The dose references listed in the Dose Reference Sequence (300A,0010) may receive dose contributions accumulated from different beams. Whereas the Beam Dose (300A,0084) that is used to determine the dose contribution of a beam to the Dose Reference may be calculated individually for each beam or on a fraction level carrying a nominal dose only, the accumulated dose values may also be interpreted as nominal or actual. For potential use cases, see Table C.8.8.10.3-1, for an example, and see Section C.8.8.14.7.

The Enumerated Value NOMINAL indicates that the dose value associated with the dose reference is a nominal value that was provided as an input for treatment planning. Such a value may be used to track delivered dose over a number of delivered RT Treatment Fractions in a Treatment Management System, or eventually to match against a prescribed dose value in a Hospital Information System for billing purposes.

The Enumerated Value ACTUAL indicates that the dose value associated with the dose reference was calculated during planning. Such a value may be used for quality assurance purposes where the plan parameters are used to re-calculate the dose and where a re-calculated value is expected to match the dose value provided by the Dose Reference.