Table C.36.6-1 specifies the Attributes of the RT Enhanced Prescription Module, which describe the delivery objectives and labels for intended treatment for a specific target, as defined by the physician.
Table C.36.6-1. RT Enhanced Prescription Module Attributes
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User-defined label for this prescription. See Section 10.31.1.1. |
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The value of the RT Physician Intent Index (3010,0058) in the RT Physician Intent Sequence (3010,0057) corresponding to the intent for which this prescription is created. Required if Referenced Parent RT Prescription Index (3010,0042) is absent. See Section C.36.6.1.5. |
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The value of the RT Prescription Index (3010,003C) corresponding to a prescription that is the parent prescription to this one. This Attribute shall reference a Prescription that contains Referenced RT Physician Intent Index (3010,005E). Required if the Referenced RT Physician Intent Index (3010,005E) is absent. See Section C.36.6.1.5. |
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References to Dosimetric Objectives in the Dosimetric Objective Sequence (3010,006C) applicable to this prescription. See Section C.36.6.1.6. |
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Reference to a Dosimetric Objective UID (3010,006E) in the Dosimetric Objective Sequence (3010,006C). |
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Weight of importance to be applied to the Dosimetric Objective. A higher value means that this objective is more important. Values are only meaningful within the Items in this Sequence. The use of weight value in the process of optimization and treatment parameter definition is implementation-dependent. Required if Absolute Dosimetric Objective Flag (3010,0073) is NO. |
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The general category of the therapeutic role of this anatomic region. |
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>>>Include Table 8.8-1 “Code Sequence Macro Attributes” |
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The specific property type of the therapeutic role of this anatomic region. Only a single Item shall be included in this Sequence. See Section C.36.6.1.1. |
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>>>Include Table 8.8-1 “Code Sequence Macro Attributes” |
Context Groups are specified in Section C.36.6.1.1. |
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Value used to resolve usage of overlapping regions of Conceptual Volumes during dose optimization. An overlapping region is part of the Conceptual Volume(s) with the lowest number. An overlapping region is not part of any other Conceptual Volume with a higher number. Overlapping regions with equal precedence are part of all Conceptual Volumes with the same value. |
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A default triplet value in which it is recommended that the anatomy be 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. |
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Constraints on primary radiation passing through the current Conceptual Volume. Enumerated Values:
Primary Radiation is defined as modulated or shaped radiation, as opposed to scattered radiation or transmission radiation. |
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The general category of this Conceptual Volume for radiotherapy purposes. |
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>>>Include Table 8.8-1 “Code Sequence Macro Attributes” |
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The specific type of this Conceptual Volume for radiotherapy purposes. Only a single Item shall be included in this Sequence. Required if Conceptual Volume Category Code Sequence (3010,0067) sequence contains one Item. See Section C.36.6.1.2. |
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>>>Include Table 8.8-1 “Code Sequence Macro Attributes” |
Context groups are specified in Section C.36.6.1.2. |
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The modifier of the specific type of this Conceptual Volume for radiotherapy purposes. |
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>>>Include Table 8.8-1 “Code Sequence Macro Attributes” |
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Conceptual Volume for which therapeutic goals are prescribed. See Section C.36.6.1.3. Only a single Item shall be included in this Sequence. The same Conceptual Volume UID (3010,0006) shall not appear in more than one Item of the RT Anatomic Prescription Sequence (3010,0060). |
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>>>Include Table 10.34-1 “Conceptual Volume Segmentation Reference And Combination Macro Attributes” |
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Referenced treatment phase(s) to which this prescription applies. Required if RT Treatment Phase Intent Presence Flag (3010,0045) of this RT Physician Intent SOP Instance equals YES. |
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Value of RT Treatment Phase Index (3010,003A) in the Intended RT Treatment Phase Sequence (3010,004B) where this prescription is related to. |
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The relationship of this prescription to another prescription, expressed in fractions. Zero or one Item shall be included in this Sequence. See Section C.36.6.1.4. |
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Value of RT Prescription Index (3010,003C) in the RT Prescription Sequence (3010,006B) specifying the prescription to which the current prescription is related. |
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The anchor point of this RT Prescription Sequence Item with respect to the prescription referenced by Referenced RT Prescription Index (3010,0041). |
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The interval expressed in number of fractions. The Fraction-Based Relationship Interval Anchor (3010,0083) establishes the anchor point to which the interval is tied. A value of 0 means that the current prescription is intended to start simultaneously with the anchor of the related prescription. If Fraction-Based Relationship Interval Anchor (3010,0083) equals START, the value shall be 0 or positive. This is the number of fractions after the first fraction of the delivery of the referenced prescription that the delivery of the current prescription is intended to start. If Fraction-Based Relationship Interval Anchor (3010,0083) equals END, the value shall be negative or 0. This is the number of fractions prior to the last fraction of the delivery of the referenced prescription that the delivery of the current prescription is intended to start. |
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Description of radiotherapy treatment previously delivered to the patient for the purpose of evaluation of prior dose. |
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References to SOP Instances representing prior treatments, e.g. for the purpose of extracting information about prior dose. |
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>>Include Table 10-11 “SOP Instance Reference Macro Attributes” |
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References to SOP Instances to be used during planning for the delivery of this prescription. When there are multiple Purposes of References, one Item will be included for each purpose. |
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>>Include Table 10.37-1 “Related Information Entities Macro Attributes” |
DCID 9510 “Purpose of Reference For RT Treatment Planning Input”. |
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Notes on this prescription, such as special provisions for this patient's treatment or other patient conditions. |
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Number of days across which the fractions in this prescription will be delivered. |
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The time structure, i.e. fractionation type, to be used for the delivery of treatment. |
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>Include Table C.36.2.1.1-1 “Radiation Fraction Pattern Macro Attributes” |
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Type of Radiation used to deliver Teletherapy. May be present only if Radiotherapy Treatment Type (3010,9980) has a value of TELETHERAPY. |
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Type of Source used to deliver Brachytherapy. May be present only if Radiotherapy Treatment Type (3010,9980) has a value of BRACHYTHERAPY. |
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>>Include Table 10-15a “Patient Orientation And Equipment Relationship Macro Attributes”. |
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Annotations on aspects of the prescription, like preparation and execution of the treatment. |
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Dosimetric Objectives defined for one or more prescription within module. Each Dosimetric Objective referenced in the Referenced Dosimetric Objectives Sequence (3010,0071) shall have a corresponding Item in this Sequence. Only Dosimetric Objectives which are referenced in the Referenced Dosimetric Objectives Sequence (3010,0071) shall be present in this sequence. Required if any Item in the Referenced Dosimetric Objectives Sequence (3010,0071) references a Dosimetric Objective. One or more Items shall be included in this Sequence. See Section C.36.6.1.6. |
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>Include Table C.36.2.1.4-1 “Dosimetric Objective Macro Attributes” |
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The UID of the Conceptual Volume in the RT Anatomic Prescription Sequence (3010,0060) to which this Dosimetric Objective applies. Required if the Dosimetric Objective applies to a specific anatomy. |
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Whether the Dosimetric Objective is intended to be evaluated over a lifetime scope or only in respect to the current prescriptions. Enumerated Values: See Section C.36.6.1.7. |
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The Therapeutic Role Type Code Sequence (3010,0065) further specifies the role of the anatomy along the Therapeutic Role Category Code Sequence (3010,0064). The CID for Therapeutic Role Type Code Sequence (3010,0065) shall correspond to the CID defined in CID 9503 “Radiotherapy Therapeutic Role Category” for each value in Therapeutic Role Category Code Sequence (3010,0064).
The Conceptual Volume Type Code Sequence (3010,0069) further specifies the type of the anatomy along the Conceptual Volume Category Code Sequence (3010,0067). Table C.36.6-3 describes the codes permitted in the Conceptual Volume Type Code Sequence (3010,0069), when the code used in the Conceptual Volume Type Code Sequence (3010,0069) is as specified.
Table C.36.6-3. Anatomy Property Type Codes
For code values of the Conceptual Volume Type Code Sequence (3010,0069) not listed in Table C.36.6-3, no Baseline or Defined Context Group is specified.
The Conceptual Volume Sequence (3010,0025) identifies the Conceptual Volume associated with an RT Anatomy Prescription Item. If the Conceptual Volume is associated with a segment, the segment is defined by the Referenced Segment Reference Index (3010,0020) in the Section 10.34 Conceptual Volume Segmentation Reference and Combination Macro. Alternatively, the anatomy volume may not (yet) be associated with a segment. For example, an initial prescription may be entered prior to the definition of an organ at risk.
The Fraction-Based Relationship Sequence (3010,0082) is used to specify the relationship between two prescriptions.
The following example shows a treatment performed in 2 phases with a break of 7 days between phases.
In RT Treatment Phase 1, the treatment of Prescription B is intended to start 10 fractions prior to the end of Prescription A.
The Section C.36.7 RT Treatment Phase Intent Module is used to specify the relationship of treatment phases to each other.
The RT Enhanced Prescription Module supports a two-level prescription model (see Figure C.36.6.1-2) in order to document an approach where a high-level prescription is created and then more details may be added. The first level would typically be created during the time of prescription definition with only high-level prescription information based on the RT Physician Intent. The second level, if present, would represent a derived prescription containing more detailed information, such as constraints and objectives. A third or subsequent levels are not permitted.
The Dosimetric Objective Sequence (3010,006C) specifies a set of intended dosimetric goals.
Each item of the Dosimetric Objective Sequence (3010,006C) shall be referenced by at least one item of the Referenced Dosimetric Objectives Sequence (3010,0071) in the current Instance.
Within an RT Physician Intent SOP Instance, a Dosimetric Objective is applicable to all Prescriptions in which the Dosimetric Objective UID (3010,006E) is referenced.
A Dosimetric Objective is intended to be satisfied by the combined effect of all treatments associated with prescriptions that reference the Dosimetric Objective UID (3010,006F).
For example, if there are primary and boost prescriptions that reference the same Dosimetric Objective UID (3010,006E) then the combined effect of both prescriptions is intended to comply with the limit in this Dosimetric Objective.
For Dosimetric Objectives that include a dose value, the value defines the total dose for all fractions of all prescriptions referencing this Dosimetric Objective, and potentially dose from previous treatment, depending on the value of Dosimetric Objective Evaluation Scope (3010,0063).
If Dosimetric Objective Evaluation Scope (3010,0063) has a value of LIFETIME, information from prior treatments shall be included in the evaluation of the Dosimetric Objective.
For example, if an organ has received dose in a prior treatment, and Dosimetric Objective Evaluation Scope (3010,0063) is marked as LIFETIME, then the previously delivered dose shall be included in the evaluation of this objective. Information about prior treatments may be described in Prior Treatment Dose Description (3010,0061) or by Instances referenced by the Prior Treatment Reference Sequence (3010,0062) in RT Prescription Sequence (3010,006B).
If Dosimetric Objective Evaluation Scope (3010,0063) has a value of CURRENT, the objective includes only those prescriptions which reference the same Dosimetric Objective, even if information of a prior treatment is available.
The Patient Equipment Relationship Code Sequence (3010,0030) specifies the orientation of the patient relative to the front of the equipment viewed from the patient support device. For example, in case of the equipment being a gantry, this is the direction from the table (being the patient support device) towards the gantry. In cases where it is not possible to understand unambiguously the direction for a certain equipment, the equipment vendor shall document this direction in its Conformance Statement.