacking).

C.7.6.16.2.2 Frame Content Macro

Table C.7.6.16-3 specifies the Attributes of the Frame Content Macro, which is used as a Functional Group Macro.

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

Table C.7.6.16-3. Frame 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 Section C.7.6.16.2.2.1 and Section 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, and Dimension Organization Type (0020,9311) is not TILED_FULL, and the SOP Class UID is not: "1.2.840.10008.5.1.4.1.1.2.2 (Legacy Converted Enhanced CT Image Storage)", or "1.2.840.10008.5.1.4.1.1.4.4" (Legacy Converted Enhanced MR Image Storage), or "1.2.840.10008.5.1.4.1.1.128.1" (Legacy Converted Enhanced PET Image Storage), or "1.2.840.10008.5.1.4.1.1.77.1.6" (VL Whole Slide Microscopy Image Storage) 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 Section C.7.6.16.2.2.1 for further explanation. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL, and Dimension Organization Type (0020,9311) is not TILED_FULL, and the SOP Class UID is not: "1.2.840.10008.5.1.4.1.1.2.2" (Legacy Converted Enhanced CT Image Storage), or "1.2.840.10008.5.1.4.1.1.4.4" (Legacy Converted Enhanced MR Image Storage), or "1.2.840.10008.5.1.4.1.1.128.1" (Legacy Converted Enhanced PET Image Storage), or "1.2.840.10008.5.1.4.1.1.77.1.6" (VL Whole Slide Microscopy Image Storage) or SOP Class UID (0008,0016) is "1.2.840.10008.5.1.4.1.1.6.3" (Photoacoustic Image Storage). 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 Section C.7.6.16.2.2.1 and Section C.7.6.16.2.2.3 for further explanation. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL, and Dimension Organization Type (0020,9311) is not TILED_FULL, and the SOP Class UID is not: "1.2.840.10008.5.1.4.1.1.2.2 (Legacy Converted Enhanced CT Image Storage)", or "1.2.840.10008.5.1.4.1.1.4.4" (Legacy Converted Enhanced MR Image Storage), or "1.2.840.10008.5.1.4.1.1.128.1" (Legacy Converted Enhanced PET Image Storage), or "1.2.840.10008.5.1.4.1.1.77.1.6" (VL Whole Slide Microscopy Image Storage) 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. Note In Section C.7.6.17.1, the index values are defined to start from 1 and monotonically increase by 1, within the scope of the Dimension Organization UID (0020,9164). Required if the value of Dimension Index Sequence (0020,9222) exists. Note For some IODs, such as the VL Whole Slide Microscopy Image IOD, the entire Frame Content Sequence (0020,9111) may be omitted, but if it is present and Dimensions are explicitly defined, then the index values need to be supplied here.
>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" or Functional MR Sequence (0018,9621) is present. May be present otherwise. See Section C.7.6.16.2.2.6 and Section C.7.6.16.2.2.8.
>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 Section 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" or Functional MR Sequence (0018,9621) is present. May be present otherwise. See Section C.7.6.16.2.2.7 and Section C.7.6.16.2.2.8.
>In-Stack Position Number	(0020,9057)	1C	The ordinal number of a frame in a group of frames, with the same Stack ID (0020,9056). Required if Stack ID (0020,9056) or Functional MR Sequence (0018,9621) is present. See Section C.7.6.16.2.2.4 and Section C.7.6.16.2.2.8 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 Section 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.

Figure C.7.6.16-2. Relationship 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.

Note

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).
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 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 Attributes and values.

In a Concatenation the Dimension Index Sequence (0020,9222) Items of the Shared Functional Groups Sequence (5200,9229) shall be identical and have the same values for all individual SOP Instances. The Items of the Per-Frame Functional Groups Sequence (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:

Number of Frames (0028,0008)
Concatenation Frame Offset Number (0020,9228)
In-concatenation Number (0020,9162)
SOP Instance UID (0008,0018)
Instance Creation Time (0008,0013)
Extended Offset Table (7FE0,0001)
Extended Offset Table Lengths (7FE0,0002)

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. When multiple SOP Instances of a Concatenation are combined into a single SOP Instance, the Basic Offset Table, if populated, and the Extended Offset Table (7FE0,0001) and Extended Offset Table Lengths (7FE0,0002) Attributes, if present, need to be regenerated to match the new content of the Pixel Data attribute.

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 C.7.6.16-3 for an example.

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.

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:

Dimension Organization UID (0020,9164) to qualify the Stack ID
Image Position (Patient) (0020,0032)
Image Orientation (Patient) (0020,0037)
Rows (0028,0010) * first value of Pixel Spacing (0028,0030) (= field of view in the row direction)
Columns (0028,0011) * second value of Pixel Spacing (0028,0030) (= field of view in the column direction)
Slice Thickness (0018,0050)

C.7.6.16.2.2.5 Frame Label

The Frame Label (0020,9453) Attribute can be used to label frames that need to be handled as a group in application. The Dimension Index Pointer (0020,9165) from the Multi-frame 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.

Figure C.7.6.16-4b. PET 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.7.6.16.2.2.8 Usage of Temporal Position Index, Stack ID and In-Stack Position Number in fMRI Volumes

For fMRI volumes the Temporal Position Index is used to distinguish between the multiple volumes acquired in time (phases of a volume) for the same Stack ID. Each frame in the volume has an In-Stack Position Number that is the ordinal number in space of each volume. See Figure C.7.6.16-4c for an example.

Figure C.7.6.16-4c. Example of Functional MRI volumes

C.7.6.16.2.3 Plane Position (Patient) Macro

Table C.7.6.16-4 specifies the Attributes of the Plane Position (Patient) Macro, which is used as a Functional Group Macro.

Table C.7.6.16-4. Plane Position (Patient) Macro Attributes

Attribute Name

Tag

Type

Attribute Description

Plane Position Sequence

(0020,9113)

Identifies the position of the plane of this frame.

Only a single Item shall be included in this Sequence.

>Image Position (Patient)

(0020,0032)

The x, y, and z coordinates of the upper left hand corner (center of the first voxel transmitted) of the frame, in mm. See Section C.7.6.2.1.1 and Section 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.
In the case of Ophthalmic Tomography Image ("1.2.840.10008.5.1.4.1.1.77.1.5.4") or Ophthalmic Optical Coherence Tomography B-scan Volume Analysis ("1.2.840.10008.5.1.4.1.1.77.1.5.8") the coordinate values are specified as nominal because the imaged volume may be deformed from the Patient-based Coordinate System due to the imaging optical path interaction with the anatomy of the eye.

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, or
SOP Class UID is Segmentation Storage ("1.2.840.10008.5.1.4.1.1.66.4") and Frame of Reference UID (0020,0052) is present, or
SOP Class UID is Ophthalmic Tomography Image Storage ("1.2.840.10008.5.1.4.1.1.77.1.5.4") and Ophthalmic Volumetric Properties Flag (0022,1622) is YES, or
SOP Class UID is Ophthalmic Optical Coherence Tomography B-scan Volume Analysis Storage ("1.2.840.10008.5.1.4.1.1.77.1.5.8").

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, 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) Macro, which is used as a Functional Group Macro.

Table C.7.6.16-5. Plane Orientation (Patient) Macro Attributes

Attribute Name

Tag

Type

Attribute Description

Plane Orientation Sequence

(0020,9116)

Identifies orientation of the plane of this frame.

Only a single Item shall be included in this Sequence.

>Image Orientation (Patient)

(0020,0037)

The direction cosines of the first row and the first column with respect to the patient. See Section C.7.6.2.1.1 and Section C.7.6.16.2.3.1 for further explanation.

Note

In the case of Ophthalmic Tomography Image ("1.2.840.10008.5.1.4.1.1.77.1.5.4") or Ophthalmic Optical Coherence Tomography B-scan Volume Analysis ("1.2.840.10008.5.1.4.1.1.77.1.5.8") the image orientation is specified as nominal because the coordinate system may be deformed from the Patient-based Coordinate System, and orientation values may vary across the field of the images.

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, or
SOP Class UID is Segmentation Storage ("1.2.840.10008.5.1.4.1.1.66.4") and Frame of Reference UID (0020,0052) is present, or
SOP Class UID is Ophthalmic Tomography Image Storage ("1.2.840.10008.5.1.4.1.1.77.1.5.4") and Ophthalmic Volumetric Properties Flag (0022,1622) is YES, or
SOP Class UID is Ophthalmic Optical Coherence Tomography B-scan Volume Analysis Storage ("1.2.840.10008.5.1.4.1.1.77.1.5.8"), or
SOP Class UID is Enhanced RT Image ("1.2.840.10008.5.1.4.1.1.481.23"), or
SOP Class UID is Enhanced Continuous RT Image ("1.2.840.10008.5.1.4.1.1.481.24").

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 Macro, which is used as a Functional Group Macro.

Table C.7.6.16-6. Referenced 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 Table 10-3 “Image SOP Instance Reference Macro Attributes”
>Purpose of Reference Code Sequence	(0040,A170)	1C	Describes the purpose for which the reference is made. Only a single Item shall be included in this Sequence. Required if SOP Class UID is not "1.2.840.10008.5.1.4.1.1.2.2" (Legacy Converted Enhanced CT Image Storage) and not "1.2.840.10008.5.1.4.1.1.4.4" (Legacy Converted Enhanced MR Image Storage) and not "1.2.840.10008.5.1.4.1.1.128.1" (Legacy Converted Enhanced PET Image Storage), may be present otherwise. See Section C.7.6.16.2.5.1 for further explanation.
>>Include Table 8.8-1 “Code Sequence Macro Attributes”			DCID 7201 “Referenced Image Purpose of Reference”, or as specified in the IOD invocation of this Functional Group.

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 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 Macro, which is used as a Functional Group Macro.

Table C.7.6.16-7. Derivation 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 Section C.12.4.1.1 for further explanation.
>Derivation Code Sequence	(0008,9215)	1C	A coded description of how this frame was derived. See Section C.12.4.1.1 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. Required if SOP Class UID is not "1.2.840.10008.5.1.4.1.1.2.2" (Legacy Converted Enhanced CT Image Storage) and not "1.2.840.10008.5.1.4.1.1.4.4" (Legacy Converted Enhanced MR Image Storage) and not "1.2.840.10008.5.1.4.1.1.128.1" (Legacy Converted Enhanced PET Image Storage), may be present otherwise.
>>Include Table 8.8-1 “Code Sequence Macro Attributes”			DCID 7203 “Image Derivation”.
>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 Section C.12.4.1.2 for further explanation.
>>Include Table 10-3 “Image SOP Instance Reference Macro Attributes”
>>Purpose of Reference Code Sequence	(0040,A170)	1C	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. Required if SOP Class UID is not "1.2.840.10008.5.1.4.1.1.2.2" (Legacy Converted Enhanced CT Image Storage) and not "1.2.840.10008.5.1.4.1.1.4.4" (Legacy Converted Enhanced MR Image Storage) and not "1.2.840.10008.5.1.4.1.1.128.1" (Legacy Converted Enhanced PET Image Storage), may be present otherwise.
>>>Include Table 8.8-1 “Code Sequence Macro Attributes”			DCID 7202 “Source Image Purpose of Reference”.
>>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 or frame. Enumerated Values: YES NO REORIENTED_ONLY A projection radiograph that has been flipped, and/or rotated by a multiple of 90 degrees Note 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. 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.

C.7.6.16.2.7 Cardiac Synchronization Macro

Table C.7.6.16-8 specifies the Attributes of the Cardiac Synchronization Macro, which is used as a Functional Group Macro.

Table C.7.6.16-8. Cardiac 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 Frame Reference DateTime (0018,9151) expressed as a positive value. See Section 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 Frame Reference DateTime (0018,9151) expressed as a positive value. See Section 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 Frame Reference DateTime (0018,9151) expressed as a negative value. See Section 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 Frame Reference DateTime (0018,9151) expressed as a negative value. See Section 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 Section 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 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.

Figure C.7.6.16-5a. Cardiac 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 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.

Figure C.7.6.16-5b. Cardiac 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 Macro, which is used as a Functional Group Macro.

Table C.7.6.16-9. Frame Anatomy Macro Attributes

Attribute Name

Tag

Type

Attribute Description

Frame Anatomy Sequence

(0020,9071)

Identifies anatomic characteristics of this frame.

Only a single Item shall be included in this Sequence.

>Frame Laterality

(0020,9072)

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 maybe 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 Table 10-5 “General Anatomy Mandatory Macro Attributes”

Anatomic Region Sequence DCID 4030 “CT, MR and PET Anatomy Imaged”.

Anatomic Region Modifier Sequence (0008,2220) DCID 2 “Anatomic Modifier”.

Primary Anatomic Structure Modifier Sequence (0008,2230) DCID 2 “Anatomic Modifier”.

C.7.6.16.2.9 Pixel Value Transformation Macro

Table C.7.6.16-10 specifies the Attributes of the Pixel Value Transformation Macro, which is used as a Functional Group Macro.

Note

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

Table C.7.6.16-10. 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.
>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 Section C.11.1.1.2 for further explanation. Enumerated Values: 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 Section 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 Macro, which is used as a Functional Group Macro.

Note

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

Table C.7.6.16-10b. Identity 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 = mSV + b. Enumerated Values:* 0
>Rescale Slope	(0028,1053)	1	m in the equation specified by Rescale Intercept (0028,1052). Enumerated Values: 1
>Rescale Type	(0028,1054)	1	Specifies the output units of Rescale Slope (0028,1053) and Rescale Intercept (0028,1052). See Section C.11.1.1.2 for further explanation. Enumerated Values: 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 Macro, which is used as a Functional Group Macro.

Table C.7.6.16-11. Frame 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 Section C.11.2.1.2 for further explanation.
>Window Width	(0028,1051)	1	Window Width for display. See Section 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 Section C.11.2.1.3 for further explanation. Defined Terms: LINEAR LINEAR_EXACT 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 Section 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 Macro, which is used as a 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.7.6.16-11b. Frame VOI LUT with LUT Macro Attributes

Attribute Name

Tag

Type

Attribute Description

Frame VOI LUT Sequence

(0028,9132)

The VOI LUT transformations applied to this frame.

Only a single Item is permitted in this Sequence.

>Include Table C.11-2b “VOI LUT Macro Attributes”

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 Macro, which is used as a Functional Group Macro.

Table C.7.6.16-12. Real World Value Mapping Macro Attributes

Attribute Name

Tag

Type

Attribute Description

Real World Value Mapping Sequence

(0040,9096)

The mapping of stored values to associated Real World values.

One or more Items shall be included in this Sequence.

>Include Table C.7.6.16-12b “Real World Value Mapping Item Macro Attributes”

Measurement Units Code Sequence DCID 82 “Measurement Unit”, or as specified in the Macro invocation.

Table C.7.6.16-12b. Real World Value Mapping Item Macro Attributes

Attribute Name	Tag	Type	Attribute Description
Real World Value First Value Mapped	(0040,9216)	1C	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 Data (0040,9212) of this Item. Required if Pixel Data (7FE0,0010) or Real World Value LUT Data (0040,9212) is present or Double Float Real World Value First Value Mapped (0040,9214) is absent. Note This Attribute may be used even when Float Pixel Data (7FE0,0008) or Double Float Pixel Data (7FE0,0009) are used instead of Pixel Data (7FE0,0010) if an integer of the size of this Attribute is sufficient to define the range. See Section C.7.6.16.2.11.1 for further explanation.
Real World Value Last Value Mapped	(0040,9211)	1C	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 Data (0040,9212) of this Item. Required if Pixel Data (7FE0,0010) or Real World Value LUT Data (0040,9212) is present or Double Float Real World Value Last Value Mapped (0040,9213) is absent. Note This Attribute may be used even when Float Pixel Data (7FE0,0008) or Double Float Pixel Data (7FE0,0009) are used instead of Pixel Data (7FE0,0010) if an integer of the size of this Attribute is sufficient to define the range. See Section C.7.6.16.2.11.1 for further explanation.
Double Float Real World Value First Value Mapped	(0040,9214)	1C	Specifies the first stored value mapped for the Real Word Value Intercept (0040,9224) and Real World Value Slope (0040,9225) of this Item. Required if Real World Value First Value Mapped (0040,9216) is absent. Note The same Attribute with a double float precision value is used whether or not Float Pixel Data (7FE0,0008) or Double Float Pixel Data (7FE0,0009) are present, an integer value is not sufficient.
Double Float Real World Value Last Value Mapped	(0040,9213)	1C	Specifies the last stored value mapped for the Real Word Value Intercept (0040,9224) and Real World Value Slope (0040,9225) of this Item. Required if Real World Value Last Value Mapped (0040,9211) is absent. Note The same Attribute with a double float precision value is used whether or not Float Pixel Data (7FE0,0008) or Double Float Pixel Data (7FE0,0009) are present, an integer value is not sufficient.
Real World Value Intercept	(0040,9224)	1C	The Intercept value in relationship between stored values (SV) and the Real World values. See Section C.7.6.16.2.11.1.2 for further explanation. Required if Float Pixel Data (7FE0,0008) or Double Float Pixel Data (7FE0,0009) are present or 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.7.6.16.2.11.1.2 for further explanation. Required if Float Pixel Data (7FE0,0008) or Double Float Pixel Data (7FE0,0009) are present or 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 Section C.7.6.16.2.11.1 for further explanation.
>Include Table 8.8-1 “Code Sequence Macro Attributes”			DCID 7181 “Abstract Multi-dimensional Image Model Component Unit”, or as specified in the Macro invocation.
Quantity Definition Sequence	(0040,9220)	3	A list of name-value pairs that describe the characteristics of the quantity represented by the Real World Value. One or more Items are permitted in this Sequence.
>Include Table 10.2.1-1 “Content Item with Modifiers Macro Attributes”			BTID 15400 “Real-World Quantity Definition”. Other TIDs may be defined by the IOD or application that uses this Macro.

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).

Table C.7.16-13. Contrast/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 (47625008, SCT, "Intravenous route") or (47625008, SCT, "Intravenous route"); may be present otherwise.

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 Macro, which is used as a Functional Group Macro.

Table C.7.6.16-14. Pixel 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. If Pixel Intensity Relationship (0028,1040) value equals LOG, exactly one Item with LUT Function (0028,9474) value TO_LINEAR LUT shall be present; other Items with other values of LUT Function (0028,9474) may be present.
>LUT Descriptor	(0028,3002)	1	Specifies the format of the LUT Data in this Sequence. See Section C.11.1.1 and Section 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.7.6.16-7a.

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

C.7.6.16.2.13.2 Pixel Intensity Relationship LUT Data Attribute

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

C.7.6.16.2.14 Frame Pixel Shift Macro

Table C.7.6.16-15 specifies the Attributes of the Frame Pixel Shift Macro, which is used as a Functional Group Macro.

Table C.7.6.16-15. Frame Pixel Shift Macro Attributes

Attribute Name

Tag

Type

Attribute Description

Frame Pixel Shift Sequence

(0028,9415)

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)

Identifier of the Subtraction Item in the Mask Subtraction Sequence (0028,6100) to which this pixel shift is associated.

See Section C.7.6.16.2.14.1.

>Mask Sub-pixel Shift

(0028,6114)

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

Figure C.7.6.16-8. Example 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 Macro, which is used as a Functional Group Macro.

Table C.7.6.16-16. Patient Orientation in Frame Macro Attributes

Attribute Name

Tag

Type

Attribute Description

Patient Orientation in Frame Sequence

(0020,9450)

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)

Patient direction of the rows and columns of this frame.

See Section 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, which is used as a Functional Group Macro.

Table C.7.6.16-17. Frame Display Shutter Macro Attributes

Attribute Name

Tag

Type

Attribute Description

Frame Display Shutter Sequence

(0018,9472)

Sequence containing the display shutter parameters for this frame.

Only a single Item shall be included in this Sequence.

>Include Table C.7-17a “Display Shutter Macro Attributes”

C.7.6.16.2.17 Respiratory Synchronization Macro

Table C.7.6.16-18 specifies the Attributes of the Respiratory Synchronization Macro, which is used as a Functional Group Macro.

Table C.7.6.16-18. Respiratory 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 Section 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 Frame Reference DateTime (0018,9151). See Section 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 Frame Reference DateTime (0018,9151). See Section 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 Values: 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 Values: 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 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 Figure C.7.6.16-9b depict the usage.

Figure C.7.6.16-9a. Respiratory Timing Tags

Figure C.7.6.16-9b. Relationship of Respiratory Amplitude Attributes

C.7.6.16.2.18 Irradiation Event Identification Macro

Table C.7.6.16-19 specifies the Attributes of the Irradiation Event Identification Macro, which is used as a Functional Group Macro.

Table C.7.6.16-19. Irradiation Event Identification Macro Attributes

Attribute Name

Tag

Type

Attribute Description

Irradiation Event Identification Sequence

(0018,9477)

Sequence containing the Irradiation Event Identification for this frame.

Only a single Item shall be included in this Sequence.

>Irradiation Event UID

(0008,3010)

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 Macro, which is used as a Functional Group Macro.

Table C.7.6.16.2-20. Radiopharmaceutical 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 Macro, which is used as a Functional Group Macro, which describes the physiological state of the patient.

Table C.7.6.16.2-21. Patient Physiological State Macro Attributes

Attribute Name

Tag

Type

Attribute Description

Patient Physiological State Sequence

(0018,9771)

Contains the Attributes describing the physiological state of the patient for this frame.

Only a single Item shall be included in this Sequence.

>Patient Physiological State Code Sequence

(0018,9772)

The physiological state of the patient.

Only a single Item shall be included in this Sequence.

>>Include Table 8.8-1 “Code Sequence Macro Attributes”

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) Macro, which is used as a Functional Group Macro.

Table C.7.6.16.2.21-1. Plane Position (Volume) Macro Attributes

Attribute Name

Tag

Type

Attribute Description

Plane Position (Volume) Sequence

(0020,930E)

Identifies the position of the plane of this frame.

Only a single Item shall be included in this Sequence.

>Image Position (Volume)

(0020,9301)

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) Macro, which is used as a Functional Group Macro.

Table C.7.6.16.2.22-1. Plane Orientation (Volume) Macro Attributes

Attribute Name

Tag

Type

Attribute Description

Plane Orientation (Volume) Sequence

(0020,930F)

Identifies orientation of the plane of this frame.

Only a single Item shall be included in this Sequence.

>Image Orientation (Volume)

(0020,9302)

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 Macro, which is used as a Functional Group Macro.

Table C.7.6.16.2.23-1. Temporal Position Macro Attributes

Attribute Name

Tag

Type

Attribute Description

Temporal Position Sequence

(0020,9310)

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)

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 Macro, which is used as a Functional Group Macro.

Table C.7.6.16.2.24-1. Image Data Type Macro Attributes

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 Section 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 Section C.7.6.16.2.24.2 for further explanation.
>Zero Velocity Pixel Value	(0018,9810)	1C	Data value at which velocity is zero. See Section C.7.6.16.2.24.3 for further information. Required if Data Type (0018,9808) is TISSUE_VELOCITY, FLOW_VELOCITY or DIRECTION_POWER. May be present otherwise.

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.
DIRECTION_POWER	Directional 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 minimum 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.7.6.16.2.24.3 Zero Velocity Pixel Value

Certain data types represent velocity that is directional by nature. For these data types, there shall be one particular pixel data value that corresponds to zero velocity. Zero Velocity Pixel Value (0018,9810) indicates the pixel data value corresponding to zero velocity.

The VR of Zero Velocity Pixel Value (0018,9810) corresponds to the value of Pixel Representation (0028,0103): If Pixel Representation (0028,0103) is 0000H (unsigned integer), the VR of Zero Velocity Pixel Value (0018,9810) shall be US; otherwise the VR of Zero Velocity Pixel Value (0018,9810) shall be SS.

C.7.6.16.2.25 Unassigned Shared and Per-Frame Converted Attributes Macros

Attributes that are present in the Classic images to be converted but that are not defined in specific Modules or specific Functional Groups required or supported by the IOD, or have their values changed during conversion, either may:

be identical in all images, in which case they shall be included in the top level Data Set or in the Unassigned Shared Converted Attributes Sequence (0020,9170), or
only be present in some images, or have a different number of values, or different values, in which case they shall be included in the Unassigned Per-Frame Converted Attributes Sequence (0020,9171).

Note

An example of an Attribute that might be included in the Unassigned Shared Converted Attributes Macro is Filter Type (0018,1160), which typically would be the same for all Classic CT images in a set, and is not included in any modality-specific Module or Functional Group Macro.
An example of an Attribute that might be included in the Unassigned Per-Frame Converted Attributes Macro is Slice Location (0020,1041), which typically would be different for each Classic CT image in a set, and is not included in any modality-specific Module or Functional Group Macro.
An example of an Attribute that might be included in the Unassigned Shared Converted Attributes Macro is Series Number (0020,0011), which typically would be the same for all Classic CT images in a set (but is not required to be), and will be replaced with a different value in the top-level Data Set, and hence if the original is to be preserved, needs to be recorded.
An example of an Attribute that might be included in the Unassigned Per-Frame Converted Attributes Macro is Instance Number (0020,0013), which typically would be different for each Classic CT image in a set, and will be replaced with a different value in the top-level Data Set, and hence if the original is to be preserved, needs to be recorded.
The UIDs of the converted Instances are recorded in the Conversion Source Attributes Sequence, and are not included in the Unassigned Shared Converted Attributes Macro and Unassigned Per-Frame Converted Attributes Macro.

For the purpose of comparing values, an Attribute that is not present in a Classic image to be converted is considered the same as an Attribute that is present but has no value. Sequence Attributes match when they have the same number of Items and Item contents in the same order (irrespective of whether the Sequences or Items are encoded with fixed or variable length).

The Unassigned Shared Converted Attributes Sequence (0020,9170), and the Unassigned Per-Frame Converted Attributes Sequence (0020,9171) may be absent, if there are no such Attributes available to be included. E.g., there may be no shared Attributes with the same values, all the shared Attributes may be included in the top-level Data Set, there may be no Attributes that vary per-frame or an individual frame may have no such Attribute.

The necessary Private Creator Data Element within each Sequence Item accompanies Private Data Elements. There is no requirement to preserve the private block of Data Elements used in the Classic images to be converted. Nor is there a requirement that a Private Data Element use the same private block in all of the Classic images.

Matching of Private Attribute Values for the purpose of determining whether they are shared or per-frame may be performed using the equivalent meaning if the Value Representation is Explicit and not UN, or known through other means, otherwise, byte matching of the UN VR shall be performed.

C.7.6.16.2.25.1 Unassigned Shared Converted Attributes Macro

Table C.7.6.16.2.25.1-1 specifies the Attributes of the Unassigned Shared Converted Attributes Macro, which is used as a Functional Group Macro.

Table C.7.6.16.2.25.1-1. Unassigned Shared Converted Attributes Macro Attributes

Attribute Name

Tag

Type

Attribute Description

Unassigned Shared Converted Attributes Sequence

(0020,9170)

Contains all of the Standard and Private Attributes that are present in all of the converted Classic images, that have the same number of values, that have the same values, and that are not in the top-level Data Set.

Only a single Item shall be included in this Sequence.

Required if any unassigned shared Attributes are present.

C.7.6.16.2.25.2 Unassigned Per-Frame Converted Attributes Macro

Table C.7.6.16.2.25.2-1 specifies the Attributes of the Unassigned Per-Frame Converted Attributes Macro, which is used as a Functional Group Macro.

Table C.7.6.16.2.25.2-1. Unassigned Per-Frame Converted Attributes Macro Attributes

Attribute Name

Tag

Type

Attribute Description

Unassigned Per-Frame Converted Attributes Sequence

(0020,9171)

Contains all of the Standard and Private Attributes that are present in only some of the converted Classic images, or that have a different number of values, or that have different values.

Only a single Item shall be included in this Sequence.

Required if any unassigned per-frame Attributes are present for this frame.

C.7.6.16.2.25.3 Image Frame Conversion Source Macro

Table C.7.6.16.2.25.2-1 specifies the Attributes of the Image Frame Conversion Source Macro, which is used as a Functional Group Macro.

Table C.7.6.16.2.25.3-1. Image Frame Conversion Source Macro Attributes

Attribute Name

Tag

Type

Attribute Description

Conversion Source Attributes Sequence

(0020,9172)

The image or other composite SOP Instance that was converted to this frame.

Only a single Item shall be included in this Sequence.

>Include Table 10-3 “Image SOP Instance Reference Macro Attributes”

C.7.6.16.2.26 Stored Value Color Range Macro

Table C.7.6.16.2.26-1 defines the Attributes of the Stored Value Color Range Macro, which is used as a Functional Group Macro.

Table C.7.6.16.2.26-1. Stored Value Color Range Macro Attributes

Attribute Name

Tag

Type

Attribute Description

Stored Value Color Range Sequence

(0028,1230)

Specifies the range of stored pixel values of this frame mapped using the Palette Color LUT.

Only a single Item shall be included in this Sequence.

>Minimum Stored Value Mapped

(0028,1231)

Minimum Stored Value to map. See Section C.7.6.16.2.26.1.

>Maximum Stored Value Mapped

(0028,1232)

Maximum Stored Value to map. See Section C.7.6.16.2.26.1.

C.7.6.16.2.26.1 Stored Value Color Range Macro Attributes Description

The voxel values of the Parametric Map shall be mapped to RGB values using the following transformation.

All values smaller than Minimum Stored Value Mapped (0028,1231) shall be treated as equal to this minimum value.

All values larger than Maximum Stored Value Mapped (0028,1232) shall be treated as equal to this maximum value.

The values between Minimum Stored Value Mapped (0028,1231) and Maximum Stored Value Mapped (0028,1232) shall be mapped to the Palette Color LUT using a linear interpolation function.

Note

The Palette Color LUT can be segmented and interpolation needs to accommodate the segmentation.

In case of floating point mapping the second value of the Palette Color Lookup Table Descriptor is not used in the mapping as the Minimum Stored Value Mapped (0028,1231) is used as start value for the LUT values.

Figure C.7.6.16.2.26.2-1. Stored Value Color Range

C.7.6.16.2.27 Frame Usefulness Macro

Table C.7.6.16.2.27-1 specifies the Attributes of the Frame Usefulness Macro, which is used as a Functional Group Macro, related to the clinical usefulness of the current frame.

Table C.7.6.16.2.27-1. Frame Usefulness Functional Group Macro Attributes

Attribute Name

Tag

Type

Attribute Description

Frame Usefulness Group Sequence

(0034,0009)

Sequence that contains the Functional Groups Sequence Attributes corresponding to the current frame or audio sample.

Only a single Item shall be included in this Sequence.

>Includes Information

(0034,000C)

Whether or not the current frame includes useful information, i.e. not noise nor void

Enumerated Values:

YES
NO

>Includes Imaging Subject

(0034,0008)

Whether or not the current frame includes the imaging subject.

Enumerated Values:

YES
NO

C.7.6.16.2.28 Camera Position Macro

Table C.7.6.16.2.28-1 specifies the Attributes of the Camera Position Macro, which is used as a Functional Group Macro, related to the position of the camera or the acquisition device for the current frame, with regards to the patient.

Table C.7.6.16.2.28-1. Camera Position Functional Group Macro Attributes

Attribute Name	Tag	Type	Attribute Description
Camera Position Group Sequence	(0034,000B)	1	Sequence that contains the Functional Groups Sequence Attributes corresponding to the current frame or audio sample. Only a single Item shall be included in this Sequence.
>Render Projection	(0070,1602)	1	Projection style. Enumerated Values: PERSPECTIVE
>Viewpoint Position	(0070,1603)	1	Position of the viewpoint in volume space. A point (x,y,z) in the Frame Reference Coordinate System referenced in the Frame of Reference Module.
>Viewpoint LookAt Point	(0070,1604)	1	Point the viewpoint is looking at. A point (x,y,z) in the Frame Reference Coordinate System referenced in the Frame of Reference Module.
>Viewpoint Up Direction	(0070,1605)	1	Vertical orientation of the view. A vector (x,y,z) in the Frame Reference Coordinate System referenced in the Frame of Reference Module.
>Render Field of View	(0070,1606)	1	The field of view specified as a 6-tuple of values (X _left, X _right, Y _top, Y _bottom, Distance _near, Distance _far) in the Viewpoint Coordinate System, in mm. See Section C.11.30.1.

C.7.6.16.2.29 Time of Frame Macro

Table C.7.6.16.2.29-1 specifies the Attributes of the Time of Frame Macro, which is used as a Functional Group Macro, related to the time of frame.

Table C.7.6.16.2.29-1. Time of Frame Functional Group Macro Attributes

Attribute Name

Tag

Type

Attribute Description

Time of Frame Group Sequence

(0034,000D)

Time characteristics of the current frame or audio sample.

Only a single Item shall be included in this Sequence.

>Frame Origin Timestamp

(0034,0007)

This timestamp contains the capture time of the payload content for this frame or audio sample. It is in TAI, not UTC.

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.7.6.17-1. Multi-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 equally spaced parallel planes (3D volume set) 3D_TEMPORAL Temporal loop of equally spaced parallel-plane 3D volume sets. TILED_FULL Tiled image in which each frame represents a single tile and the positions of the tiles are implicitly defined as per Section C.7.6.17.3. TILED_SPARSE Tiled image in which each frame represents a single tile and the positions of tiles are explicitly defined by per-frame Functional Group Macro entries.
Dimension Index Sequence	(0020,9222)	1C	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. Required if Dimension Organization Type (0020,9311) is absent or not TILED_FULL. May be present otherwise.
>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 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)	1	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.
>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) references a single Attribute that describes the actual values that define the dimension. 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. Each index value is an ordinal number starting from 1 and monotonically increasing by 1 within the scope of a Dimension Organization UID (0020,9164). These values are independent of the actual values of the Attribute referenced by the Dimension Index Pointer (0020,9165), i.e., the index values are logical indices, rather than actual indices. Frames assigned the same index shall contain nominally the same value for the referenced Attribute. If the referenced 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.

The Dimension Index Pointer (0020,9165) shall not contain the Data Element Tag for Frame Content Sequence (0020,9111) or Dimension Index Values (0020,9157).

Note

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.
The Dimension Index Pointer (0020,9165) may point to a Data Element Tag (gggg,eeee) that 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 indices used in the Dimension Index Values (0020,9157) may or may not be identical to the value of indexed Attribute referenced by Dimension Index Pointer (0020,9165). For example, if the referenced Attribute is itself encoded in an index-like fashion (being an ordinal number starting from 1), such as In-Stack Position Number (0020,9057), then index value 1 would typically correspond to In-Stack Position Number (0020,9057) value 1. On the other hand, if the referenced Attribute encodes some physical measure, such as a time or distance, or a categorical value, such as a string describing the phase of contrast, or a more complex description such as an entire Functional Group, then the index value is independent of the encoded value.
The scope of the values of Dimension Index Pointer (0020,9165) is defined to be within a single Dimension Organization UID (0020,9164). If the same Dimension Organization UID (0020,9164) is present in multiple Instances (whether part of a Concatenation or not), at least one of those Instances (though not necessarily every Instance) will contain a value of 1 for the Dimension Index Values (0020,9157).

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.

Figure C.7.6.17-1. Example 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.

Dimension Organization Sequence (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.

Figure C.7.6.17-2. Example of Use of Dimension Organization Module

C.7.6.17.3 Spatial Location and Optical Path of Tiled Images

If Dimension Organization Type (0020,9311) is present with a value of TILED_FULL, then the Per-Frame Functional Group Macros that would otherwise describe the spatial location of each tile explicitly (e.g., the X, Y and Z offsets from the origin in the Slide Coordinate System Plane Position (Slide)), and the optical path or segment, may be omitted.

A value of TILED_FULL indicates that the frames across all Instances of a Concatenation, or a single Instance in the absence of a Concatenation, comprise a non-sparse non-overlapping representation of an entire rectangular region, and are sequentially encoded as successive frames in Pixel Data (7FE0,0010) in an implicit order varying:

first along the row direction from left to right, where the row direction is defined in the Slide Coordinate System by the first three values of Image Orientation (Slide) (0048,0102),
then along the column direction from top to bottom, where the column direction is defined in the Slide Coordinate System by the second three values of Image Orientation (Slide) (0048,0102),
then along the depth direction from the glass slide towards the coverslip, where the depth direction is defined in the Slide Coordinate System from zero to positive,
then along optical paths, if applicable, where the direction is defined by successive Items of the Optical Path Sequence (0048,0105) in the order in which they are listed in that Sequence,
then along the segments, if applicable, where the direction is defined by ascending numeric values of Segment Number (0062,0004) as defined in the Segment Sequence (0062,0002).

If Dimension Organization Type (0020,9311) is absent or has a value of TILED_SPARSE, then the location of each tile is explicitly encoded using information in the Per-Frame Functional Groups Sequence, and the recipient shall not make any assumption about the spatial position or optical path or segment or order of the encoded frames, but shall rely on the values of the relevant Per-Frame Functional Group Macro.

Note

Images with an Image Type (0008,0008) Value 3 of THUMBNAIL, LABEL or OVERVIEW are single frame and may have a spatial extent that is not the same as the Total Pixel Matrix, so Dimension Organization Type (0020,9311) is not applicable.

The same previously applied to images with an Image Type (0008,0008) Value 3 of LOCALIZER, which has been retired. See PS3.3-2021c.

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 R-R 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 Heart Rate (0018,1088) is not used in this Module, since its value can be derived as 1/Cardiac R-R 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 Section 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 Synchronization Sequence (0018,9118) in the Cardiac Synchronization Functional Group uses the same Attributes and specifies the values for a single frame.

C.7.6.18.1.1 Cardiac Synchronization Module 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 C.7.6.18-2 specifies the Attributes of the Respiratory Synchronization Module.

Table C.7.6.18-2. Respiratory 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 Section 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 C.7.6.18-3 specifies the Attributes of the Bulk Motion Synchronization Module.

Table C.7.6.18-3. Bulk Motion Synchronization Module Attributes

Attribute Name

Tag

Type

Attribute Description

Bulk Motion Compensation Technique

(0018,9172)

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)

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

Table C.7.6.19-1 specifies the Attributes of the 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 Pixel Presentation (0008,9205) for such frames equals COLOR.

Table C.7.6.19-1. Supplemental Palette Color Lookup Table 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 Section 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 Section 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 Section 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 Section 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 Section 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 Section C.7.6.3.1.6 for further explanation.

C.7.6.20 Patient Orientation Module

Table C.7.6.20-1 specifies the Attributes of the Patient Orientation Module, which describe the patient orientation related to gravity and equipment.

Table C.7.6.20-1. Patient Orientation Module Attributes

Attribute Name	Tag	Type	Attribute Description
Include Table 10-15 “Patient Orientation Macro Attributes”

C.7.6.21 Image - Equipment Coordinate Relationship Module

Table C.7.6.21-1 specifies the Attributes of the Image - Equipment Coordinate Relationship Module, which specify how the equipment (e.g., gantry) and patient oriented coordinate system (in conjunction with Image Position (Patient) (0020,0032) and Image Orientation (Patient) (0020,0037) Attributes) are related.

Table C.7.6.21-1. Image - Equipment Coordinate Relationship Module Attributes

Attribute Name	Tag	Type	Attribute Description
Image to Equipment Mapping Matrix	(0028,9520)	1	A 4x4 rigid 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 Section 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 Section 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 ^AM_B describes how to transform a point (^Bx,^By,^Bz) with respect to the Patient-Based Coordinate System into (^Ax,^Ay,^Az) with respect to the equipment coordinate system according to the equation below.

Equation C.7.6.21.1-1.

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-Based Coordinate System and the Equipment-Based 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.

C.7.6.22 Specimen Module

Table C.7.6.22-1 specifies the Attributes of the Specimen Module, which identify one or more Specimens being imaged.

Table C.7.6.22-1. Specimen Module Attributes

Attribute Name	Tag	Type	Attribute Description
Include Table C.7.6.22-2 “Specimen Macro Attributes”

Table C.7.6.22-2. Specimen Macro Attributes

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 Table 10-17 “HL7v2 Hierarchic Designator Macro Attributes”
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 Table 10-17 “HL7v2 Hierarchic Designator Macro Attributes”
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 Table 8.8-1 “Code Sequence Macro Attributes”			BCID 8101 “Container Type”.
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 Table 8.8-1 “Code Sequence Macro Attributes”			BCID 8102 “Container Component Type”.
>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 Section C.7.6.22.1.1 and Section 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 Table 10-17 “HL7v2 Hierarchic Designator Macro Attributes”
>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 Table 8.8-1 “Code Sequence Macro Attributes”			BCID 8103 “Anatomic Pathology Specimen Type”.
>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 Table 10-2 “Content Item Macro Attributes”			BTID 8001 “Specimen Preparation”
>Include Table 10-8 “Primary Anatomic Structure Macro Attributes”			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. BCID 8134 “Anatomic Structure”
>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 Table 10-2 “Content Item Macro Attributes”			DTID 8004 “Specimen Localization”.

C.7.6.22.1 Specimen Module Attribute Descriptions

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).

Note

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.
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

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 delivered 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 specific 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 “Specimen Localization”, 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 of the Enhanced Palette Color Lookup Table Module, which define data flow through the Enhanced Blending and Display Pipeline. See Section 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 Values: PRIMARY_PVALUES PRIMARY_SINGLE SECONDARY_SINGLE SECONDARY_HIGH SECONDARY_LOW See Section 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 Section C.7.6.23.3 for usage.
>Include Table C.11-2b “VOI LUT Macro Attributes”
Blending LUT 1 Sequence	(0028,1404)	1C	Specification of the weight of the primary path input to the Blending Operation, i.e., the value that 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 Values: CONSTANT ALPHA_1 ALPHA_2 TABLE See Section 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 that 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 Section 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.
Color Space	(0028,2002)	3	A label that identifies the well-known color space of the image. Shall be consistent with any ICC Profile (0028,2000) that is also present. See Section C.11.15.1.2.

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 Section 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 Section C.7.6.16.2.11 Real World Value Mapping Macro.

Note

Annex QQ “Enhanced US Data Type Blending Examples (Informative)” in PS3.17 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.

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 (2¹⁶) 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 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
ONE_MINUS: The Blending LUT 2 value is (1 - Blending LUT 1 output); used for Blending LUT 2 Transfer Function (0028,140D) only

If the value is TABLE:

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.

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 (2¹⁶), 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 that 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.7.6.24 Floating Point Image Pixel Module

Table C.7.6.24-1 specifies the Attributes of the Floating Point Image Pixel Module. This Module differs from the Section C.7.6.3 Image Pixel Module in that:

instead of integer stored pixel values, float stored pixel values are used
Bits Stored (0028,0101) and High Bit (0028,0102) are not used because the stored pixel values always occupy the entire word
Pixel Representation (0028,0103) is not used because the stored pixel values are always signed
Photometric Interpretation is constrained
Pixel Data Provider URL (0028,7FE0) is not used

Table C.7.6.24-1. Floating Point Image Pixel Module Attributes

Attribute Name	Tag	Type	Attribute Description
Samples per Pixel	(0028,0002)	1	Number of samples (planes) in this image. See Section C.7.6.3.1.1 for further explanation.
Photometric Interpretation	(0028,0004)	1	Specifies the intended interpretation of the pixel data. Enumerated Values: MONOCHROME2
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 PS3.5 for further explanation. Enumerated Values: 32
Float Pixel Data	(7FE0,0008)	1	A data stream of the pixel samples that comprise the Image. The order of pixels encoded for each image plane is left to right, top to bottom, i.e., the upper left pixel (labeled 1,1) is encoded 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.
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 Section C.7.6.3.1.7.
Float Pixel Padding Value	(0028,0122)	3	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 Section C.7.6.24.1.
Float Pixel Padding Range Limit	(0028,0124)	1C	Pixel value that represents one limit (inclusive) of a range of padding values used together with Float Pixel Padding Value (0028,0122). Required if Float Pixel Padding Value (0028,0122) is present. See Section C.7.6.24.1. Note If only a single padding value rather than a range is required, then both Float Pixel Padding Value (0028,0122) and Float Pixel Padding Range Limit (0028,0124) will contain the same value. The general considerations described in Section C.7.5.1.1.2 may be helpful in understanding the corresponding floating point Attributes, but are not normative.

C.7.6.24.1 Float Pixel Padding Value and Float Pixel Padding Range Limit

Float Pixel Padding Value (0028,0122) and Float Pixel Padding Range Limit (0028,0124) may specify any valid [IEEE 754] value, including NaN (Not a Number) and infinity values.

Note

If using [IEEE 754] NaN values, it is recommended to set the sign bit to 0 and the is_quiet bit to 1. The range of NaN bit combinations under this recommendation is 7FC00000H through 7FFFFFFFH.

C.7.6.25 Double Floating Point Image Pixel Module

Table C.7.6.25-1 specifies the Attributes of the Double Floating Point Image Pixel Module. This Module differs from the Section C.7.6.3 Image Pixel Module in that:

instead of integer stored pixel values, double float stored pixel values are used
Bits Stored (0028,0101) and High Bit (0028,0102) are not used because the stored pixel values always occupy the entire word
Pixel Representation (0028,0103) is not used because the stored pixel values are always signed
Photometric Interpretation is constrained
color palette tables are not used
Pixel Data Provider URL (0028,7FE0) is not used

Table C.7.6.25-1. Double Floating Point Image Pixel Module Attributes

Attribute Name	Tag	Type	Attribute Description
Samples per Pixel	(0028,0002)	1	Number of samples (planes) in this image. See Section C.7.6.3.1.1 for further explanation.
Photometric Interpretation	(0028,0004)	1	Specifies the intended interpretation of the pixel data. Enumerated Values: MONOCHROME2
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 PS3.5 for further explanation. Enumerated Values: 64
Double Float Pixel Data	(7FE0,0009)	1	A data stream of the pixel samples that comprise the Image. The order of pixels encoded for each image plane is left to right, top to bottom, i.e., the upper left pixel (labeled 1,1) is encoded 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.
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 Section C.7.6.3.1.7.
Double Float Pixel Padding Value	(0028,0123)	3	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 Section C.7.6.25.1.
Double Float Pixel Padding Range Limit	(0028,0125)	1C	Pixel value that represents one limit (inclusive) of a range of padding values used together with Double Float Pixel Padding Value (0028,0123). Required if Double Float Pixel Padding Value (0028,0123) is present. See Section C.7.6.25.1. Note If only a single padding value rather than a range is required, then both Double Float Pixel Padding Value (0028,0123) and Double Float Pixel Padding Range Limit (0028,0125) will contain the same value. The general considerations described in Section C.7.5.1.1.2 may be helpful in understanding the corresponding floating point Attributes, but are not normative.

C.7.6.25.1 Double Float Pixel Padding Value and Double Float Pixel Padding Range Limit

Double Float Pixel Padding Value (0028,0123) and Double Float Pixel Padding Range Limit (0028,0125) may specify any valid [IEEE 754] value, including NaN (Not a Number) and infinity values.

Note

If using [IEEE 754] NaN values, it is recommended to set the sign bit to 0 and the is_quiet bit to 1. The range of NaN bit combinations under this recommendation is 7FF8000000000000H through 7FFFFFFFFFFFFFFFH.

C.7.6.26 Real-Time Bulk Data Flow Module

Table C.7.6.26-1 specifies the Attributes of the Real-Time Bulk Data Flow Module, which references pixels/waveforms that are not contained within the DICOM data set but conveyed in the associated Flows, as described in Section 6.1 in PS3.22 .

Table C.7.6.26-1 specifies the Attributes for the Real-Time Bulk Data Flow Module.

Table C.7.6.26-1. Real-Time Bulk Data Flow Module Attributes

Attribute Name	Tag	Type	Attribute Description
Real-Time Bulk Data Flow Sequence	(0034,000A)	1	Identifies the Source and Flows of a SMPTE ST 2110 communication providing Bulk Data. At least one item shall be included in this sequence.
>Source Identifier	(0034,0005)	1	UUID of the Source of the Flow(s). See Section C.7.6.26.1.1.
>Flow Identifier Sequence	(0034,0001)	1	Identifies the Flow(s) provided by the Source. One or more items shall be included in this sequence.
>>Flow Identifier	(0034,0002)	1	UUID of the Flow. See Section C.7.6.26.1.2.
>>Flow Transfer Syntax UID	(0034,0003)	1	UID of the encoding method of the referenced Flow See Section C.7.6.26.1.3.
>>Flow RTP Sampling Rate	(0034,0004)	1	Sampling rate in Hertz used by RTP for generating timestamp See Section C.7.6.26.1.4.

In case the Source is producing different Flows of the same Essence (e.g., video with two different sampling rates), the sequence must include at least the audio or video Flow that is associated with the present RTV Flow, and may in addition include the other Flow(s), enabling the receiver to subscribe to another Flow.

C.7.6.26.1 Real-Time Bulk Data Flow Module Attribute Descriptions

C.7.6.26.1.1 Source Identifier

The Source Identifier(0034,0005) is a Universally Unique Identifier (UUID). The value is 128 bits long encoded in binary. It shall correspond to the value of the Source Identifier of the related bulk data Flow which may contain this Source Identifier in the RTP Extended Header. In case such Source Identifier is not present in the related bulk data flow, this Source Identifier shall be set to enable multiple IODs to refer the same Source.

C.7.6.26.1.2 Flow Identifier

The Flow Identifier (0034,0002) is a Universally Unique Identifier (UUID). The value is 128 bits long encoded in binary. It shall correspond to the value of the Flow Identifier of the bulk data Flow which may contain this Flow Identifier in the RTP Extended Header. In case such Flow Identifier is not present in the related bulk data flow, this Flow Identifier shall be set to enable multiple IODs to refer the same Flow.

C.7.6.26.1.3 Flow Transfer Syntax UID

The Flow Transfer Syntax UID (0034,0003) shall be the one relative to the corresponding Flow. The sequence shall have at least one item in which the Flow Transfer Syntax UID and the Flow RTP Sampling Rate correspond to the Transfer Syntax UID (0002,0010) and RTV Flow RTP Sampling Rate (0002,0037), respectively, of the DICOM-RTV Meta Information Header.

C.7.6.26.1.4 Flow RTP Sampling Rate

The Flow RTP Sampling Rate (0034,0004) shall be the one defined in the SDP of the corresponding Flow.

C.7.6.27 Current Frame Functional Groups Module

Table C.7.6.27-1 specifies the Attributes of the Current Frame Functional Groups Module, which are related to the current frame when the IOD is transported using Real-Time Communication. It corresponds to the "per-frame" Attribute for the non-Real-Time IODs.

Note

The group number (0006H) of the Sequence containing the Attributes of the Current Frame Functional Groups Module is used to contain Attributes that are specific to real-time transfer. If this information needs to be kept in a persistent object, its contents have to be copied into an Attribute that has a group number of 0008H or higher. The Current Frame Functional Groups Module is relative to the dynamic part of the RTP Payload. Its group number is lower than that of other Attributes in order to be placed before the static part of the RTP Payload, but higher than the Attributes of the RTV Metadata Information, in order to be placed after the header of the RTP Payload, as is done in PS3.10.

Table C.7.6.27-1. Current Frame Functional Groups Module Attributes

Attribute Name

Tag

Type

Attribute Description

Current Frame Functional Groups Sequence

(0006,0001)

Sequence that contains the Functional Groups Sequence Attributes corresponding to the current frame or audio sample.

Only a single Item shall be included in this Sequence.

>Include one or more Functional Group Macros that are contained in every frame.

For each IOD that includes this module, a table is defined in which the permitted Functional Group Macros and their usage is specified.

C.7.6.27.1 Current Frame Functional Groups Module Attribute Descriptions

C.7.6.27.1.1 Frame Origin Timestamp

Frame Origin Timestamp (0034,0007) contains 10 bytes conforming with the IEEE 1588:2008 (PTPv2) standard. IEEE 1588:2008 represents seconds and nanoseconds since Epoch, defined as 1 of January, 1970, at 00:00:00 TAI (International Atomic Time). The first 6 bytes contain the number of seconds, and the last 4 bytes contain the number of nanoseconds. The Time Source and Time Distribution Protocol values defined in Table C.7-7 “Synchronization Module Attributes” describe how the time was obtained.

If the RTP Header extension of a frame contains an PTP Origin Timestamp, that values shall be used for the Frame Origin Timestamp. Otherwise, the Frame Origin Timestamp value can be derived from Flow RTP sampling rate, the RTP Timestamp, and the reference time for the RTP Timestamp.

Frame Origin Timestamp is used to pair content from different Flows (payload flow with metadata flow), through a time alignment mechanism.

C.7.6.28 Real-Time Acquisition Module

Table C.7.6.28-1 specifies the Attributes of the Real-Time Acquisition Module, which are related to all frames when the IOD is transported using Real-Time Communication.

Table C.7.6.28-1. Real-Time Acquisition Module Attributes

Attribute Name

Tag

Type

Attribute Description

Shared Functional Groups Sequence

(5200,9229)

Sequence that contains the Functional Group Macros that are shared for all frames.

Only a single Item shall be included in this Sequence.

>Include one or more Functional Group Macros that are shared by all frames.

For each IOD that includes this module, a table is defined in which the permitted Functional Group Macros and their usage is specified.

The Item may be empty if the requirements for inclusion of the Functional Groups are not satisfied.

Stereo Pairs Present

(0022,0028)

The multi-frame pixel data consists of left and right stereoscopic pairs. See Section C.7.6.28.1.1 for further explanation.

Enumerated Values:

YES
NO

C.7.6.28.1 Real-Time Acquisition Module Attribute Descriptions

C.7.6.28.1.1 Stereo Pairs Present

Stereo Pairs Present (0022,0028) shall have the value of YES when frame is encoded as left and right stereoscopic pair.

C.7.6.29 Sparse Multi-frame Functional Groups Module

Table C.7.6.29-1 specifies the Attributes of the Sparse Multi-frame Functional Groups Module. This Module is included in SOP Instances which contain frames acquired continuously with a high frame rate, resulting in a high number of frames.

Unlike the Per-Frame Functional Groups Sequence (5200,9230) where functional groups that are not shared must be populated on every frame, the Selected Frame Functional Groups Sequence (3002,0101) allows a selected subset of frames to be populated. For Frames that are not selected, the functional groups that are not shared are not present. The Selected Frame Functional Groups Sequence (3002,0101) allows frames to be omitted, but does not allow required Attributes within the selected frames to be omitted.

The Per-Frame Functional Group Macros of a frame shall be populated if any value of the required Attributes of the per-frame Functional Group Macro changes; the definition of the change is up to the discretion of the implementer and shall be documented in the Conformance Statement.

Per-Frame Functional Group Macros for Frames may also be populated even if all required Attribute values do not change, e.g., when frames are populated with a constant sampling rate.

The frames in this SOP Instance are identified by a number. The first frame is identified as frame number 1 and subsequent frames are identified by a number incremented by 1. The values in Selected Frame Number (3002,0100) correspond to these numbered frames.

The rest of the semantics of Section C.7.6.16 Multi-frame Functional Groups Module applies to this Module.

Table C.7.6.29-1. Sparse Multi-frame Functional Groups Module Attributes

Attribute Name	Tag	Type	Attribute Description
Shared Functional Groups Sequence	(5200,9229)	1	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. Only a single 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 Selected Frame Functional Groups Sequence (3002,0101).			For each IOD that includes this Module, a table is defined in which the permitted Functional Group Macros and their usage is specified. The Item may be empty if the requirements for inclusion of the Functional Groups are not satisfied.
Selected Frame Functional Groups Sequence	(3002,0101)	1C	Sequence that contains the Functional Group Sequence Attributes corresponding to selected frames of the Multi-frame Image. One or more Items shall be included in this Sequence. The number of Items shall be greater than zero and the less as the number of frames in the Multi-frame Image. See Section C.7.6.29.1.1 for further explanation. Required if for any frame of the selected subset of frames, there are Per-Frame Functional Groups that are not empty.
>Selected Frame Number	(3002,0100)	1	Identifies the corresponding frame in the SOP Instance.
>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 Section C.7.6.6.1.1 for further explanation.
Stereo Pairs Present	(0022,0028)	3	The multi-frame pixel data consists of left and right stereoscopic pairs. See Section C.7.6.6.1.3 for further explanation. Enumerated Values: YES NO
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 Section 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 Section C.7.6.16.2.2.4 for further specification. The first Instance in a concatenation (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. If present, shall have a value greater than one, unless an IOD overrides this constraint to enumerate a value of 1 to prevent the use of Concatenations (e.g., see Section C.8.17.7 and Section C.8.17.16).

C.7.6.29.1 Sparse Multi-frame Functional Groups Module Attribute Descriptions

C.7.6.29.1.1 Selected Frame Functional Groups Sequence

The Selected Frame Functional Groups Sequence (3002,0101) Attribute consists of a Sequence of Items. Each Item describes a frame in the multi-frame pixel data, identified by Selected Frame Number (3002,0100). Frames are implicitly numbered starting from 1. See Figure C.7.6.29-1.

Figure C.7.6.29-1. A Graphical Presentation of the Multi-frame Functional Groups Structure for Sparse Multi-frame Functional Groups

C.7.6.30 Enhanced Patient Orientation Module

Table C.7.6.30-1 specifies the Attributes of the Enhanced Patient Orientation Module, which describe the patient orientation with respect to gravity and equipment

Table C.7.6.30-1. Enhanced Patient Orientation Module Attributes

Attribute Name	Tag	Type	Attribute Description
Include Table 10-15a “Patient Orientation and Equipment Relationship Macro Attributes”

C.7.6.30.1 Enhanced Patient Orientation Module Attributes

The Enhanced Patient Orientation Module describes the patient orientation with respect to gravity and to the equipment (i.e., the gantry) using three Attributes invoked from the Patient Orientation and Equipment Relationship Macro Attributes. See examples in Table C.7.6.30.1-1

Patient Orientation Code Sequence (0054,0410) describes the rough orientation of the imaged part of the Patient with respect to gravity; vertical, horizontal, or in-between.

Note

(102539006, SCT, "semi-erect") refers to the imaged anatomy being partway between erect and recumbent, for example, inclined 45 degrees.

Patient Orientation Modifier Code Sequence (0054,0412) provides a more detailed description of the orientation and positioning of the patient.

Patient Equipment Relationship Code Sequence (3010,0030) describes the orientation of the Patient with respect to the imaging equipment.

Table C.7.6.30.1-1. Examples of Enhanced Patient Orientation Module Attribute Values

Graphic

Description

Patient Orientation Code Sequence (0054,0410)

Patient Orientation Modifier Code Sequence (0054,0412)

Patient Equipment Relationship Code Sequence (3010,0030)

Patient Position (0018,5100)

Current Conventional CT

(102538003, SCT, "recumbent")

(40199007, SCT, "supine")

HFS

Standing CT of the Chest

(10904000, SCT, "standing")

HFV

Standing CT of the Foot

(10904000, SCT, "standing")

HFV

Seated CT of the Chest

(33586001, SCT, "sitting")

(102538003, SCT, "recumbent")

HFV

Dedicated Breast CT

(1240000, SCT, "prone")

(126833, DCM, "anterior first")

AFP

Dental Cone beam

(10904000, SCT, "standing")