Table C.8-74 specifies the Attributes of the Mammography Image Module, which describe a Digital Mammography X-Ray Image including its acquisition and positioning.
Table C.8-74. Mammography Image Module Attributes
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Image identification characteristics. See Section C.8.11.7.1.4 for specialization. |
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Distance in mm from source to detector center on the chest wall line Note
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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
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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. |
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The interpretation of the sign of the Positioner Primary Angle (0018,1510). Enumerated Values:
See Section C.8.31.2.1. |
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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. |
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Laterality of the region examined. Shall be consistent with any laterality information contained in Primary Anatomic Structure Modifier Sequence (0008,2230) and/or Laterality (0020,0060), if present. |
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Whether or not the imaged breast contains a breast implant regardless of the visibility of a breast implant in the Pixel Data. |
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Indicates whether this image is a partial view, that is a subset of a single view of the breast. If this Attribute is absent, then the image may or may not be a partial view. 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"). |
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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"). |
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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"). |
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Include Table 10-5 “General Anatomy Mandatory Macro Attributes” |
Anatomic Region Sequence DCID 4013 “Anatomic Region for Mammography”. |
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Sequence that describes the projection of the anatomic region of interest on the image receptor. |
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>Include Table 8.8-1 “Code Sequence Macro Attributes” . |
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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. |
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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). |
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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. |
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The z value in mm displayed to the user at the time of biopsy. |
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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.
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.
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.
Figure C.8.11.7-2. CC, FB, XCCL and XCCM partial views
Figure C.8.11.7-3. ML, MLO, LM, LMO, SIO and ISO partial views
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
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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.
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See Section 6.4 “Value Multiplicity (VM) and Delimitation” in PS3.5 for a description of value delimitation.
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
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
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:
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.
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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 or absent 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
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 or absent if none of the Defined Terms applies. For non-contrast images Value 5 remains optional and implementation specific.
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A recipient may use the different values for biopsy, tomosynthesis and contrast views to determine how to display them, for example in hanging protocols. See examples in Table C.8-74f.
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The entry "empty" in the table indicates that the value is present with zero length and a preceding delimiter (e.g. "Pre-contrast 2D" has two empty values at the end and would be expressed as ORIGINAL\PRIMARY\PRE_CONTRAST\\). Other empty or non-empty values may follow an empty value.
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The entry "-" in the table indicates that the value is not present and neither is its preceding delimiter (e.g. "Stereotactic post-biopsy" has two absent values at the end and would be expressed as ORIGINAL\PRIMARY\POSTBIOPSY). No other values may follow an absent value.
Table C.8-74f. Example Image Type Values for Mammography Biopsy, Tomosynthesis and Contrast Views (Informative)