| DICOM PS3.17 2026a - Explanatory Information |
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This Annex describes examples and considerations for the usage of the Sensitive Content Code Sequence (0008,001D) Attribute. See Table C.12-1 SOP Common Module Attributes in PS3.3 .
Some healthcare sites have policies and procedures whereby medical images such as abuse photos, plastic surgery photos, and photos of certain anatomy, are considered sensitive due to their content, and access to those images is restricted and/or audited differently than access to other medical images.
A HIMSS-SIIM Enterprise Imaging Community Whitepaper describes "sensitive images" as "any image obtained or used for the purpose of providing care with the potential to reveal personal information (beyond protected health information) that may cause the patient, patient proxy, or health care provider embarrassment, shock, grief, or emotional distress" (see http://link.springer.com/article/10.1007/s10278-024-00980-8).
Sensitive Content Code Sequence (0008,001D) contains codes for both sensitive content categories and sensitive content details. Multiple categories of sensitivity may be encoded since more than one may apply and the policies and procedures applicable to each category may also differ.
The codes are intended to describe the nature of image content that is associated with corresponding site policies and procedures. The policies themselves are not encoded. It is assumed that implementations will be configured to invoke appropriate behaviors based on the presence of these codes.
The decision to populate such codes is primarily up to the site managing the images and may be based on local policies, regulations, customs and conventions. Determining which categories and details will be used and determining the criteria by which the codes are applied are also largely a local policy decision.
The ability to assign such codes to an image instance might be provided by the originating image acquisition device, the image archive, or some third-party workstation or QA system. Typically, it is expected that assignment of codes, if any, would occur either during or shortly after the image acquisition workflow.
Assignment of codes might be done manually or might be automated with or without human review. Some codes might be assigned based on the type of procedure, target anatomy, or analysis of the image itself.
The choice of codes to apply to a given image might differ between institutions, regions, practitioners, and patients based on local customs, policies and conventions. As such, when images from another institution are imported locally, the coercion process to integrate external images into the local image management might involve adding, modifying, or removing codes in the Sensitive Content Code Sequence (0008,001D) to better support local policies and procedures for sensitive images. That process should take into consideration both the policies of the originating site and those of the receiving site. Since (131392, DCM, “Personal Content”) may be based on a determination by the patient, it would likely remain unmodified during coercion. If codes are modified or removed, it is recommended that implementations consider recording the original values in the Original Attributes Sequence (0400,0561) to provide an audit trail.
Since the sensitivity codes may be added or changed after creation of the image, it is likely that digital signatures of the image content might exclude this attribute to avoid breaking the image signature when this attribute is modified.
| DICOM PS3.17 2026a - Explanatory Information |
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