DICOM PS3.3 2019c - Information Object Definitions

C.8.11.7 Mammography Image Module

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

Table C.8-74. Mammography Image Module Attributes

Attribute Name

Tag

Type

Attribute Description

Image Type

(0008,0008)

1

Image identification characteristics.

See Section C.8.11.7.1.4 for specialization.

Positioner Type

(0018,1508)

1

Enumerated Values:

MAMMOGRAPHIC

NONE

Distance Source to Detector

(0018,1110)

3

Distance in mm from source to detector center on the chest wall line

Note

  1. This value is traditionally referred to as Source Image Distance (SID).

  2. See Section C.8.11.7.1.1.

Distance Source to Patient

(0018,1111)

3

Distance in mm from source to the breast support side that is closest to the Imaging Subject, as measured along the X-Ray beam vector.

Note

  1. This value is traditionally referred to as Source Object Distance (SOD).

  2. See notes for this Attribute in Section C.8.11.5 DX Positioning Module.

  3. See Section C.8.11.7.1.1 for description of X-Ray beam vector.

Positioner Primary Angle

(0018,1510)

3

Signed position in degrees of the X-Ray beam vector in the coronal anatomical plane as if the patient were standing facing the equipment where vertical is zero.

Positioner Primary Angle Direction

(0018,9559)

3

The interpretation of the sign of the Positioner Primary Angle (0018,1510).

Enumerated Values:

CW

Clockwise. Positioner Primary Angle movement is positive when movement is from vertical to the patient's right (with patient standing, facing equipment).

CC

Counter clockwise. Positioner Primary Angle is positive when movement is from vertical to the patient's left (with patient standing, facing the equipment).

See Section C.8.31.2.1.

Positioner Secondary Angle

(0018,1511)

3

Position in degrees of the X-Ray beam vector in the sagittal anatomical plane as if the patient were standing where movement of the X-Ray source from anterior to posterior is positive, and vertical is zero.

Image Laterality

(0020,0062)

1

Laterality of the region examined.

Enumerated Values:

R

right

L

left

B

both (e.g., cleavage)

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.

Organ Exposed

(0040,0318)

1

Organ to which Organ Dose (0040,0316) applies.

Enumerated Values:

BREAST

Note

In the Mammography IOD, Organ Dose (0040,0316) refers to the mean glandular dose.

Breast Implant Present

(0028,1300)

3

Whether or not the imaged breast contains a breast implant regardless of the visibility of a breast implant in the Pixel Data.

Enumerated Values:

YES

NO

Note

The value is expected to be YES for all images acquired on a breast that contains a breast implant, even when a breast implant is displaced during image acquisition.

Partial View

(0028,1350)

3

Indicates whether this image is a partial view, that is a subset of a single view of the breast.

Enumerated Values:

YES

NO

If this Attribute is absent, then the image may or may not be a partial view.

Note

This may occur when a breast is larger than the active area of the detector.

If this Attribute is present, its value shall be NO if there is a View Modifier Code Sequence (0054,0222) Item of value (399163009, SCT, "Magnification") or (399055006, SCT, "Spot Compression").

Partial View Description

(0028,1351)

3

Free text description of the portion of the breast captured in a partial view image.

This Attribute shall not be present if there is a View Modifier Code Sequence (0054,0222) Item of value (399163009, SCT, "Magnification") or (399055006, SCT, "Spot Compression").

Partial View Code Sequence

(0028,1352)

3

Sequence that describes the portion or section of the breast captured in a partial view image.

Only one or two Items are permitted in this Sequence.

See Section C.8.11.7.1.3.

If this Attribute is absent, then the image may or may not be a partial view.

This Attribute shall not be present if there is a View Modifier Code Sequence (0054,0222) Item of value (399163009, SCT, "Magnification") or (399055006, SCT, "Spot Compression").

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

DCID 4005 “Partial View Section for Mammography”.

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

Defined CID for the Anatomic Region Sequence is CID 4013 “Anatomic Region for Mammography”.

View Code Sequence

(0054,0220)

1

Sequence that describes the projection of the anatomic region of interest on the image receptor.

Only a single Item shall be included in this Sequence.

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

DCID 4014 “View for Mammography”.

>View Modifier Code Sequence

(0054,0222)

2

View modifier.

Zero or more Items shall be included in this Sequence.

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

DCID 4015 “View Modifier for Mammography”.

Biopsy Target Sequence

(0018,2041)

3

Sequence that identifies the targets of a biopsy procedure. One or more Items are permitted in this Sequence, where the coordinate system is the same for all Items within a pair of stereo images.

>Target UID

(0018,2042)

1

Unique identifier for the target.

Note

To identify the same target in corresponding minus and plus stereo images.

>Localizing Cursor Position

(0018,2043)

1

Coordinates of localizing cursor position with respect to pixels in the image specified by a column (delimiter) row pair. The values shall be in the range 0\0 (TLHC) to Columns\Rows (BRHC).

>Calculated Target Position

(0018,2044)

1

The calculated target position (x, y, z) in mm in an equipment relative right-handed coordinate system where the origin is under the central X-Ray beam at the chest wall, and a z value of zero is located at the surface that the breast is in contact with that is closest to the detector.

X is parallel to the chest wall, y is positive toward the patient's nipple, and z is positive toward the X-Ray source.

>Displayed Z Value

(0018,2046)

1

The z value in mm displayed to the user at the time of biopsy.

Note

  1. This may be the same as the z value of Calculated Target Position or different in direction or reference point, such as relative to the compression paddle.

  2. This is not the distance that the needle was inserted, particularly for a lateral (parallel) approach.

>Target Label

(0018,2045)

3

Target description.


C.8.11.7.1 Mammography Image Attribute Descriptions
C.8.11.7.1.1 Mammography X-Ray Beam and X-Ray Beam Vector Definition

Figure C.8.11.7-1 shows the X-Ray beam for a digital mammography system. The X-Ray beam vector is defined from the Focal Spot to the center of the chest wall line of the Image Detection device.

X-Ray Beam for a Digital Mammography System

Figure C.8.11.7-1. X-Ray Beam for a Digital Mammography System


C.8.11.7.1.2 Detector Primary and Secondary Angles

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

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

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

C.8.11.7.1.3 Partial View Code Sequence

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

Partial View Code Sequence Items (Code Meaning)

Partial View Images (A, B, C, D, E)

A) Item 1 = Lateral

B) Item 1 = Medial

CC, FB, XCCL and XCCM partial views

A) Item 1 = Posterior

B) Item 1 = Anterior

CC, FB, XCCL and XCCM partial views

A) Item 1 = Lateral, Item 2 = Posterior

B) Item 1 = Medial, Item 2 = Posterior

C) Item1 = Anterior

CC, FB, XCCL and XCCM partial views

A) Item 1 = Lateral, Item 2 = Posterior

B) Item 1 = Medial, Item 2 = Posterior

C) Item 1 = Lateral, Item 2 = Anterior

D) Item 1 = Medial, Item 2 = Anterior

CC, FB, XCCL and XCCM partial views

A) Item 1 = Lateral, Item 2 = Posterior

B) Item 1 = Central, Item 2 = Posterior

C) Item 1 = Medial, Item 2 = Posterior

D) Item 1 = Lateral, Item 2 = Anterior

E) Item 1 = Medial, Item 2 = Anterior

CC, FB, XCCL and XCCM partial views

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


Note

If six images are required, then the "Central, Anterior" combination would be added.

Partial View Code Sequence Items (Code Meaning)

Partial View Images (A, B, C, D, E)

A) Item 1 = Superior

B) Item 1 = Inferior

ML, MLO, LM, LMO, SIO and ISO partial views

A) Item 1 = Posterior

B) Item 1 = Anterior

ML, MLO, LM, LMO, SIO and ISO partial views

A) Item 1 = Superior, Item 2 = Posterior

B) Item1 = Inferior, Item 2 = Posterior

C) Item 1 = Anterior

ML, MLO, LM, LMO, SIO and ISO partial views

A) Item 1 = Superior, Item 2 = Posterior

B) Item 1 = Inferior, Item 2 = Posterior

C) Item 1 = Superior, Item 2 = Anterior

D) Item 1 = Inferior, Item 2 = Anterior

ML, MLO, LM, LMO, SIO and ISO partial views

A) Item 1 = Superior, Item 2 = Posterior

B) Item 1 = Central, Item 2 = Posterior

C) Item 1 = Inferior, Item 2 = Posterior

D) Item 1 = Superior, Item 2 = Anterior

E) Item 1 = Inferior, Item 2 = Anterior

ML, MLO, LM, LMO, SIO and ISO partial views

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


Note

If six images are required, then the "Central, Anterior" combination would be added.

C.8.11.7.1.4 Image Type

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

Value 3 shall be present and have zero length (null value), except when used to identify a stereotactic mammography image, digital breast tomosynthesis projection or generated 2D image, or contrast enhanced image.

Note

In a previous version of PS3.3, Value 3 was required to be zero length (null value). If Value 3 is zero length, the image may or may not be a stereotactic mammography image, digital breast tomosynthesis projection or generated 2D image, or contrast enhanced image, if the Instance was created before these terms were defined.

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

Table C.8-74a. Enumerated Values of Image Type (0008,0008) Value 3 for Stereotactic Mammography

Enumerated Value

Definition

ACR MQCM Equivalent

STEREO_SCOUT

A localizer image for a stereotactic acquisition.

…SC

STEREO_MINUS

The paired image obtained with the X-Ray source angle decreased from the scout position, to determine positioning coordinates prior to needle positioning.

…ST-

STEREO_PLUS

The paired image obtained with the X-Ray source angle increased from the scout position, to determine positioning coordinates prior to needle positioning.

…ST+

PREFIRE_MINUS

The paired image obtained with the X-Ray source angle decreased from the scout position, with the biopsy needle in position prior to needle deployment.

…PRF-

PREFIRE_PLUS

The paired image obtained with the X-Ray source angle increased from the scout position, with the biopsy needle in position prior to needle deployment.

…PRF+

POSTFIRE_MINUS

The paired image obtained with the X-Ray source angle decreased from the scout position, with the biopsy needle in position following needle deployment through the targeted lesion.

…POF-

POSTFIRE_PLUS

The paired image obtained with the X-Ray source angle increased from the scout position, with the biopsy needle in position following needle deployment through the targeted lesion.

…POF+

POSTBIOPSY_MINUS

The image obtained following tissue acquisition with the X-Ray source angle decreased from the scout position.

…POB-

POSTBIOPSY_PLUS

The image obtained following tissue acquisition with the X-Ray source angle increased from the scout position.

…POB+

POSTBIOPSY

The image obtained following tissue acquisition with the X-Ray source in the scout position.

…POB

POSTMARKER_MINUS

The image obtained following micromarker placement with the X-Ray source angle decreased from the scout position.

…POM-

POSTMARKER_PLUS

The image obtained following micromarker placement with the X-Ray source angle increased from the scout position.

…POM+

POSTMARKER

The image obtained following micromarker placement with the X-Ray source in the scout position.

…POM


The Enumerated Values for Value 3 of digital breast tomosynthesis projection images and mathematically generated 2D images are:

Table C.8-74b. Enumerated Values of Image Type (0008,0008) Value 3 for Digital Breast Tomosynthesis Projection and Generated 2D Images

Enumerated Value

Definition

ACR MQCM Equivalent

TOMO_PROJ

Identifies the image as a digital breast tomosynthesis projection image.

n/a

TOMOSYNTHESIS

Identifies the image as digital breast tomosynthesis; shall be used only for generated 2D images when no other Value 3 takes precedence.

n/a

TOMO_SCOUT

A localizer image that may be used to determine positioning coordinates prior to needle positioning.

…SC

PREFIRE

The image obtained with the biopsy needle in position prior to needle deployment.

…PRF

POSTFIRE

The image obtained with the biopsy needle in position following needle deployment through the targeted lesion.

…POF

POSTBIOPSY

The image obtained following tissue acquisition with the X-Ray source in the scout position.

…POB

POSTMARKER

The image obtained following micromarker placement with the X-Ray source in the scout position.

…POM


Note

Digital breast tomosynthesis projection images acquired as part of a biopsy procedure (and resulting derived images such as mathematically generated 2D) omit the _MINUS and _PLUS endings because a single digital breast tomosynthesis acquisition produces a set of projection images that replaces the _MINUS and _PLUS image pair used in conventional 2D breast biopsy imaging.

The Enumerated Values for Value 3 of contrast enhanced images are:

Table C.8-74c. Enumerated Values of Image Type (0008,0008) Value 3 for Contrast Enhanced Images

Enumerated Value

Definition

PRE_CONTRAST

Collected before contrast was administered.

POST_CONTRAST

Collected during or after contrast was administered.


If more than one characteristic (biopsy, tomosynthesis, contrast enhanced) applies to an image, Value 3 shall contain the biopsy image type. If biopsy is not involved, Value 3 shall contain the tomosynthesis image type.

Note

For example, Attributes of the Contrast/Bolus Module may be used to identify contrast enhanced characteristics of a biopsy and/or tomosynthesis projection or generated 2D image that is also contrast enhanced.

Value 4 shall be present for images acquired using contrast enhanced digital X-Ray imaging of the breast (but may be empty if none of the Defined Terms applies), and for mathematically generated 2D images. For other images Value 4 remains optional and implementation specific.

Table C.8-74d. Defined Terms of Image Type (0008,0008) Value 4 for Contrast Enhanced and Generated 2D Images

Enumerated Value

Definition

GENERATED_2D

Mathematically generated 2D view.

ADDITION

Created through Pixel by pixel addition operation.

SUBTRACTION

Created through Pixel by pixel subtraction operation.


If more than one characteristic (contrast enhanced, tomosynthesis) applies to an image, Value 4 shall contain the contrast enhanced image type. If contrast enhanced is not involved, Value 4 shall contain the generated 2D image type.

Value 5 shall be present for images acquired using contrast enhanced digital X-Ray imaging of the breast, but may be empty if none of the Defined Terms applies. For non-contrast images Value 5 remains optional and implementation specific.

Table C.8-74e. Defined Terms of Image Type (0008,0008) Value 5 for Contrast Enhanced 2D Images

Enumerated Value

Definition

LOW_ENERGY

Low energy image.

HIGH_ENERGY

High energy image.


Note

A recipient may use the different values for biopsy, tomosynthesis and contrast views to determine how to display them, for example in hanging protocols:

Image Type Value 3

Image Type Value 4

Image Type Value 5

Conventional 2D mammography

empty

-

-

Stereotactic post-biopsy

POSTBIOPSY

-

-

Pre-contrast 2D

PRE_CONTRAST

empty

empty

Post-contrast 2D low energy

POST_CONTRAST

-

LOW_ENERGY

Post-contrast 2D addition

POST_CONTRAST

ADDITION

empty

Stereotactic scout pre-contrast

STEREO_SCOUT

empty

empty

Stereotactic stereo post-contrast high energy

STEREO_PLUS

empty

HIGH_ENERGY

Stereotactic post-fire post-contrast subtraction

POSTFIRE_MINUS

SUBTRACTION

empty

Tomosynthesis generated 2D

TOMOSYNTHESIS

GENERATED_2D

-

Tomosynthesis biopsy scout generated 2D

TOMO_SCOUT

GENERATED_2D

-

Tomosynthesis generated 2D post-contrast low energy

TOMOSYNTHESIS

GENERATED_2D

LOW_ENERGY

Tomosynthesis generated 2D post-contrast subtraction

TOMOSYNTHESIS

SUBTRACTION

empty

Tomosynthesis projection

TOMO_PROJ

-

-

Tomosynthesis projection post-biopsy

POSTBIOPSY

-

-

Tomosynthesis projection post-biopsy post-contrast subtraction

POSTBIOPSY

SUBTRACTION

empty

DICOM PS3.3 2019c - Information Object Definitions