PS3.3

The information in this publication was considered technically sound by the consensus of persons engaged in the development and approval of the document at the time it was developed. Consensus does not necessarily mean that there is unanimous agreement among every person participating in the development of this document.

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Foreword

This DICOM Standard was developed according to the procedures of the DICOM Standards Committee.

The DICOM Standard is structured as a multi-part document using the guidelines established in [ISO/IEC Directives, Part 2].

PS3.1 should be used as the base reference for the current parts of this Standard.

1 Scope and Field of Application

This Part of the DICOM Standard specifies the set of Information Object Definitions (IODs) that provide an abstract definition of real-world objects applicable to communication of digital medical information. For each IOD, this Part specifies:

any necessary information for the semantic description of the IOD
relationships to associated real-world objects relevant to the IOD
Attributes that describe the characteristics of the IOD

For each IOD, this Part does not specify:

the nature of any Service Class Definition intended to reference the IOD
the nature of any interactions that result in the usage of the IOD

This Part is related to other parts of the DICOM Standard in that:

PS3.4 Service Class Specifications, specifies application level services by grouping DIMSE services with IODs as defined in this Part;
PS3.5 Data Structure and Semantics, defines the data encoding used in the DIMSE Protocol when applied to IODs defined in this Part;
PS3.6 Data Dictionary, contains an index by Tag of all IOD Attributes defined in this Part. This index includes the Value Representation and Value Multiplicity for each Attribute;
PS3.7 Message Exchange Protocol, defines the DIMSE Services and Protocol that may be applied to IODs defined in this Part.

2 Normative References

The following standards contain provisions that, through reference in this text, constitute provisions of this Standard. At the time of publication, the editions indicated were valid. All standards are subject to revision, and parties to agreements based on this Standard are encouraged to investigate the possibilities of applying the most recent editions of the standards indicated below.

2.1 International Organization for Standardization (ISO) and International Electrotechnical Commission (IEC)

[ISO/IEC Directives, Part 2] ISO/IEC. 2016/05. 7.0. Rules for the structure and drafting of International Standards. http://www.iec.ch/members_experts/refdocs/iec/isoiecdir-2%7Bed7.0%7Den.pdf .

[ISO 646] ISO. 1990. Information Processing - ISO 7-bit coded character set for information interchange.

[ISO/IEC 2022] ISO/IEC. 1994. Information technology - Character code structure and extension techniques.

[ISO 3950] ISO. 2010. Dentistry - Designation system for teeth and areas of the oral cavity.

[ISO 7498-1] ISO. 1994. Information Processing Systems - Open Systems Interconnection - Basic Reference Model.

[ISO 7498-2] ISO. 1989. Information processing systems - Open Systems Interconnection - Basic reference Model - Part 2: Security Architecture.

[ISO/TR 8509] ISO. Information Processing Systems - Open Systems Interconnection - Service Conventions. ISO/TR 8509 has been withdrawn. See ISO/IEC 2382-26:1993 Information technology - Vocabulary - Part 26: Open systems interconnection .

[ISO 8825-1] ISO. 2002. Information technology - ASN.1 encoding rules: Specification of Basic Encoding Rules (BER), Canonical Encoding Rules (CER) and Distinguished Encoding Rules (DER).

[ISO/IEC 8859] ISO/IEC. Information processing - 8-bit single-byte coded graphic character sets.

[ISO/IEC 8859-1] ISO/IEC. 1987. Information processing - 8-bit single-byte coded graphic character sets - Part 1: Latin alphabet No. 1.

[ISO/IEC 8859-2] ISO/IEC. 1987. Information processing - 8-bit single-byte coded graphic character sets - Part 2: Latin alphabet No. 2.

[ISO/IEC 8859-3] ISO/IEC. 1988. Information processing - 8-bit single-byte coded graphic character sets - Part 3: Latin alphabet No. 3.

[ISO/IEC 8859-4] ISO/IEC. 1988. Information processing - 8-bit single-byte coded graphic character sets - Part 4: Latin alphabet No. 4.

[ISO/IEC 8859-5] ISO/IEC. 1988. Information processing - 8-bit single-byte coded graphic character sets - Part 5: Latin/Cyrillic alphabet.

[ISO/IEC 8859-6] ISO/IEC. 1987. Information processing - 8-bit single-byte coded graphic character sets - Part 6: Latin/Arabic alphabet.

[ISO/IEC 8859-7] ISO/IEC. 1987. Information processing - 8-bit single-byte coded graphic character sets - Part 7: Latin/Greek alphabet.

[ISO/IEC 8859-8] ISO/IEC. 1988. Information processing - 8-bit single-byte coded graphic character sets - Part 8: Latin/Hebrew alphabet.

[ISO/IEC 8859-9] ISO/IEC. 1989. Information processing - 8-bit single-byte coded graphic character sets - Part 9: Latin alphabet No. 5.

[ISO/IEC 8859-15] ISO/IEC. 1999. Information technology — 8-bit single-byte coded graphic character sets — Part 15: Latin alphabet No. 9.

[ISO/IEC 10118-3] ISO/IEC. 1998. Information technology - Security techniques - Hash-functions - Part 3: Dedicated hash-functions (RIPEMD-160 reference). The draft RIPEMD-160 specification and sample code are also available at http://homes.esat.kuleuven.be/~bosselae/ripemd160.html .

[ISO/IEC 10646] ISO/IEC. 2020. Information Technology - Universal Coded Character Set (UCS). ISO/IEC 10646-2020 is the same as Unicode Version 13.0, available at http://unicode.org .

[ISO/IEC 10918-1] ISO/IEC. 1994. JPEG Standard for digital compression and encoding of continuous-tone still images. Part 1 - Requirements and implementation guidelines.

[ISO/IEC 10918-5] ISO/IEC. 2013. JPEG Standard for digital compression and encoding of continuous-tone still images. Part 5 - JPEG File Interchange Format (JFIF).

[ISO 11664-4] ISO. 2008. Colorimetry - Part 4: CIE 1976 L*a*b* Colour space. ISO 11664-4 2008 is the same as CIE S 014-4/E:2007 .

[ISO 12232] ISO. 2006. Photography - Digital still cameras - Determination of exposure index, ISO speed ratings, standard output sensitivity, and recommended exposure index. http://www.iso.org/standard/37777.html .

[ISO 12233] ISO. 2018. Photography - Electronic still picture imaging - Resolution and spatial frequency responses. http://www.iso.org/standard/71696.html .

[ISO 12234-2] ISO. 2001. Electronic still-picture imaging - Removable memory - Part 2: TIFF/EP image data formats. http://www.iso.org/standard/29377.html .

[ISO/IEC 13818-1] ISO/IEC. 2000. Information technology - Generic coding of moving pictures and associated audio information: Systems.

[ISO/IEC 13818-2] ISO/IEC. 2000. Information technology - Generic coding of moving pictures and associated audio information: Video.

[ISO/IEC 13818-3] ISO/IEC. 1998. Information technology - Generic coding of moving pictures and associated audio information - Part 3: Audio.

[ISO/IEC 13818-4] ISO/IEC. 2004. Information technology - Generic coding of moving pictures and associated audio information - Part 4: Conformance testing.

[ISO/IEC 14495-1] ISO/IEC. 1997. Lossless and near-lossless coding of continuous tone still images (JPEG-LS).

[ISO/IEC 14496-10] ISO/IEC. 2009. Information technology - Coding of audio-visual objects - Part 210: Advanced Video Coding. http://www.iso.org/iso/iso_catalogue/catalogue_tc/catalogue_detail.htm?csnumber=52974 .

[ISO/IEC 14496-22] ISO/IEC. Information technology - Coding of audio-visual objects - Part 22: Open Font Format. http://www.iso.org/iso/iso_catalogue/catalogue_tc/catalogue_detail.htm?csnumber=52136 .

[ISO 14524] ISO. 2009. Photography - Electronic still-picture cameras - Methods for measuring opto-electronic conversion functions (OECFs). http://www.iso.org/standard/43527.html .

[ISO/IEC 15444-1] ISO/IEC. 2004. JPEG 2000 Image Coding System.

[ISO/IEC 15444-15] ISO/IEC. 2019. JPEG 2000 Image Coding System — Part 15: High-Throughput JPEG 2000.

[ISO 15076-1] ISO. 2005. Image technology colour management - Architecture, profile format, and data structure. Also available as ICC.1:2004-10 (Profile version 4.2.0.0), International Color Consortium, available at http://www.color.org/v4spec.xalter .

[ISO/IEC 18181-1] ISO/IEC. 2022. Information technology - JPEG XL Image Coding System - Part 1 Core Coding System.

[ISO 21320-1] ISO/IEC. 2015. Information technology – Document Container File – Part 1: Core. http://standards.iso.org/ittf/PubliclyAvailableStandards/c060101_ISO_IEC_21320-1_2015.zip .

[ISO 22028-2] ISO. 2013. Photography and graphic technology - Extended colour encodings for digital image storage, manipulation and interchange - Part 2: Reference output medium metric RGB colour image encoding (ROMM RGB). http://www.iso.org/iso/catalogue_detail.htm?csnumber=56591 .

[ISO/IEC 23008-2] ISO/IEC. Information technology - High efficiency coding and media delivery in heterogeneous environments - Part 2: High efficiency video coding. http://www.iso.org/iso/iso_catalogue/catalogue_tc/catalogue_detail.htm?csnumber=67660 .

[ISO 32000-1] ISO. Document management - Portable document format - Part 1. http://www.iso.org/iso/catalogue_detail.htm?csnumber=51502 .

[IEC 60601-2-1] IEC. 2020. Ed.4. Medical Electrical Equipment - Part 2-1: Particular requirements for the basic safety and essential performance of electron accelerators in the range 1 MeV to 50 MeV.

[IEC 60601-2-33] IEC. 2010. Ed.3.1. Medical Electrical Equipment - Part 2-33: Particular requirements for the basic safety and essential performance of magnetic resonance equipment for medical diagnosis.

[IEC 60601-2-44] IEC. 2016. Ed.3.2. Medical Electrical Equipment - Part 2-44: Particular Requirements for the Safety of X-Ray Equipment for Computed Tomography.

[IEC 60601-2-63] IEC. 2012. Medical Electrical Equipment - Part 2-63: Particular requirements for the basic safety and essential performance of dental extra-oral X-Ray equipment.

[IEC 60601-2-64] IEC. 2014. Medical Electrical Equipment - Part 2-64: Particular requirements for the basic safety and essential performance of light ion beam medical electrical equipment.

[IEC 61217] IEC. 2011. Ed 2. Radiotherapy Equipment - Coordinates, Movements and Scales.

[IEC 61966-2.1] IEC. 1999. Ed 1.0. Multimedia systems and equipment - colour measurement and management - Part 2.1: colour management - Default RGB colour space - sRGB.

[IEC 62494-1] IEC. 2008. Medical electrical equipment - Exposure index of digital X-Ray imaging systems - Part 1: Definitions and requirements for general radiography.

[IEC 62563-1] IEC. 2009. Ed 1.0. Medical Electrical Equipment - Medical image display systems - Part 1: Evaluation methods.

[ISO IR 13] ISO. 1975. Registration - The Japanese KATAKANA graphic set of characters. http://www.itscj.ipsj.or.jp/iso-ir/013.pdf .

[ISO IR 14] ISO. 1975. Registration - The Japanese Roman graphic set of characters. http://www.itscj.ipsj.or.jp/iso-ir/014.pdf .

[ISO IR 100] ISO. 1986. Registration - Right-hand Part of the Latin Alphabet Nr. 1. http://www.itscj.ipsj.or.jp/iso-ir/100.pdf .

[ISO IR 101] ISO. 1986. Registration - Right-hand Part of the Latin Alphabet Nr. 2. http://www.itscj.ipsj.or.jp/iso-ir/101.pdf .

[ISO IR 109] ISO. 1986. Registration - Right-hand Part of the Latin Alphabet Nr. 3. http://www.itscj.ipsj.or.jp/iso-ir/109.pdf .

[ISO IR 110] ISO. 1986. Registration - Right-hand Part of the Latin Alphabet Nr. 4. http://www.itscj.ipsj.or.jp/iso-ir/110.pdf .

[ISO IR 126] ISO. 1986. Registration - Right-hand Part of the Latin/Greek alphabet. http://www.itscj.ipsj.or.jp/iso-ir/126.pdf .

[ISO IR 127] ISO. 1986. Registration - Right-hand Part of Latin/Arabic alphabet. http://www.itscj.ipsj.or.jp/iso-ir/127.pdf .

[ISO IR 138] ISO. 1987. Registration - Latin/Hebrew alphabet. http://www.itscj.ipsj.or.jp/iso-ir/138.pdf .

[ISO IR 144] ISO. 1988. Registration - Cyrillic Part of the Latin/Cyrillic Alphabet. http://www.itscj.ipsj.or.jp/iso-ir/144.pdf .

[ISO IR 148] ISO. 1988. Registration - Right-hand Part of Latin alphabet No. 5. http://www.itscj.ipsj.or.jp/iso-ir/148.pdf .

[ISO IR 166] ISO. 1992. Registration - Thai Character Set. http://www.itscj.ipsj.or.jp/iso-ir/166.pdf .

[ISO IR 192] ISO. 1996. Registration - UCS Transformation Format (UTF-8), implementation level 3, without standard return. http://www.itscj.ipsj.or.jp/iso-ir/192.pdf .

[ISO IR 203] ISO. 1998. Registration - European supplementary Latin set ("Latin 9"). http://www.itscj.ipsj.or.jp/iso-ir/203.pdf .

2.2 International Telecommunications Union (ITU)

[ITU-T G.711] ITU. 1998. Pulse code modulation (PCM) of voice frequencies.

[ITU-T X.509] ITU. 2000. Information technology - Open Systems Interconnection - The directory: Public-key and attribute certificate frameworks. ITU-T Recommendation X.509 is similar to ISO/IEC 9594-8 1990. However, the ITU-T recommendation is the more familiar form, and was revised in 1993 and 2000, with two sets of corrections in 2001. ITU-T was formerly known as CCITT. .

2.3 Internet Engineering Task Force (IETF)

[RFC1321] IETF. The MD5 Message-Digest Algorithm. http://tools.ietf.org/html/rfc1321 .

[RFC1951] IETF. DEFLATE Compressed Data Format Specification Version 1.3. http://tools.ietf.org/html/rfc1952 .

[RFC1952] IETF. GZIP file format specification version 4.3. http://tools.ietf.org/html/rfc1952 .

[RFC2046] IETF. November 1996. Multipurpose Internet Mail Extensions (MIME) Part Two: Media Types. http://tools.ietf.org/html/rfc2046 .

[RFC2437] IETF. October 1998. PKCS #1 RSA Cryptography Specifications Version 2.0. http://tools.ietf.org/html/rfc2437 . The RSA Encryption Standard is also defined in informative Annex A of ISO/IEC 9796, and in Normative Annex A of the CEN/TC251 European Prestandard prENV 12388:1996. .

[RFC3161] IETF. Internet X.509 Public Key Infrastructure; Time Stamp Protocols. http://tools.ietf.org/html/rfc3161 .

[RFC3986] IETF. Uniform Resource Identifiers (URI): Generic Syntax. http://tools.ietf.org/html/rfc3986 .

[RFC5652] IETF. September 2009. Cryptographic Message Syntax. http://tools.ietf.org/html/rfc5652 .

[RFC6151] IETF. March 2011. Updated Security Considerations for the MD5 Message-Digest and the HMAC-MD5 Algorithms. http://tools.ietf.org/html/rfc6151 .

[RFC7230] IETF. Hypertext Transfer Protocol (HTTP/1.1): Message Syntax and Routing. http://tools.ietf.org/html/rfc7230 .

[RFC7231] IETF. Hypertext Transfer Protocol (HTTP/1.1): Semantics and Content. http://tools.ietf.org/html/rfc7231 .

[RFC7530] IETF. Network File System (NFS) Version 4 Protocol. http://tools.ietf.org/html/rfc7530 .

2.4 Health Level Seven (HL7)

[HL7 V2.5] ANSI/HL7. 2003. HL7 Standard Version 2.5 - An Application Protocol for Electronic Data Exchange in Healthcare Environments. http://www.hl7.org/documentcenter/private/standards/V25/HL7_Messaging_v25_PDF.zip .

[HL7 V2.9.1] HL7. 2024. HL7 Version 2.9.1 Messaging Standard - An Application Protocol for Electronic Data Exchange in Healthcare Environments. http://www.hl7.org/implement/standards/product_brief.cfm?product_id=649 .

[HL7 V3 DT R1] ANSI/HL7. 2004. HL7 Version 3 Standard: Data Types - Abstract Specification, Release 1.

[HL7 CDA R1] ANSI/HL7. 2000. HL7 Version 3 Standard: Clinical Document Architecture Framework, Release 1. http://www.hl7.org/documentcenter/private/standards/cda/r1/HL7_CDA_R1_FINAL.zip .

[HL7 CDA R2] ANSI/HL7. 2005. HL7 Version 3 Standard: Clinical Document Architecture Framework, Release 2. http://www.hl7.org/documentcenter/private/standards/cda/r2/cda_r2_normativewebedition2010.zip .

[HL7 SCTP R1.0] HL7. 2000. HL7 Structured Clinical Trial Protocol Standard, Release 1.0.

[HL7 SPL R1.0] ANSI/HL7. 2024. HL7 Structured Product Labeling Standard, Release 1.0. http://www.hl7.org/documentcenter/private/standards/SPL/SPL_Specification_ANSI_R1.0-2004.zip .

[HL7 Gender Harmony Model] HL7. 2021. The HL7 Informative Document: Gender Harmony - Modeling Sex and Gender Representation, Release 1. http://www.hl7.org/implement/standards/product_brief.cfm?product_id=564 .

[HL7 Gender Harmony IG] HL7. . HL7 Cross Paradigm Implementation Guide: Gender Harmony - Sex and Gender Representation, Edition 1. http://hl7.org/xprod/ig/uv/gender-harmony/ .

[HL7 CDA R2.0 Gender Harmony IG] HL7. . HL7 CDA® R2 Implementation Guide: Gender Harmony - Sex and Gender Representation, Edition 1. http://www.hl7.org/implement/standards/product_brief.cfm?product_id=633 .

[HL7 FHIR 5 Patient Gender] HL7. HL7 FHIR Release 5 - Patient Gender and Sex. http://hl7.org/fhir/R5/patient.html#gender .

2.5 United States National Institute of Standards and Technology (NIST)

[FIPS PUB 46] NIST. . Data Encryption Standard (DES). Withdrawn . http://csrc.nist.gov/publications/fips/archive/fips46-3/fips46-3.pdf .

[FIPS PUB 81] NIST. . DES Modes of Operation. Withdrawn .

[FIPS PUB 180-4] NIST. August 2015. Secure Hash Standard (SHS). http://doi.org/10.6028/NIST.FIPS.180-4 .

[FIPS PUB 202] NIST. August 2015. SHA-3 Standard. http://doi.org/10.6028/NIST.FIPS.202 .

2.6 Other References

[ACR-NEMA 300-1985] National Electrical Manufacturers Association. 1985. Digital Imaging and Communications. http://dicom.nema.org/medical/dicom/1985/ACR-NEMA_300-1985.pdf .

[ACR-NEMA 300-1988] National Electrical Manufacturers Association. 1988. Digital Imaging and Communications. http://dicom.nema.org/medical/dicom/1988/ACR-NEMA_300-1988.pdf .

[Adobe RGB] Adobe Systems Incorporated. 1998. 2005-05. Adobe RGB (1998) Color Image Encoding. http://www.adobe.com/digitalimag/pdfs/AdobeRGB1998.pdf .

[Anderson 1986] Medical Physics. Anderson LL. 1986. 13. 6. 898-903. “A "natural" volume-dose histogram for brachytherapy”. doi:10.1118/1.595815

[ANSI X9.52] ANSI. 1998. Triple Data Encryption Algorithm Modes of Operation, Accredited Standards Committee (ASC) X9, Financial Services.

[APEX] Douglas A. Kerr. August 4, 2007. APEX — The Additive System of Photographic Exposure. http://dougkerr.net/Pumpkin/articles/APEX.pdf .

[BI-RADS®] American College of Radiology, Reston, Virginia. 1998. 3.0. Breast Imaging Reporting and Data System Atlas. http://www.acr.org/Quality-Safety/Resources/BIRADS .

[CIE Publication 15.2] Commission Internationale de l'Eclairage/International Commission on Illumination. 1986. Second Edition. Colorimetry.

[ECMA 235] European Computer Manufacturers Association. 1996. The ECMA GSS-API Mechanism. http://www.ecma-international.org/publications/standards/Ecma-235.htm .

[EXIF 2.31] Camera and Imaging Products Association (CIPA). July 2016. 2.31. Exchangeable Image File Format for Digital Still Cameras - CIPA DC-008, JEITA CP-3451C Translation. http://cipa.jp/std/documents/e/DC-008-Translation-2016-E.pdf .

[FDA UDI] U.S. Food and Drug Administration. 2016. 1.2. UDI formats by FDA-Accredited Issuing Agency. http://www.fda.gov/downloads/MedicalDevices/DeviceRegulationandGuidance/UniqueDeviceIdentification/UDIIssuingAgencies/UCM489869.pdf .

[GBK] China National Information Technology Standardization Technical Committee. 1995. Chinese Internal Code Extension Specification.

[GB 2312] National Standard Administration of China. 1981. GB/T 2312 Simplified Chinese Characters Coding Specification.

[GB 18030] Standards Administration of China. Information Technology - Chinese Coded character set.

[ICRU Report 50] International Commission on Radiation Units and Measurements. 1993. Prescribing, Recording, and Reporting Photon Beam Therapy.

[JIS X 0201] JIS. 1976. Code for Information Interchange.

[JIS X 0208] JIS. 1990. Code for the Japanese Graphic Character set for information interchange.

[JIS X 0212] JIS. 1990. Code of the supplementary Japanese Graphic Character set for information interchange.

[KS X 1001] KS. 1997. Code for Information Interchange (Hangul and Hanja).

[NEMA UD3] National Electrical Manufacturers Association and American Institute of Ultrasound in Medicine. 2004. Standard for Real-Time Display of Thermal and Mechanical Acoustic Output Indices on Diagnostic Ultrasound Equipment.

[NEMA XR-17] National Electrical Manufacturers Association. 2013. X-ray Equipment for Interventional Procedures User Quality Control Mode.

[NEMA XR-25] National Electrical Manufacturers Association. 2010. Computed Tomography Dose Check.

[IEEE 754] IEEE. 2019. IEEE Standard for Floating Point Arithmetic. http://dx.doi.org/10.1109/IEEESTD.2019.8766229 .

[IEEE 1588] Institute of Electrical and Electronics Engineers. 2008. Standard for a Precision Clock Synchronization Protocol for Networked Measurement and Control Systems. doi:10.1109/IEEESTD.2008.4579760

[IHE ITI TF-2b] IHE International. 2020. Integrating the Healthcare Enterprise Radiology Technical Framework Volume 2b Transactions Part B – Sections 3.29 – 3.64. http://www.ihe.net/uploadedFiles/Documents/ITI/IHE_ITI_TF_Vol2b.pdf .

[IHE RAD TF-1] IHE International. 2020. Integrating the Healthcare Enterprise Radiology Technical Framework Volume 1 Integration Profiles. http://www.ihe.net/uploadedFiles/Documents/Radiology/IHE_RAD_TF_Vol1.pdf .

[IHE RAD TF-1x] IHE International. 2020. Integrating the Healthcare Enterprise Radiology Technical Framework Volume 1x Appendices to Integration Profiles. http://www.ihe.net/uploadedFiles/Documents/Radiology/IHE_RAD_TF_Vol1x.pdf .

[IHE RAD TF-2] IHE International. 2020. Integrating the Healthcare Enterprise Radiology Technical Framework Volume 2 Transactions. http://www.ihe.net/uploadedFiles/Documents/Radiology/IHE_RAD_TF_Vol2.pdf .

[IHE RAD TF-2x] IHE International. 2020. Integrating the Healthcare Enterprise Radiology Technical Framework Volume 2x Appendices to Transactions. http://www.ihe.net/uploadedFiles/Documents/Radiology/IHE_RAD_TF_Vol2x.pdf .

[IHE RAD TF-3] IHE International. 2020. Integrating the Healthcare Enterprise Radiology Technical Framework Volume 3 Cross-Transaction Specifications and Content Specifications. http://www.ihe.net/uploadedFiles/Documents/Radiology/IHE_RAD_TF_Vol3.pdf .

[IHE RAD TF-4] IHE International. 2020. Integrating the Healthcare Enterprise Radiology Technical Framework Volume 4 National Extensions. http://www.ihe.net/uploadedFiles/Documents/Radiology/IHE_RAD_TF_Vol4.pdf .

[OBJ] Wavefront Technologies. 1992. Advanced Visualizer. B1. Object Files (.obj). http://www.cs.utah.edu/~boulos/cs3505/obj_spec.pdf .

[PDF] Adobe Systems Incorporated. 1985. Fifth Edition. PDF Reference, version 1.6. http://www.adobe.com/devnet/pdf/pdf_reference_archive.html .

[TIS 620-2533] Thai Industrial Standards Institute. 1990. Thai Characters Code for Information Interchange. http://www.nectec.or.th/it-standards/std620/std620.html .

[McCollough 2007] Radiology. McCollough CH. 2007. 243. 2. 527. “A multi-institutional, multi-manufacturer, international standard for the quantification of coronary artery calcium using cardiac CT”. doi:10.1148/radiol.2432050808

[CSS2] W3C. 2011. Cascading Style Sheet (CSS) CSS2 generic font families. http://www.w3.org/TR/REC-CSS2/fonts.html#generic-font-families .

[HPGL] Hewlett Packard. . PCL/PJL Reference PCL5 Printer Language Technical Reference Manual. IIHP 5961-0509. http://www.hp.com/ctg/Manual/bpl13211.pdf .

[AAPM TG 116] American Association of Physicists in Medicine. July 2009. Report of AAPM Task Group 116 - An Exposure Indicator for Digital Radiography. http://www.aapm.org/pubs/reports/rpt_116.pdf .

[AAPM Report 204] American Association of Physicists in Medicine. 2011. Report of AAPM Task Group 204 - Size-Specific Dose Estimates (SSDE) in Pediatric and Adult Body CT Examinations. http://www.aapm.org/pubs/reports/RPT_204.pdf .

[AAPM Report 220] American Association of Physicists in Medicine. September 2014. Report of AAPM Task Group 220 - Use of Water Equivalent Diameter for Calculating Patient Size and Size-Specific Dose Estimates (SSDE) in CT. http://www.aapm.org/pubs/reports/rpt_220.pdf .

[AAPM OR 03] American Association of Physicists in Medicine. 2005. Assessment of Display Performance for Medical Imaging Systems. http://www.aapm.org/pubs/reports/OR_03.pdf .

[DIN 6868-57] Deutsches Institut für Normung. 2001. Image quality assurance in diagnostic X-Ray departments - Acceptance testing for image display devices.

[US 6,272,235] Bacus JV and Bacus JW. Method and Apparatus for Creating a Virtual Microscope Slide. US Patent. 6,272,235. August 7, 2001.

[Porter and Duff 1984] Computer Graphics. Porter, Thomas and Duff, Tom. 1984. 18. 3. 253-259. “Compositing Digital Images”. doi:10.1145/800031.808606 http://keithp.com/~keithp/porterduff/p253-porter.pdf .

[Phong 1975] Communications of the ACM. Phong, Bui Tuong. 1975. 18. 6. 311-317. “Illumination for computer generated pictures”. doi:10.1145/360825.360839 http://www.cs.northwestern.edu/~ago820/cs395/Papers/Phong_1975.pdf .

[Poynton 2008] Poynton, Charles. 2008/01/24. Chroma subsampling notation. http://www.poynton.com/PDFs/Chroma_subsampling_notation.pdf .

[STL 1989] 3D Systems, Inc.. 1989. StereoLithography Interface Specification.

[POSIX] IEEE and The Open Group. 2017. POSIX.1-2017 (IEEE Std 1003.1™-2017). http://pubs.opengroup.org/onlinepubs/9699919799/ .

[ZIP] PKWARE, Inc.. 1989. ZIP File Format Specification. http://www.pkware.com/documents/casestudies/APPNOTE.TXT .

[Chytyk-Praznik 2013] Med Phys. Chytyk-Praznik K, VanUytven E, vanBeek TA, Greer PB, and McCurdy BMC. 2013. 40. 3. 031713. “Model-based prediction of portal dose images during patient treatment”. doi:10.1118/1.4792203

3 Definitions

For the purposes of this Standard the following definitions apply.

3.1 Reference Model Definitions

This Part of the Standard is based on the concepts developed in [ISO 7498-1] and [ISO 7498-2] and makes use of the following terms defined in them:

Application Entity (AE): See [ISO 7498-1].
Service: See [ISO 7498-1].

3.2 Service Conventions Definitions

This Part of the Standard makes use of the following terms defined in [ISO/TR 8509]:

Primitive: See [ISO/TR 8509].

3.3 DICOM Introduction and Overview Definitions

This Part of the Standard makes use of the following terms defined in PS3.1:

Attribute: See Attribute in PS3.1 .
Command: See Command in PS3.1 .
Data Dictionary: See Data Dictionary in PS3.1 .
Message: See Message in PS3.1 .
Service-Object Pair Class (SOP Class): See Service-Object Pair Class in PS3.1 .

3.4 DICOM Service Class Specifications

This Part of the Standard makes use of the following terms defined in PS3.4:

Real-World Activity: See Real-World Activity in PS3.4 .
Real-World Object: See Real-World Object in PS3.4 .
Service Class: See Service Class in PS3.4 .
Service Class User (SCU): See Service Class User in PS3.4 .
Service Class Provider (SCP): See Service Class Provider in PS3.4 .
Service-Object Pair Instance (SOP Instance): See Service-Object Pair Instance in PS3.4 .
Preformatted Grayscale Image: See Preformatted Grayscale Image in PS3.4 .
Preformatted Color Image: See Preformatted Color Image in PS3.4 .
Related General SOP Class: See Related General SOP Class in PS3.4 .

3.5 DICOM Data Structures and Encoding

This Part of the Standard makes use of the following terms defined in PS3.5:

Basic Offset Table (BOT): See Basic Offset Table in PS3.5 .
Data Element: See Data Element in PS3.5 .
Data Element Tag: See Data Element Tag in PS3.5 .
Data Element Type: See Data Element Type in PS3.5 .
Data Set: See Data Set in PS3.5 .
Defined Term: See Defined Term in PS3.5 .
Encapsulated Format: See Encapsulated Format in PS3.5 .
Enumerated Value: See Enumerated Value in PS3.5 .
Extended Offset Table (EOT): See Extended Offset Table in PS3.5 .
Fragment: See Fragment in PS3.5 .
Item: See Item in PS3.5 .
Native Format: See Native Format in PS3.5 .
Sequence of Items: See Sequence of Items in PS3.5 .
Unique Identifier (UID): See Unique Identifier in PS3.5 .
Value: See Value in PS3.5 .
Value Length: See Value Length in PS3.5 .
Value Multiplicity (VM): See Value Multiplicity in PS3.5 .
Value Representation (VR): See Value Representation in PS3.5 .

3.6 DICOM Message Exchange

This Part of the Standard makes use of the following terms defined in PS3.7:

DICOM Message Service Element (DIMSE): See DICOM Message Service Element in PS3.7 .
DIMSE-N Services: See DIMSE-N Services in PS3.7 .
DIMSE-C Services: See DIMSE-C Services in PS3.7 .

3.7 DICOM Upper Layer Service

This Part of the Standard makes use of the following terms defined in PS3.8:

DICOM Upper Layer Service: See DICOM Upper Layer Service in PS3.8 .

3.8 DICOM Information Object

Acquisition Context

A description of the conditions present during data acquisition.

Acquisition Protocol Element

A sequential component of the acquisition portion of a protocol, that contains the parameters necessary to perform a single acquisition. In the case of CT, this would correspond to tube voltage, tube current, rotation time, spatial location, etc. and an Acquisition Protocol Element also corresponds to an [NEMA XR-25] PROTOCOL ELEMENT. In the case of XA, this would correspond to technical factors and control algorithms for the image acquisition, e.g. kVp, mA, pulse width, image quality targets, rotation range, etc.

Annotation

Additional information associated with an object.

Assertion

An affirmative statement or declaration by a specified entity about a specified or implied subject for a specified or implied purpose.

Attribute Tag

A unique identifier for an Attribute of an Information Object composed of an ordered pair of numbers (a Group Number followed by an Element number).

Attribute Value

A Value of the Data Element corresponding to the Attribute of an Information Object.

Basic Directory IOD

The Basic Directory Information Object Definition is an abstraction of the information to identify a File-set and facilitate access to the information stored in the files of a File-set based on key medical information.

Basic Directory Information Model

A model that defines the relationship between the various types of Directory Records that may be used in constructing DICOM Directories.

Cine Run

A set of temporally related Frames acquired at constant or variable Frame rates. This term incorporates the general class of serialography (archaic).

Note

A Cine Run is typically encoded as a Multi-frame Image.

Coded Entry Value

The Attribute Value that consists of an Item of a Code Sequence Attribute.

Code Sequence Attribute

Attribute that (usually) includes the string "Code Sequence" in the Attribute Name and has a VR of SQ (Sequence of Items). Its purpose is to encode concepts using code values and optional text meanings from Coding Schemes. Section 8.1 through Section 8.8 specify the Attributes of which the Sequence Items (Attribute Sets) of Code Sequence Attributes are constructed.

Composite IOD

An Information Object Definition that represents parts of several entities in the DICOM Application Model. Such an IOD includes Attributes that are not inherent in the Real-World Object that the IOD represents but rather are inherent in related Real-World Objects.

Derived Image

An image in which the pixel data was constructed from pixel data of one or more other images (source images).

DICOM Application Model

An Entity-Relationship diagram used to model the relationships between Real-World Objects that are within the area of interest of the DICOM Standard.

DICOM Information Model

An Entity-Relationship diagram that is used to model the relationships between the Information Object Definitions representing classes of Real-World Objects defined by the DICOM Application Model.

Frame

A single two-dimensional pixel plane of a Multi-frame Image.

Functional Group

A set of logically related Attributes that are likely to vary together. May be used in Multi-frame IODs to describe parameters that change on a per-frame basis.

Information Entity

That portion of information defined by a Composite IOD that is related to one specific class of Real-World Object. There is a one-to-one correspondence between Information Entities and entities in the DICOM Application Model.

Information Object Definition (IOD)

A data abstraction of a class of similar Real-World Objects that defines the nature and Attributes relevant to the class of Real-World Objects represented.

Inventory

A listing of DICOM Studies, Series, and SOP Instances, and associated metadata, managed by a repository system.

Module

A set of Attributes within an Information Entity or Normalized IOD that are logically related to each other.

Multi-frame Image

Image that contains multiple two-dimensional pixel planes.

Normalized IOD

An Information Object Definition that represents a single entity in the DICOM Application Model. Such an IOD includes Attributes that are only inherent in the Real-World Object that the IOD represents.

Protocol Element

A sequential component of a protocol, consisting of all the parameters necessary to perform that component of the protocol.

Reconstruction Protocol Element

A sequential component of the reconstruction portion of a protocol, such as generating CT thin images or multiplanar reformats, or generating XA 2D processed images and/or 3D X-Ray images.

Region of Interest (ROI)

A selected subset of samples within a dataset identified for a particular purpose.

Scope of Inventory

The parameters that select the DICOM Studies that are included in an Inventory. Parameters are specified as matching rules for Attribute Values.

Segment

A part of a whole, such as the classification of pixels in an image.

Specialization

Specialization is the replacement of the Type, Value range and/or description of an Attribute in a general Module of an IOD, by its Type, Value range and/or description defined in a modality-specific Module of an IOD.

Note

The same Attribute may be present in multiple Modules in the same IOD but not specified to be "Specialized".

Storage Protocol Element

A sequential component of the storage portion of protocol, such as sending a Series of images to a PACS or an archive or a processing workstation.

Structure Set

A set of areas of significance.

3.9 Character Handling Definitions

This Part of the standard makes use of the following terms defined in [ISO/IEC 2022]:

Coded Character Set: See [ISO/IEC 2022].
Code Extension: See [ISO/IEC 2022].
Escape Sequence: See [ISO/IEC 2022].

3.10 Radiotherapy

This Part of the Standard is based on the concepts developed in [IEC 61217] and makes use of the following terms defined in it:

FIXED REFERENCE System: See [IEC 61217].
GANTRY System: See [IEC 61217].
BEAM LIMITING DEVICE System: See [IEC 61217].
WEDGE FILTER system: See [IEC 61217].
X-RAY IMAGE RECEPTOR System: See [IEC 61217].
PATIENT SUPPORT System: See [IEC 61217].
TABLE TOP ECCENTRIC System: See [IEC 61217].
TABLE TOP System: See [IEC 61217].

3.11 Macros

Attribute Macro: A set of Attributes that are described in a single table that is referenced by multiple Module or other tables.

3.12 Device Independent Pixel Values

This Part of the Standard makes use of the following terms defined in PS3.14:

P-Value: See P-Value in PS3.14 .
Profile Connection Space Value (PCS-Value): A device independent color value that is created by the application of the transformation specified in an ICC profile.

3.13 Codes and Controlled Terminology Definitions

This Part of the Standard makes use of the following terms defined in PS3.16:

Baseline Context Group Identifier (BCID): See Baseline Context Group Identifier in PS3.16 .
Defined Context Group Identifier (DCID): See Defined Context Group Identifier in PS3.16 .
Context Group: See Context Group in PS3.16 .
Context Group Version: See Context Group Version in PS3.16 .
Context ID (CID): See Context ID in PS3.16 .
Mapping Resource: See Mapping Resource in PS3.16 .
Relationship Type: See Relationship Type in PS3.16 .
DICOM Content Mapping Resource (DCMR): See DICOM Content Mapping Resource in PS3.16 .
Template: See Template in PS3.16 .
Template ID (TID): See Template ID in PS3.16 .
Value Set: See Value Set in PS3.16 .
Baseline Template Identifier (BTID): See Baseline Template Identifier in PS3.16 .
Defined Template Identifier (DTID): See Defined Template Identifier in PS3.16 .
Coding Scheme: See Coding Scheme in PS3.16 .

3.14 Reference Model Security Architecture Definitions

This Part of the Standard makes use of the following terms defined in [ISO 7498-2]:

Digital Signature: The definition is "Data appended to, or a cryptographic transformation of, a data unit that allows a recipient of the data unit to prove the source and integrity of that unit and protect against forgery e.g., by the recipient."
Data Confidentiality: The definition is "the property that information is not made available or disclosed to unauthorized individuals, entities or processes."
Data Origin Authentication: The definition is "the corroboration that the source of data received is as claimed."
Data Integrity: The definition is "the property that data has not been altered or destroyed in an unauthorized manner."
Key Management: The definition is "the generation, storage, distribution, deletion, archiving and application of keys in accordance with a security policy."

3.15 Security Definitions

This Part of the Standard makes use of the following terms defined in [ECMA 235]:

Security Context: The definition is "security information that represents, or will represent a Security Association to an initiator or acceptor that has formed, or is attempting to form such an association."

3.16 DICOM Security Profiles

This Part of the Standard makes use of the following terms defined in PS3.15:

Message Authentication Code (MAC): See Message Authentication Code in PS3.15 .
Certificate: See Certificate in PS3.15 .

3.17 Multi-dimensional Definitions

Reference Coordinate System (RCS): The RCS is the spatial coordinate system in a DICOM Frame of Reference. It is the chosen origin, orientation and spatial scale of an Image IE in a Cartesian space. The RCS is a right-handed Cartesian coordinate system i.e., the vector cross product of a unit vector along the positive x-axis and a unit vector along the positive y-axis is equal to a unit vector along the positive z-axis. The unit length is one millimeter. Typically, the Image IE contains a spatial mapping that specifies the relationship of the image samples to the Cartesian spatial domains of the RCS.
Corneal Coordinate System: The Corneal Coordinate System is used as the Frame of Reference that establishes the spatial relationship relative to the corneal vertex. The corneal vertex is the point located at the intersection of the patient's line of sight (visual axis) and the outer corneal surface. See Section C.8.30.3.1.4 for further explanation.
Fiducial: A fiducial is some unique feature or landmark suitable as a spatial reference or correlation between similar objects. The fiducial may contribute to the definition of the origin and orientation of a chosen coordinate system. Identifying fiducials in different collections of data is a common means to establish the spatial relationship between similar objects.
Fiducial Point: A Fiducial Point defines a specific location of a Fiducial. A Fiducial Point is relative to an image or to an RCS.
Multi-Planar Reconstruction (MPR): Also called Multi-Planar Reformatting. A data visualization created by sampling volume data, typically represented by a stack of image planes, that lies in the neighborhood of the intersection of the volume with a plane, curved plane, slab or curved slab.
Planar Multi-Planar Reconstruction (Planar MPR): An MPR where the samples are centered on a single plane intersected with the volume.
Volumetric Presentation State (VPS): A Presentation State that defines a transformation from 3D spatial input data (volume) to 2D spatial output data, with or without affecting other dimensions such as temporal.
Volumetric Presentation State Reference Coordinate System (VPS-RCS): The Reference Coordinate System to which inputs to a Volumetric Presentation State are registered and to which Attribute Values of a Volumetric Presentation State are referenced (unless stated otherwise).
Volumetric Presentation View: A presentation, with two spatial dimensions, of volume data.

3.18 Display Equipment Definitions

This Part of the Standard makes use of the following terms, some of which are defined in PS3.14 or [IEC 62563-1]:

Display System: See Display System in PS3.14 .
Display Subsystem: A part of a Display System. A Display Subsystem consists of one Display Device and zero or more other devices (such as controllers). A Display System has one or more Display Subsystems.
Display Device: See [IEC 62563-1].

Note

The definition is "specific hardware/medium used to display images presented through an analogue or digital interface".

3.19 Digital Input Values To Display Systems

This Part of the Standard makes use of the following terms defined in PS3.14:

Digital Driving Level (DDL): See Digital Driving Level in PS3.14 .

3.20 Device Identification Definitions

Unique Device Identifier (UDI): An alphanumeric identifier issued by the unique device identification system established by the FDA to label and identify devices through distribution and use. See http://www.fda.gov/udi.

3.21 Structured Report Definitions

Content Item: A node in the Content Tree of a DICOM SR document, consisting of either a container with a coded Concept Name, or a name-value pair with a coded Concept Name and a Concept Value.
Content Tree: The tree of Content Items of a DICOM SR document.

3.22 Miscellaneous Definitions

Externally-Sourced Data Set: A collection of data that has been obtained from or is defined by an entity separate from the system creating an object.

3.23 DICOM Media Storage and File Format

This Part of the Standard makes use of the following terms defined in PS3.10:

DICOM File Format: See DICOM File Format in PS3.10 .

4 Symbols and Abbreviations

The following symbols and abbreviations are used in this Part of the Standard.

ACR: American College of Radiology
ASCII: American Standard Code for Information Interchange
AE: Application Entity
ANSI: American National Standards Institute
BEV: Beam's-eye view
Brachy: Brachytherapy
BRHC: Bottom Right Hand Corner
CC: Counter-clockwise
CDA: Clinical Document Architecture (HL7)
CEN TC251: Comité Européen de Normalisation - Technical Committee 251 - Medical Informatics
CCIR: Consultative Committee, International Radio
Chest CAD: Computer-Aided Detection and/or Computer-Aided Diagnosis for chest radiography
CSV: Comma-separated Values
CTV: Clinical target volume
CW: Clockwise
DICOM: Digital Imaging and Communications in Medicine
DIMSE: DICOM Message Service Element
DIMSE-C: DICOM Message Service Element-Composite
DIMSE-N: DICOM Message Service Element-Normalized
DRR: Digitally-reconstructed radiograph
DVH: Dose-volume histogram
EPI: Electronic Portal Image
EPID: Electronic Portal Imaging Device
FDA: (United States) Food and Drug Administration
FHIR: Fast Healthcare Interoperability Resources
GTV: Gross tumor volume
Gy: Gray
HISPP: Healthcare Information Standards Planning Panel
HL7: Health Level 7
HMD: Hierarchical Message Description (HL7)
ICRU: International Commission on Radiation Units
IE: Information Entity
IEC: International Electrotechnical Commission
IEEE: Institute of Electrical and Electronics Engineers
IHE: Integrating the Healthcare Enterprise
II: Instance Identifier (HL7)
IOD: Information Object Definition
ISO: International Standards Organization
ITU-T: International Telecommunications Union - Telecommunications Standardization Sector
IVOCT: Intravascular Optical Coherence Tomography
JIRA: Japan Medical Imaging and Radiological Systems Industries Association
JPIP: JPEG 2000 Interactive Protocol
LUT: Lookup Table
MAC: Message Authentication Code
Mammography CAD: Computer-Aided Detection and/or Computer-Aided Diagnosis for Mammography
MeV: Mega electron Volt
MLC: Multileaf (multi-element) collimator
MPPS: Modality Performed Procedure Step
MSDS: Healthcare Message Standard Developers Sub-Committee
MU: Monitor unit
MV: Megavolt
NaN: Not a Number (see IEEE 754)
NEMA: National Electrical Manufacturers Association
OID: Object Identifier (ISO 8824)
OPT: Ophthalmic Tomography
OSI: Open Systems Interconnection
OWL: Web Ontology Language
PDF: Portable Document Format
PTV: Planning target volume
R&V: Record and verify
RCS: Reference Coordinate System
ROI: Region of interest
RT: Radiotherapy
SAD: Source-axis distance
SCP: Service Class Provider
SCTP: Structured Clinical Trial Protocol (HL7)
SCU: Service Class User
SD: Structured Documents (HL7)
SID: Source Image Receptor Distance
SOD: Source Object Distance
SOP: Service-Object Pair
SPL: Structured Product Labeling (HL7)
SR: Structured Reporting
SSD: Source-skin distance
STL: StereoLithography data format
TLHC: Top Left Hand Corner
UDI: Unique Device Identifier
UID: Unique Identifier
UUID: Universal Unique Identifier (ISO/IEC 11578)
XDS: Cross-Enterprise Document Sharing Profile (IHE)
XML: Extensible Markup Language

5 Conventions

5.1 Entity-Relationship Model

5.1.1 Entity

An entity is used in an Entity-Relationship (E-R) model to represent a Real-World Object, class of Real-World Objects, or DICOM data representation (such as an IOD or Module). An entity is depicted as shown in Figure 5.1-1.

Figure 5.1-1. Entity Convention

5.1.2 Relationship

A relationship, which defines how entities are related, is depicted as a diamond within this Part of the DICOM Standard as shown in Figure 5.1-2.

Figure 5.1-2. Relationship Convention

The relationship is read from source to destination entity as indicated by the arrows. The a and b show the source and destination cardinality of the relationship respectively. The following cardinalities are permitted:

(a = 1, b = 1) - one source entity is related to one destination entity
(a = 1, b = 0-n) - one source entity is related to zero or more destination entities
(a = 1, b = 1-n) - one source entity is related to one or more destination entities
(a = 1-n, b = 1) - one or more source entities are related to one destination entity
(a = 1-n, b = 0-n) - one or more source entities are related to zero or more destination entities
(a = 1-n, b = 1-n) - one or more source entities are related to one or more destination entities

In a relationship where (a = 1-n, b = 1-n) the values of the source and destination cardinalities may be different. The value "n" simply denotes one or more.

Note

DICOM has added the use of arrows to the E-R diagramming conventions often used in other literature. This has been done to avoid the possibility of inferring an incorrect relationship that can result from reading a relationship in the reverse order of that intended. For example, a relationship "Cat Catches Mouse" could be read "Mouse Catches Cat" if the arrows were not present.

A relationship may be bi-directional (i.e., the relationship is true in both directions). In such a case, the convention used is arrows pointing toward both the source and the destination entities.

5.2 Sequences

Certain Tables in this Standard describe Sequences of Items by using the symbol: '>'. The symbol '>' precedes the Attribute (or Module) Name of the members of an Item. All marked Attributes (or Modules) belong to the generic description of an Item that may be repeated to form a Sequence of Items. This Sequence of Items is nested in the Attribute (or Module) that precedes in the table the first member marked with a '>'.

Note

The following table describes the "Referenced Series Sequences" Attribute as a Sequence of one or more Items where each Item contains the three Attributes marked by a '>'. The Sequence of Items is nested inside the Value of the Referenced Series Sequence Attribute. The following Attribute (not marked) is not part of the Items of the Sequence.

…	…
Referenced Series Sequence	…
>Series Date	…
>Series Time	…
>Series Instance UID	…
Modality	…

This notation may be used to create nested hierarchical structures by using '>>' at the second level of nesting and so on.

The Type of the Sequence Attribute defines whether the Sequence Attribute itself must be present, and the Attribute Description of the Sequence Attribute may define whether and how many Items shall be present in the Sequence. The Types of the Attributes of the Data Set included in the Sequence, including any conditionality, are specified within the scope of each Data Set, i.e., for each Item present in the Sequence. See PS3.5.

For describing the number of Items in the Attribute description the following sentences are preferred:

Sequence Attribute Type	Number of Items	Sentence
1 or 1C	1	Only a single Item shall be included in this Sequence.
1 or 1C	1-n	One or more Items shall be included in this Sequence.
2 or 2C	0-1	Zero or one Item shall be included in this Sequence.
2 or 2C	0-n	Zero or more Items shall be included in this Sequence.
3	1	Only a single Item is permitted in this Sequence.
3	1-n	One or more Items are permitted in this Sequence.

Note

The encoding of empty Sequence Attributes is described in PS3.5.

In a number of cases for Normalized IODs, the Data Element Type and Conditions are defined in the appropriate Service definition in PS3.4, in other cases in the Attribute description in PS3.3. It is not necessary to specify for any Attribute within a Sequence the condition that it is "required if a Sequence Item is present", since this is always implicit, whether or not there are additional requirements.

5.3 Triplet Encoding of Structured Data (Retired)

This section has been retired. See Section 8.

5.4 Attribute Macros

Some tables contain references to Attribute Macros. This convention is used in cases where the same Attributes are used in multiple tables or multiple places in one Module. The reference means that the Attributes of the Attribute Macro shall be included in the Module in place of the row that contains the reference to the Attribute Macro.

In some cases, the Attribute Macro is used in a Sequence (the VR of the Data Element in which the Attribute is encoded is SQ, see PS3.5). When this is done, the reference is preceded by one or more ">" characters. The number of ">" characters indicates the level in the Sequence that all of the Attributes in the Attribute Macro occupy.

There may be specialization of the description of the Attributes in the Attribute Macro. In these cases, this specialization is described in the Description column of the Module.

Following is an example of this convention.

Table 5.4-1 is an example of a Module table using the Attribute Macro convention.

Table 5.4-1. Example Module Table

Attribute Name	Tag	Type	Attribute Description
Attribute A	(aaaa,aaaa)	1	This is an example.
Attribute B Sequence	(bbbb,bbbb)	1	This is an example of a Sequence Attribute.
>Include Table 5.4-2 “Example Macro Attributes”			In this Module, Attribute D (dddd,dddd) is Type 1.

Table 5.4-2 is an example of the Attribute Macro referenced in Table 5.4-1.

Table 5.4-2. Example Macro Attributes

Attribute Name	Tag	Type	Attribute Description
Attribute C	(cccc,cccc)	1	This is an example.
Attribute D	(dddd,dddd)	3	This Attribute is generally a Type 3.

The contents of the Example Module Table, if it had not been described with the Example Macro would have been as shown in Table 5.4-3.

Table 5.4-3. Example Module Table Without The Use of An Attribute Macro

Attribute Name	Tag	Type	Attribute Description
Attribute A	(aaaa,aaaa)	1	This is an example.
Attribute B Sequence	(bbbb,bbbb)	1	This is an example of a Sequence Attribute.
>Attribute C	(cccc,cccc)	1	This is an example.
>Attribute D	(dddd,dddd)	1	In this Module, this Attribute has been specialized to Type 1 as indicated in Table 5.4-1.

5.5 Types and Conditions in Normalized IODs

When a Normalized IOD in PS3.3 invokes Modules (e.g., the SOP Common Module) or Attribute Macros that are specified with Data Element Types, those specified Data Element Types and Conditions do not apply. Rather, the Data Element Types and Conditions have to be specified for each Attribute for both SCU and SCP in the appropriate Service definition in PS3.4.

5.6 Invocation of Context Groups

The conventions used for Code Sequences are:

no Baseline Defined
using the Context Group as Baseline Context Group
using the Context Group as Defined Context Group

In combination with the definition of the Context Group as Extensible or Non-extensible in PS3.16, the conventions in Table 5.6-1 apply.

Table 5.6-1. Conventions for Specification of Context Groups

	Extensible Context Group	Non-Extensible Context Group
No Baseline or Defined CID specified	Any Code may be used if its meaning is applicable to the context of invocation.
Baseline Context Group Identifier (BCID)	Codes in the Context Group may be used. Alternative Codes for the same Concept (i.e., with the same meaning) may be used instead of the Codes in the Context Group, since this can be construed as not using the Baseline Context Group. Codes not in the Context Group may be used as an extension when their meaning is within the scope of that Context Group. I.e., any Code may be used if its meaning is applicable to the context of invocation. See also Section 7.2.3 “Extension of Context Groups” in PS3.16 .	Non-extensible Context Groups are not used as Baseline Context Groups.
Defined Context Group Identifier (DCID)	Codes in the Context Group shall be used. Codes not in the Context Group may be used as an extension to the specified Context Group when their meaning is within the scope of that Context Group. See also Section 7.2.3 “Extension of Context Groups” in PS3.16 .	Codes in the Context Group shall be used. Codes not in the Context Group shall not be used.

Extensible Context Group

Non-Extensible Context Group

No Baseline or Defined CID specified

Any Code may be used if its meaning is applicable to the context of invocation.

Baseline Context Group Identifier (BCID)

Codes in the Context Group may be used.

Alternative Codes for the same Concept (i.e., with the same meaning) may be used instead of the Codes in the Context Group, since this can be construed as not using the Baseline Context Group.

Codes not in the Context Group may be used as an extension when their meaning is within the scope of that Context Group.

I.e., any Code may be used if its meaning is applicable to the context of invocation.

Non-extensible Context Groups are not used as Baseline Context Groups.

Defined Context Group Identifier (DCID)

Codes in the Context Group shall be used.

Codes not in the Context Group may be used as an extension to the specified Context Group when their meaning is within the scope of that Context Group.

Codes in the Context Group shall be used.

Codes not in the Context Group shall not be used.

6 DICOM Information Model

The DICOM Information Model defines the structure and organization of the information related to the communication of medical images. Figure 6-1 shows the relationships between the major structures of the DICOM Information Model.

Figure 6-1. Major Structures of DICOM Information Model

6.1 Information Object Definition

An Information Object Definition (IOD) is an object-oriented abstract data model used to specify information about Real-World Objects. An IOD provides communicating Application Entities with a common view of the information to be exchanged.

An IOD does not represent a specific Instance of a Real-World Object, but rather a class of Real-World Objects that share the same properties. An IOD used to generally represent a single class of Real-World Objects is called a Normalized Information Object. An IOD that includes information about related Real-World Objects is called a Composite Information Object.

6.1.1 Composite IOD

A Composite IOD is an IOD that represents parts of several entities included in the DICOM Model of the Real World. This Model is introduced in Section 7. Such an IOD includes Attributes that are not inherent in the Real-World Object that the IOD represents but rather are inherent in related Real-World Objects.

These related Real-World Objects provide a complete context for the exchanged information. When an Instance of a Composite IOD is communicated, this entire context is exchanged between Application Entities. Relationships between Composite IOD Instances shall be conveyed in this contextual information.

The Composite IODs are specified in Annex A.

6.1.2 Normalized IOD

A Normalized IOD is an IOD that generally represents a single entity in the DICOM Model of the Real World.

When an Instance of a Normalized IOD is communicated, the context for that Instance is not actually exchanged. Instead, the context is provided through the use of pointers to related Normalized IOD Instances.

The Normalized IODs are specified in Annex B.

6.2 Attributes

The Attributes of an IOD describe the properties of a Real-World Object Instance. Related Attributes are grouped into Modules that represent a higher level of semantics documented in the Module Specifications found in Annex C.

Attributes are encoded as Data Elements using the rules, the Value Representation and the Value Multiplicity concepts specified in PS3.5. For specific Data Elements, the Value Representation and Value Multiplicity are specified in the Data Dictionary in PS3.6.

When multiple Modules containing the same Attributes(s) are included in an IOD, the Attribute shall be encoded only once into a Data Element.

6.3 On-line Communication and Media Storage Services

For on-line communication the DIMSE Services allow a DICOM Application Entity to invoke an operation or notification across a network or a point-to-point interface. DIMSE Services are defined in PS3.7.

For media storage interchange, Media Storage Services allow a DICOM Application Entity to invoke media storage related operations.

Note

These Media Storage Services are discussed in PS3.10.

6.3.1 DIMSE-C Services

DIMSE-C Services are services applicable only to a Composite IOD, except for C-FIND that may apply to both normalized and Composite Instances. DIMSE-C Services provide only operation services.

6.3.2 DIMSE-N Services

DIMSE-N Services are services applicable only to a Normalized IOD. DIMSE-N Services provide both operation and notification services.

6.4 DIMSE Service Group

A DIMSE Service Group specifies one or more operations/notifications defined in PS3.7 that are applicable to an IOD.

DIMSE Service Groups are defined in PS3.4 in the specification of a Service-Object Pair Class.

6.5 Service-Object Pair Class (SOP Class)

The SOP Class definitions in PS3.4 contain the rules and semantics that may restrict the use of the services in the DIMSE Service Group and/or the Attributes of the IOD. PS3.10 and PS3.18 contain the rules and semantics that may restrict the Attributes of the IOD or the use of the services in the Media Storage Services and the Web Services respectively.

The selection of SOP Classes is used by Application Entities to establish an agreed set of capabilities to support their interaction for SOP Classes based on DIMSE Services. This negotiation is performed at association establishment time as described in PS3.7. An extended negotiation allows Application Entities to further agree on specific options within a SOP Class.

Note

The SOP Class as defined in the DICOM Information Model is equivalent in ISO/OSI terminology to the Managed Object Class. Readers familiar with object-oriented terminology will recognize the SOP Class operations (and notifications) as comprising the methods of an object class.

6.5.1 Normalized and Composite SOP Classes

DICOM defines two types of SOP Classes, Normalized and Composite. For DIMSE Services, Normalized SOP Classes are defined as the union of a Normalized IOD and a set of DIMSE-N Services, while Composite SOP Classes are defined as the union of a Composite IOD and a set of DIMSE-C Services. Media Storage Services only support Composite IODs and Web Services supports both Normalized and Composite SOP Classes.

Note

SOP Class Specifications play a central role for defining DICOM conformance requirements. It allows DICOM Application Entities to select a well-defined application level subset of the DICOM V3.0 Standard to which they may claim conformance. See PS3.2.

6.6 Association Negotiation

Association establishment is the first phase of communication between peer DICOM compliant Application Entities. The Application Entities shall use association establishment to negotiate which SOP Classes can be exchanged and how this data will be encoded.

Association Negotiation is defined in PS3.7.

6.7 Service Class Specification

A Service Class Specification defines a group of one or more SOP Classes related to a specific function that is to be accomplished by communicating Application Entities. A Service Class Specification also defines rules that allow implementations to state some pre-defined level of conformance to one or more SOP Classes. Applications may conform to SOP Classes as either or both a Service Class User (SCU) or Service Class Provider (SCP).

Service Class Specifications are defined in PS3.4.

Note

Such interaction between peer Application Entities work on a 'client/server model'. The SCU acts as the 'client', while the SCP acts as the 'server'. The SCU/SCP roles are determined during association establishment.

7 DICOM Model of the Real World

Figure 7-1a, Figure 7-1b and Figure 7-3 depict the DICOM view of the Real-World that identifies the relevant Real-World Objects and their relationships within the scope of the DICOM Standard. It provides a common framework to ensure consistency between the various Information Objects defined by the DICOM Standard.

Figure 7-1a. DICOM Model of the Real World

Note

Though typically a single Series is spatially defined by a single Frame of Reference, there may be situations in which a Series contains some Instances without a defined Frame of Reference.

Figure 7-1b. DICOM Model of the Real World - PRINT

Figure 7-2b. DICOM Information Model - PRINT

Figure 7-2c. DICOM Information Model - RADIOTHERAPY

Figure 7-2d. DICOM Information Model - IMPLANT TEMPLATES

Figure 7-3. Model of the Real World for the Purpose of Modality-IS Interface

7.1 DICOM Information Model

The DICOM Information Model is derived from the DICOM Model of the Real World. The DICOM Information Model presented by Figure 7-2b, Figure 7-2c and Figure 7-2d identify the various IODs specified by this Standard and their relationships. There is not always a one-to-one correspondence between DICOM IODs and Real-World Objects. For example a Composite IOD contains Attributes of multiple real-world objects such as Series, Equipment, Frame of Reference, Study and Patient.

The entities in Figure 7-2b, Figure 7-2c and Figure 7-2d correspond to IODs defined in Annex A, Annex B and Annex C.

7.2 Organization of Annexes A, B and C

Annex A defines Composite IODs (e.g., Images) acquired on a number of Modalities (e.g., CT, MR, NM, US, CR, Secondary Capture). These Composite IODs reference Modules found in Annex C.

Annex B defines Normalized IODs (e.g., Film Session, Print Job) for a number of Service Classes specified in PS3.4. These Normalized IODs reference Module definitions found in Annex C.

7.3 Extension of the DICOM Model of the Real World

For the purpose of the Basic Worklist Management Service Class and the Modality Performed Procedure Step SOP Classes an enhancement of the original DICOM Model of the Real World is made, as depicted in Figure 7-3.

Annex B “Integration of Modality Worklist and Modality Performed Procedure Step in The Original DICOM Standard (Informative)” in PS3.17 discusses the relationship of this extension to the original DICOM model of the real world.

Figure 7-3 is an abstract description of the real world objects invoked in the Modality-IS Interface. It is not to be seen as a database scheme for an implementation.

7.3.1 Definition of the Extensions of the DICOM Real World Model

7.3.1.1 Patient

A Patient is a human or non-human organism receiving, or registered to receive, healthcare services, or the subject of one or more Studies for some other purpose, such as research.

Note

In some circumstances, multiple humans or non-human organisms may be studied simultaneously, and for the purpose of the model are identified as a single Patient. E.g., a mother and one or more fetuses during antepartum obstetric ultrasound, multiple specimens in a single tissue microarray, or a group of multiple research small animals imaged simultaneously.

7.3.1.2 Service Episode and Visit

A Service Episode is a collection of events, aggregated during an interval bounded by start and stop times. A Service Episode is the context in which the treatment or management of an arbitrary subset of a Patient's medical conditions occurs. The definition of the start time, stop time, and included events of a Service Episode is entirely arbitrary; it may include a single outpatient visit or a hospitalization, or extend over significant period of time, e.g., the duration of a pregnancy, or an oncology treatment regimen, or a cardiac episode from infarction through rehabilitation. A Service Episode may involve one or more Healthcare Organizations (administrative entities that authorize Healthcare Providers to provide services within their legal administrative domain, e.g., hospitals, private physician's offices, multispecialty clinics, nursing homes).

A subset of Service Episode, the Visit, is the collection of events that fall under the accountability of a particular Healthcare Organization in a single facility. A Visit may be associated with one or more physical locations (e.g., different rooms, departments, or buildings) within the Healthcare Organization's definition of a facility, with admission and discharge diagnoses and with time boundaries of the visit.

Note

The Visit is a part of the Service Episode. The Service Episode describes several administrative aspects of healthcare, while the Visit is limited to the description of one visit of a Patient to a facility.
In the context of the Modality Worklist SOP Class, the Attributes of the Service Episode are defined in the Visit Modules.
The Attributes for Visit often use the term "admission" for historical reasons, although a visit in an ambulatory clinic does not involve an admission as an in-patient.

7.3.1.3 Imaging Service Request

An Imaging Service Request is a set of one or more Requested Procedures selected from a list of Procedure Types. An Imaging Service Request is submitted by one authorized imaging service requester to one authorized imaging service provider in the context of one Service Episode. An Imaging Service Request includes pertinent specific and general information. Each instance of an Imaging Service Request carries the information common to one or more Requested Procedures requested at the same moment. An Imaging Service Request may be associated with one or more Visits that occur within the same Service Episode. The existence of an Imaging Service Request will typically result in the creation of one or more Imaging Service Reports and the distribution of Imaging Service Reports to one or more destinations.

In the context of the Modality Worklist the information provided by the Imaging Service Request aims at performing one or more imaging procedures, i.e., at acquiring new images.

Note

An Imaging Service Request is identified by an Accession Number (0008,0050), which is a typically a departmental Information System generated number, but may be generated by a more comprehensive system that spans departments, or enterprises. The scope of uniqueness of an Accession Number (0008,0050) is defined by its issuer, which may be encoded in Issuer of Accession Number Sequence (0008,0051).

7.3.1.4 Procedure Type

A Procedure Type identifies a class of procedures. In the context of imaging services, a Procedure Type is an item in a catalog of imaging procedures that can be requested and reported upon in an imaging service facility. An instance of a Procedure Type typically has a name and one or more other identifiers. A Procedure Type is associated with one or more Procedure Plans.

Note

The information content of this entity relates to the general identification of a Procedure Type rather than to its decomposition into the protocol(s) required to perform a specific instance of a Requested Procedure for a particular Patient.

7.3.1.5 Requested Procedure

A Requested Procedure is an instance of a Procedure of a given Procedure Type. An instance of a Requested Procedure includes all of the items of information that are specified by an instance of a Procedure Plan that is selected for the Requested Procedure by the imaging service provider. This Procedure Plan is defined by the imaging service provider on the basis of the Procedure Plan templates associated with the considered Procedure Type. An Imaging Service Request may include requests for several different Requested Procedures. The purpose of this entity is to establish the association between Imaging Service Requests and Procedure Types, to convey the information that belongs to this association and to establish the relationships between Requested Procedures and the other entities that are needed to describe them. A single Requested Procedure of one Procedure Type is the smallest unit of service that can be requested, reported, coded and billed. Performance of one instance of a Requested Procedure is specified by exactly one Procedure Plan. A Requested Procedure leads to one or more Scheduled Procedure Steps involving Protocols as specified by a Procedure Plan. A Requested Procedure may be associated with one or more Visits. A Requested Procedure may involve one or more pieces of equipment.

7.3.1.6 Scheduled Procedure Step

A Modality Scheduled Procedure Step is an arbitrarily defined scheduled unit of service, that is specified by the Procedure Plan for a Requested Procedure. A Modality Scheduled Procedure Step prescribes a Protocol, which may be identified by one or more protocol codes. A Modality Scheduled Procedure Step involves equipment (e.g., imaging Modality equipment, anesthesia equipment, surgical equipment, transportation equipment), human resources, consumable supplies, location, and time (e.g., start time, stop time, duration). While in the context of imaging services the scheduling of a Modality Scheduled Procedure Step might include only a general designation of imaging Modality that could be satisfied by multiple pieces of the same equipment type, the performance of one instance of a Modality Scheduled Procedure Step involves one and only one piece of imaging Modality equipment.

The performance of a Modality Scheduled Procedure Step may result in the creation of zero or more Modality Performed Procedure Step Instances.

Note

The Procedure Step entity is provided to support management of the logistical aspects of procedures (e.g., materials management, human resources, scheduling). The full definition of the contents of Procedure Steps and protocols according to which they are performed is implementation dependent and is beyond the scope of this Standard.
A Modality Scheduled Procedure Step may contribute to more than one Requested Procedure (e.g., a Modality Scheduled Procedure Step requiring an intravenous iodine contrast injection might be shared by an intravenous pyelogram and a CT examination). However, for billing purposes an Instance of a Modality Scheduled Procedure Step is typically considered to be a part of only one Requested Procedure.

7.3.1.7 Procedure Plan

A Procedure Plan is a specification that defines the set of Protocols that must be done in order to perform the Scheduled Procedure Steps of a Requested Procedure. Each Scheduled Procedure Step is performed according to a single Protocol, which may be identified by one or more Protocol Codes and may be described in a Defined Procedure Protocol. The Protocols actually performed during a Procedure Step may be recorded in a Performed Procedure Protocol and may differ from those prescribed in the related Procedure Plan. Audit of actually performed Protocols versus the prescribed Procedure Plan is an important element of quality control.

7.3.1.8 Protocol

A Protocol is a specification of actions prescribed by a Procedure Plan to perform a specific Procedure Step. A Scheduled Procedure Step contains only one Protocol, which may be conveyed by one or more Protocol Codes.

A Protocol may be specified by a Defined Procedure Protocol to be used on any appropriate Patient.

A Protocol can be documented, once a Procedure Step has been performed, in a Performed Procedure Protocol.

7.3.1.8.1 Defined Procedure Protocol

A Defined Procedure Protocol describes a set of parameters and associated details for the prescribed action. The Defined Procedure Protocol may provide specific values for relevant parameters, or may provide constraints on those parameters (such as an acceptable range) to guide the choice of specific values.

Defined Procedure Protocol is not associated with any particular Patient or Scheduled Procedure Step. A Defined Procedure Protocol may contain parameters specific to a particular model or version of device, or it may be generic in that it only describes parameters common to multiple device models.

A Defined Procedure Protocol may include information such as the clinical purpose, indications, and appropriate device models, intended for selection and management.

7.3.1.8.2 Performed Procedure Protocol

A Performed Procedure Protocol encodes the parameter values used. A Performed Procedure Protocol is always associated with a specific Patient and Performed Procedure Step. The Performed Procedure Protocol may reference the Defined Procedure Protocol on which it was based, but does not otherwise record the original constraints and whether or not they were satisfied by the final values as recorded in the Performed Procedure Protocol.

7.3.1.9 Modality Performed Procedure Step

A Performed Procedure Step is an arbitrarily defined unit of service that has actually been performed (not just scheduled). Logically it corresponds to a Scheduled Procedure Step, but real-world conditions may dictate that what is actually performed does not correspond exactly with what was requested or scheduled.

Note

For example, two or more Scheduled Procedure Steps, Requested Procedures or Imaging Service Requests may have been generated by different Referring Physicians but may be satisfied be a single Performed Procedure Step at the discretion of a Performing Physician or Operator. Alternatively, a single Scheduled Procedure Step may need to be satisfied by multiple Performed Procedure Steps on different types or instances of equipment, due to clinical need or failure conditions, or over extended periods of time.

It contains information describing the type of procedure actually performed. This information is represented by the Performed Protocol that may be defined by one or more Protocol Codes.

A Requested Procedure results in the creation of zero or more Performed Procedure Steps.

A Scheduled Procedure Step results in the creation of zero or more Performed Procedure Steps.

The Performed Procedure Step contains information about its state (e.g., in progress, discontinued or completed).

A Modality Performed Procedure Step (MPPS) is a Performed Procedure Step that results from activity (such as the acquisition of images from a Patient or other Imaging Subject) on a Modality.

It contains information describing the performance of a step of an imaging procedure, including data about the performance of the procedure itself, and data for billing and material management.

The Modality Performed Procedure Step contains references to zero or more Series of Images and other Composite SOP Instances that may be created as part of the procedure step. A particular Series is part of only one Modality Performed Procedure Step.

The purpose of the Modality Performed Procedure Step is to report what was performed; it does not imply any storage semantics. While the MPPS represents a unit of service within a workflow, the specification of the workflow itself is beyond the scope of the Standard, and the MPPS does not identify or control any subsequent activities to be performed.

Note

For example, a modality may create both "for processing" images for automated analysis and "for presentation" images for human review from the same acquisition. The Standard does not specify whether the production of these is a single unit of service, or two. A single Modality Performed Procedure Step Instance could list both the "for processing" images and the "for presentation" images, regardless of whether or not both sets of images were stored to the same or different AEs, or indeed were stored at all, since the MPPS is independent of the storage semantics. Alternatively, the modality may treat these two sets of images as two separate units of service, and send two separate MPPS Instances.

A Radiation Dose SR from the irradiation events of an acquisition could be referenced in the same MPPS Instance as that of the acquired images, again irrespective of where such a Radiation Dose Structured Report might be transmitted, if at all. Alternatively, the modality may treat the production of the Radiation Dose SR as a separate unit of service, and report it in a distinct MPPS.

Another example is the case of thin and thick slice CT images acquired from the same acquisition (raw) data. When the reconstruction of both sets of images is prospectively defined and automatically initiated by the protocol selection, then both sets might be referenced from a single MPPS Instance. However, if the reconstruction of one or the other set is performed retrospectively by manual intervention some time after the acquisition MPPS had been completed, the subsequent Instances will necessarily be referenced in a new MPPS Instance, since the acquisition MPPS cannot be modified once completed.
The completion of an MPPS may be a significant event that triggers or enables downstream activity, but it is not the intent to require the modality to be configured to "manage" such activity. The "units of service" that the modality describes in an MPPS, and how the modality relates those Performed Procedure Steps to Scheduled Procedure Steps, are implementation decisions beyond the scope of the Standard. The IHE Radiology Scheduled Workflow Profile [IHE RAD TF-1] provides additional guidance for implementation.
An MPPS may describe Instances that were acquired but that have not been, nor may ever be, stored. For example, a modality may be capable of storing a CT acquisition as multiple single-frame CT Image Storage SOP Instances, as a single multi-frame Enhanced CT Image Storage SOP Instance, or as several Enhanced CT Image Storage SOP Instances that together comprise a Concatenation. An MPPS may describe all three possibilities, even though only one choice may ultimately be stored, perhaps depending on the negotiated capabilities of the storage recipient. Alternatively, separate MPPS Instances could be used for different storage SOP Classes.
The MPPS contains only the Instances that the modality created, not Instances converted and created subsequently in response to a query (e.g., during legacy conversion).
The MPPS is not a substitute for, nor is equivalent to, a Storage Commitment request, nor an Instance Availability Notification.

7.3.1.10 General Purpose Scheduled Procedure Step (Retired)

Retired. See PS3.3-2011.

7.3.1.11 General Purpose Performed Procedure Step (Retired)

Retired. See PS3.3-2011.

7.3.1.12 Workitem (Retired)

Retired. See PS3.3-2011.

7.3.1.13 Clinical Document

A Clinical Document is a part of the medical record of a Patient. A Clinical Document is a documentation of clinical observations and services and has the following characteristics:

Persistence - A clinical document continues to exist in an unaltered state, for a time period defined by local and regulatory requirements.
Stewardship - A clinical document is maintained by an organization entrusted with its care.
Potential for authentication - A clinical document is an assemblage of information that is intended to be legally authenticated.
Context - A clinical document establishes the default context for its contents.
Wholeness - Authentication of a clinical document applies to the whole and does not apply to portions of the document without the full context of the document.
Human readability - A clinical document is human readable.

Note

This definition is from ANSI/HL7 CDA R1.0-2000, and HL7 v3 CDA R2-2005.

Clinical Documents may provide significant context for the performance of imaging and related procedures, e.g., patient clinical history, pre-imaging-procedure lab test results, or patient advance medical directives.

Clinical Documents may be associated with Service Episodes, Service Requests, Requested Procedures, or other entities subsidiary to the Patient in the Real-World Model. Such associations are not explicitly modeled for the purposes of the Modality-IS context.

Clinical Documents are one sub-class of the class of healthcare Structured Documents; Structured Documents, in general, are not necessarily related to a Patient. Structured Documents may be used for imaging procedure operational instructions, e.g., in product labeling, Procedure Plans, or patient care plans.

Note

The format and semantics of Structured Documents, including Clinical Documents, are defined outside the scope of the DICOM Standard (e.g., by HL7). DICOM provides the means to reference Structured Documents within the Modality-IS context.
The general class of Structured Documents is not modeled in the Real-World Model; only specific sub-classes, e.g., Clinical Documents, are modeled.

7.4 Extension of the DICOM Model of the Real World for the General Purpose Worklist (Retired)

Retired. See PS3.3-2011.

7.5 Organizing Large Sets of Information

For the purpose of accommodating large sets of Frames in Multi-frame Image SOP Instances the Real-World Entity Relationship Diagram has been extended to describe the relationships of these instances: Concatenation (see Section 7.5.1) and Dimension Organization (see Section 7.5.2). Figure 7.5-1 depicts the additions to Figure 7-1a.

Figure 7.5-1. Extension of the Real World Model with Concatenations and Dimensions

7.5.1 Concatenation

For implementation specific reasons (such as practical limits on the maximum size of an individual SOP Instance) the content of a Multi-frame Image may need to be split into more than one SOP Instance. These SOP Instances together form a Concatenation, which is a group of SOP Instances within a Series that is uniquely identified by Concatenation UID (0020,9161).

7.5.2 Dimension Organization

The Dimension Organization contains a set of dimensions. A dimension is a set of Attributes that change on a per-frame basis in a manner that is known before the image is acquired, are defined by the generating application and are especially intended for presentation. Other Attributes may also change on a per-frame basis but if they are not present in the Dimension Organization, they are not considered significant as a dimension for organizational purposes.

Receiving applications shall use the order of dimensions for guidance when presenting images if the Multi-frame Dimension Module is present. The first Item of the Dimension Index Sequence shall be the slowest varying index.

Note

See Section C.7.6.17 for an example.

7.6 Extension of the DICOM Model of the Real World for Clinical Trials and Research

The DICOM Model of the Real World is extended for Clinical Trials and research with the addition of several objects whose relationships to each other and existing DICOM Real World objects are shown in Figure 7.6-1.

Attributes of the Clinical Trial Sponsor, Clinical Trial Protocol, Clinical Trial Subject, and Clinical Trial Site objects are represented in the Clinical Trial Subject Module within the Patient IE. Attributes of the Clinical Trial Time Point object are represented in the Clinical Trial Study Module within the Study IE. The Clinical Trial Coordinating Center Attribute is represented in the Clinical Trial Series Module within the Series IE.

Figure 7.6-1. DICOM Model of the Real World - Clinical Trials and Research

7.6.1 Clinical Trial and Research Information Entities

For the purpose of Clinical Trial and Research Information, an extension of the DICOM Model of the Real World is made, as depicted in Figure 7.6-1.

7.6.1.1 Clinical Trial Sponsor

A Clinical Trial Sponsor identifies the agency, group, or institution responsible for conducting and/or funding the clinical trial or research, and for assigning a Protocol Identifier.

7.6.1.2 Clinical Trial Protocol

A Clinical Trial Protocol identifies the investigational Protocol in which the Subject has been enrolled. The Protocol has a Protocol Identifier and Protocol Name, as well as information related to Ethics Committee, Institutional Review Board (IRB) or Institutional Animal Care and Use Committees (IACUC) approval.

7.6.1.3 Clinical Trial Subject

A Clinical Trial Subject identifies the Patient who is enrolled as a Subject in the investigational Protocol.

7.6.1.4 Clinical Trial Site

A Clinical Trial Site identifies the location or institution at which the Subject is treated or evaluated and that is responsible for submitting clinical trial or research data. Images and/or clinical trial data may be collected for a given Subject at alternate institutions, e.g., follow-up scans at a satellite imaging center, but the Clinical Trial Site represents the primary location for Patient management and data submission in the context of a clinical trial or research. In pre-clinical research with small animals, it is typically the single laboratory or shared resource facility.

7.6.1.5 Clinical Trial Time Point

The Clinical Trial Time Point identifies an imaging Study within the context of a series of longitudinal data acquisitions in an investigational protocol. A Time Point defines a set of Studies that are grouped together as a clinical time point or submission in a clinical trial or for other research.

7.6.1.6 Clinical Trial Coordinating Center

The Clinical Trial Coordinating Center identifies the institution responsible for coordinating the collection, management, processing, and/or analysis of images and associated data for Subjects enrolled in a clinical trial or research. Within a given Clinical Trial Protocol, there may be multiple Clinical Trial Coordinating Centers, each handling different aspects of the clinical data submitted by the Clinical Trial Sites. In pre-clinical research with small animals, it may be a facility where post processing is performed, separate from the laboratory where the data is acquired.

7.7 Extension of the DICOM Model of the Real World for Hanging Protocols

See Section 7.13.

Note

The specifications of this section have been consolidated into the Real World Model for Non-Patient-Related Information.

7.8 Extension of the DICOM Model of the Real World for Color Palettes

See Section 7.13.

Note

The specifications of this section have been consolidated into the Real World Model for Non-Patient-Related Information.

7.9 Extension of the DICOM Model of the Real World for Specimens

The DICOM Model of the Real World is extended for Specimens with the addition of several objects whose relationships to each other and existing DICOM Real World objects are shown in Figure 7.9-1.

Attributes of the Specimen, Container, Component and Preparation Step objects are represented in the Specimen Module within the Image IODs.

Figure 7.9-1. DICOM Model of the Real World - Specimens

7.9.1 Specimen

A physical object (or a collection of objects) is a specimen when the laboratory considers it a single discrete, uniquely identified unit that is the subject of one or more steps in the laboratory (diagnostic) workflow.

7.9.2 Container

Specimen containers (or just "containers") play an important role in laboratory (diagnostic) processes. In most, but not all, process steps, specimens are held in containers, and a container often carries its specimen's ID. Sometimes the container becomes intimately involved with the specimen (e.g., a paraffin block), and in some situations (such as examining tissue under the microscope) the container (the slide and coverslip) become part of the optical path.

7.9.3 Container Component

Containers are often made up of components. For example, a "slide" is container that is made up of the glass slide, the coverslip and the "glue" the binds them together.

7.9.4 Preparation Step

Before a slide is imaged, the preparation of the specimen (including sampling, processing and staining) will take place. Specimen preparation is described as a sequence of time-stamped process steps. Multiple steps are possible, and may include sampling from ancestor specimens.

7.10 Extension of DICOM Model of the Real World for Implant Templates

See Section 7.13.

Note

The specifications of this section have been consolidated into the Real World Model for Non-Patient-Related Information.

7.11 Extension of the DICOM Model of the Real World for the Unified Procedure Step (UPS)

The DICOM Model of the Real World is extended with the addition of a Unified Procedure Step object whose relationship to existing DICOM Real World objects is shown in Figure 7.11-1.

Figure 7.11-1. DICOM Model of the Real World - Unified Procedure Step

7.11.1 Unified Procedure Step

A Unified Procedure Step (UPS) represents an arbitrary unit of service. Unified Procedure Steps are generally scheduled in response to a Requested Procedure, although a UPS may be triggered by other events, such as a scheduled calibration, completion of prior work in a pipeline, etc.

The Unified Procedure Step (UPS) unifies the details of the procedure step that has been requested, the progress details during performance, and the details of the procedure step actually performed. The details can describe the specific service activity, the subject and/or data acted on, the originator and context of the request, the human/equipment/application resources involved, the priority, date, time and location of the activity, and references to resulting output data.

Normally the details about the activity as performed correspond to the details of the activity as requested, however real-world conditions may dictate that what is actually performed does not correspond exactly with what was requested or scheduled.

7.11.2 Worklist

A Worklist is an arbitrary collection of Unified Procedure Steps that share a common worklist label.

7.12 Extension of The DICOM Model of The Real World For Display System

The DICOM Model of the Real World is extended for Display System with the addition of an entity that is separate from the rest of the DICOM Real World objects, as shown in Figure 7.12-1. A Display System is not associated with any specific objects in the existing DICOM Information model, because it is not associated with a specific Patient. One Display System object is included in a Display System IOD.

Figure 7.12-1. DICOM Model of the Real World - Display System

A Display Subsystem represents the target of a Display QA task such as calibration. For example, a PACS reading station with one color controller driving one display, and 4 grayscale displays each driven by two controllers is modeled as 5 Display Subsystems, each of which can be the target of a Display QA task. A tablet represents one Display System with a Display Device but no externally exposed controller. Although Display Subsystem may include components beyond the Display Device, this Model focuses on the Display Device only.

Figure 7.12-2. Display Subsystem Composition in the Display System IOD

Figure 7.12-2 illustrates how the composition of Display Subsystems is represented in the Display System IOD.

7.13 DICOM Model of the Real World for Non-Patient-Related Information

The DICOM Model of the Real World is extended for a variety of non-patient-related information with the specification of entities that are generally separate from the rest of the DICOM Real World Information Model. These information entities are not associated with a specific Patient. While there may be entity relationships, there is no hierarchy applied to these entities.

7.13.1 Hanging Protocol Information Entity

A Hanging Protocol Information Entity specifies the viewing preferences of a specific user or group, for a specific type of Study (Modality, Anatomy, Laterality combination, and optionally Procedure, and/or Reason). A Hanging Protocol definition includes descriptors that identify the Hanging Protocol, the creator, the type of Study it addresses, the type of image sets to display, the intended display environment, and the intended layout for the screen(s).

The Hanging Protocol IE does not have any relationships with other Information Entities. See Figure 7.13-1.

Figure 7.13-1. DICOM Model of the Real World - Hanging Protocol

7.13.2 Color Palette Information Entity

A Color Palette Information Entity specifies a color palette suitable for application to an image with a single channel of information (grayscale) to render it in color, i.e., pseudo-coloring.

The Color Palette IE may be referenced by Image or Presentation State Information Entities. See Figure 7.13-2.

The Color Palette IOD instantiates the Color Palette IE only.

Figure 7.13-2. DICOM Model of the Real World - Color Palette

7.13.3 Implant Related Information Entities

7.13.3.1 Implant Template Information Entity

An Implant Template Information Entity specifies a 2D- and/or 3D-template representing a physical implant. The IE specifies mechanisms for implant assembly, i.e., the rigid connection of two or more implants.

The Implant Template IE may be related to a Surface IE (see Section A.1.2.18) or to an Encapsulated Document IE (see Section A.1.2.16) for the specification of the 2D- or 3D-template.

The Implant Template IE may be related to a Frame of Reference IE (see Section A.1.2.5) to support registration of the template with Patient anatomical landmarks in a separate Frame of Reference.

The Implant Template IE may be related to an Implant Assembly Template IE for the specification of multi-part assemblies. The Implant Template IE may be related to an Implant Template Group IE for shared management of a set of templates.

See Figure 7.13-3.

Figure 7.13-3. DICOM Model of the Real World - Implant Templates

7.13.3.2 Implant Assembly Template Information Entity

An Implant Assembly Template Information Entity specifies how to combine several implants to fulfill a certain purpose.

The Implant Assembly Template IE is related to Implant Template IEs.

7.13.3.3 Implant Template Group Information Entity

An Implant Template Group Information Entity specifies a set of Implant Templates for shared specification and management. It facilitates browsing through a set of similar implants by providing similar matching coordinates, and by ordering the referenced templates by dimensional size or similar attributes.

The Implant Template Group IE is related to Implant Template IEs.

7.13.4 Extension of The DICOM Model of The Real World For Protocol Storage

The DICOM Model of the Real World is extended with the addition of Defined Procedure Protocol and Performed Procedure Protocol objects whose relationship to existing DICOM Real World objects is shown in Figure 7.13.4-1.

Note that the information in the Equipment IE describes the equipment that created the Instance. The information in the Protocol Parameters may describe the equipment on which the protocol is intended to be executed which may or may not be the same as the equipment that created the Instance.

Figure 7.13.4-1. DICOM Model of the Real World - Protocol Storage

7.13.5 Approval Information Entity

An Approval Information Entity describes an approval of an Instance.

Figure 7.13.5-1. DICOM Model of the Real World - Approval

7.13.6 Inventory

Figure 7.13.6-1 shows the E-R diagram for the Inventory Information Model. The Inventory Information Entity provides an Inventory of Studies, and their component Series and SOP Instances, managed by a repository (such as a Picture Archiving and Communication System - PACS). The Inventory Information Model includes contextual information about each Study through the Patient and Imaging Service Request IEs. It includes information on the stored SOP Instances, including access mechanisms supported by the repository.

Note

This information model is similar to the Study Root Query/Retrieve Information Model (see Section C.6.2.1 in PS3.4).
There is a potentially complex relationship between the Study and Imaging Service Requests in the real world (e.g., see [IHE RAD TF-2] Section 4.6.4.1.2.3 Relationship between Scheduled and Performed Procedure Steps). However, the Inventory Information Model follows the basic Study Information Model and supports only a single Accession Number representing an Imaging Service Request (see Section C.7.2.1). Note that if a Study has multiple associated Imaging Service Requests, the request Attributes may be encoded at the Series level.

Figure 7.13.6-1. Inventory Information Model E-R Diagram

7.14 Extension of The DICOM Model of The Real-world for Radiotherapy Second Generation Information Objects

For the purpose of RT Second Generation SOP Classes the DICOM Model of the Real-World is described in this section. This subset of the real-world model covers the requirements for transferring information about planned and performed radiotherapeutic treatments and associated data.

Figure 7.14-1 describes the most important elements involved in the radiotherapy domain in DICOM.

Figure 7.14-1. DICOM Model of the Real World - Radiotherapy

Note

IODs which contain a representation of Volumes, Surfaces, Lines, Points can be annotated by an RT Segment Annotation.
For better readability the diagram only contains the most important relationships, e.g. all objects have a relation to the Patient, but not all of these relationships are part of this diagram.

7.14.1 RT Course

The RT Course is a top-level entity that represents a radiotherapy treatment course, usually specified in one or more RT Prescriptions, generally for a defined tumor or group of tumors. A patient undergoing treatments of radiotherapy has one treatment course at a time. The RT Course may consist of several RT Treatment Phases (possibly with breaks of treatment in between them). Each treatment phase may consist of one or more RT Treatment Sessions. An RT Treatment Session is delivered in one patient visit to a venue with a treatment machine and will typically deliver a fraction of one or more RT Radiation Sets. A new RT Course is administered, when the patient is treated for a re-occurrence or a new tumor site - typically after a period of a year or more after the previous RT Course has been finished.

The RT Course can be thought of as a container collecting all major objects which are relevant to this course. The RT Physician Intent and RT Radiation Sets reference other companion objects necessary to prepare, conduct and review the treatment. Timing information (start dates and phasing of treatment, breaks etc.) are also part of the RT Course information. Additionally it contains information of the ongoing status in treatment planning and delivery. The RT Course is a dynamic object that represents the current status of the patient"s treatment.

The RT Course may also include information about previously conducted treatments by referencing previous RT Course objects or by directly recording the information in Attributes.

7.14.2 RT Physician Intent

The RT Physician Intent describes how the physician wishes to achieve curative or palliative therapy. This information includes, but is not limited to the use of external radiation therapy or brachytherapy, total and fractional doses and fractionation schemes, treatment sites, Dosimetric Objectives, envisioned treatment technique, beam energy or isotopes, and patient setup notes.

7.14.3 Conceptual Volume

The Conceptual Volume is a reference to a certain anatomical region or point. Conceptual Volumes may or may not have a representation in segmented images. In most cases they will be related to one or more volumetric representations in various image sets taken at different times.

For example, during a radiotherapy course at the time of prescription, physicians specify regions to which dose is prescribed. Subsequently these regions are referenced in other objects in order to track calculated and delivered dose in the course of treatment. This referencing capability is provided by the Conceptual Volume.

7.14.4 RT Segment Annotation

The RT Segment Annotation annotates segmented regions defined in other SOP Instances with radiotherapy-specific information about the role and RT-specific types of the regions (e.g. clinical target volume, organ at risk, bolus), and other information such as density definitions. An RT Segment Annotation SOP Instance may reference any geometric general-purpose representation entity defined by DICOM.

7.14.5 RT Radiation Set

An RT Radiation Set is a collection of RT Radiations. An RT Radiation Set defines a Radiotherapy treatment fraction, which will be applied one or more times. The RT Radiation Set is delivered by delivering the radiation of all referenced RT Radiations.

Parallel and intermittent fractionation schemes, e.g. treatment of several target sites with different timing schemes, are represented by multiple RT Radiation Sets.

7.14.6 RT Radiation

An RT Radiation is a contiguous set of Control Points, describing machine and positioning parameters to be applied during treatment delivery. An RT Radiation describes one portion of an RT Radiation Set and represents an single-fraction delivery of therapeutic radiation intended to be delivered in an indivisible manner. An RT Radiation is typically referred to in end-user terminology as a beam (in external beam treatment) or a catheter (in brachytherapy).

7.14.7 RT Radiation Record

The RT Radiation Record records actual treatment parameters that have been applied during the delivery of an RT Radiation in the context of a specific fraction. Typically, those parameters are the same as those described within an RT Radiation, but may differ due to therapist decisions and/or circumstances of the delivery technology and/or for various other reasons.

7.14.8 RT Treatment Phase

An RT Course may be divided into multiple RT Treatment Phases. Each RT Treatment Phase represents a period of time during which a defined number of RT Treatment Fractions are delivered by RT Radiation Sets in order to reach a specific treatment goal (see Section 7.14.9 and Section 7.14.10).

An RT Treatment Phase also defines the chronological relationship between RT Radiation Sets that are concurrently and/or subsequently treated.

7.14.9 RT Fractionation, RT Fractionation Scheme

Fractionation describes the splitting of a course of therapeutic radiation delivery into multiple sessions. Each session may consist of the delivery of one or more RT Radiation Sets. The temporal pattern of session is called a fractionation scheme.

Further descriptions and examples of this such schemes can seen in Section 7.14.10.

7.14.10 RT Treatment Session, RT Treatment Fraction

An RT Treatment Session is a collection of RT treatment events that are performed in a contiguous manner without any break in-between (other than time needed for required preparations) during a single Visit. It is bound by the time period between the patient entering the treatment room and leaving the treatment room. In a treatment session one or more RT Radiation Sets (RSet in Figure 7.14-2) may be treated, each one instructed by an RT Radiation Set Delivery Instruction. An RT Treatment Session may also include imaging. A group of radiation deliveries that are separated by an intentional delay to accommodate radiobiological recovery effects are considered separate Treatment Sessions.

The Treatment Session UID (300A,0700), if present, uniquely identifies a RT Treatment Session.

Each treatment of an RT Radiation Set is labeled as an RT Treatment Fraction (often abbreviated as Fx) with a fraction number starting with 1 at the first RT Treatment Session in which the RT Radiation Set is delivered, incremented by 1 at each subsequent treatment session.

An RT Treatment Fraction is the delivery of a portion of the total dose (whose delivery is defined by an RT Radiation Set) which has been divided equally into smaller doses to be delivered over a period of time (e.g. daily for 4-6 weeks). In radiotherapy, this division of dose over a period of time is known as dose fractionation.

Figure 7.14-2. RT Treatment Phase, RT Treatment Session, RT Treatment Fraction

Partial treatments annotate RT Treatment Fractions, that are not completely performed for any reason (e.g. patient sickness, delivery device breakdown). The remainder of the RT Treatment Fraction is usually delivered at a later time. This remaining portion has the same fraction number as the one of the Partial Treatment Fraction. Further treatments will start a new RT Treatment Fraction with an incremented fraction number.

In Figure 7.14-3, the shaded areas of each Radiation Set represent the portion where dose is actually delivered. Partially shaded Radiation Sets therefore represents a partial treatment.

Figure 7.14-3. Partial RT Treatment Fraction and Resumption

7.14.11 Dosimetric Objective

The Dosimetric Objective Macro specifies an intended goal to be used in the definition of the dosimetric plan for plan optimization etc. Dosimetric Objectives may define limits which affect the dose, such as dose volume constraints, minimum or maximum dose, treatment time or MU limits, and radiobiologic effects.

8 Encoding of Coded Entry Data

The primary method of incorporating coded entry data in DICOM IODs is the Code Sequence Attribute. Code Sequence Attributes are encoded as a Sequence of Items using a Macro that is described in this section. These Attributes typically include the string "Code Sequence" in the Attribute Name. Their purpose is to encode terms by using codes from Coding Schemes.

Note

In this Standard, Code Sequence Attributes are defined for a variety of concepts, for example: Primary Anatomic Structure Sequence (0008,2228) and other Attributes to describe anatomy; and Intervention Drug Code Sequence (0018,0029), to document administration of drugs that have special significance in Imaging Procedures.

Each Item of a Code Sequence Attribute contains the triplet of Coding Scheme Designator (0008,0102), the Code Value (0008,0100) (or Long Code Value (0008,0119) or URN Code Value (0008,0120)), and Code Meaning (0008,0104). Other optional and conditional Attributes may also be present.

For any particular Code Sequence Attributes, the range of codes that may be used for that Attribute (the Value Set) may be suggested or constrained by specification of a Context Group. The Module or Template in which the Attribute is used will specify whether or not the context group is baseline or defined. A Baseline Context Group lists codes for terms that are suggested and may be used, but are not required to be used. A Defined Context Group lists codes for terms that shall be used if the term is used.

Context Groups are defined in a Mapping Resource, such as the DICOM Content Mapping Resource (DCMR) specified in PS3.16. Context Groups consist of lists of contextually related coded concepts, including Code Value (0008,0100) (or Long Code Value (0008,0119) or URN Code Value (0008,0120)) and Coding Scheme Designator (0008,0102). Each concept is unique within the Context Group and identified by its Code Value (0008,0100) (or Long Code Value (0008,0119) or URN Code Value (0008,0120)) and Coding Scheme Designator (0008,0102). The Context Group specification identifies whether it is extensible, i.e., whether it may be modified in an Application to use additional terms (see PS3.16). Whether a Context Group is used as a Baseline or Defined Context Group is defined not in the mapping resource, but rather in the Template or Module in which the Code Sequence Attribute is used.

Context Groups are identified by labels referred to as Context Identifiers (CID). Formally, the Context Identifier (0008,010F) specifies the context of use, not the specific list of coded values selected for that context of use in the Context Group. The set of values specified in the Standard for a particular context may change over time, and set of values used by an Application Entity for a particular context may include a local or private extension beyond the Standard value set.

Note

A specific set of coded values used by an Application Entity is therefore identified by the Mapping Resource (0008,0105), plus the Context Identifier (0008,010F), plus the Context Group Version (0008,0106), plus the identifiers for any private extension.
The use by an Application Entity of coded terms not in the Standard specified Context Group does not require the explicit identification of a private extension. The Application Entity is then the implicit source of the extension.
For the purpose of harmonization with HL7 vocabulary concepts, Context Groups are equivalent to HL7 Value Sets.

8.1 Code Value

Code Value (0008,0100) is an identifier that is unambiguous within the Coding Scheme denoted by Coding Scheme Designator (0008,0102) and Coding Scheme Version (0008,0103).

The Long Code Value (0008,0119) or URN Code Value (0008,0120) is only used for codes that exceed the 16 character size limit of Code Value (0008,0100). If the length of the code value exceeds 16, the Code Value (0008,0100) shall not be present. If the length of the code value is 16 characters or less, the Code Value (0008,0100) shall contain the code and neither Long Code Value (0008,0119) nor URN Code Value (0008,0120) shall be present. The URN Code Value (0008,0120) shall be used for codes that are represented using URN or URL notation. The Long Code Value (0008,0119) shall be used for codes that are represented using other notations and that exceed 16 characters in length.

Note

The Code Value is typically not a natural language string, e.g., "76752008".

8.2 Coding Scheme Designator and Coding Scheme Version

The Attribute Coding Scheme Designator (0008,0102) identifies the Coding Scheme in which the code for a term is defined. Standard Coding Scheme designators used in DICOM information interchange are listed in PS3.16. Other Coding Scheme designators, for both private and public Coding Schemes, may be used, in accordance with PS3.16. Further identification of the Coding Scheme designators used in a SOP Instance may be provided in the Coding Scheme Identification Sequence (0008,0110) (see Section C.12.1).

Note

Typical Coding Schemes used in DICOM include "DCM" for DICOM defined codes, "SCT" for SNOMED CT, and "LN" for LOINC. See Annex 8 “Coding Schemes” in PS3.16.
Coding Scheme designators beginning with "99" and the Coding Scheme designator "L" are defined in HL7 V2 to be private or local Coding Schemes.
Most IODs that define the use of coded terms provide for the use of private codes and Coding Schemes through replacement of Baseline Context Groups or extension of Defined Context Groups. Systems supporting such private code use must provide a mechanism for the configuration of sets of Coding Scheme Designator (0008,0102), Code Value (0008,0100) (or Long Code Value (0008,0119) or URN Code Value (0008,0120)), and Code Meaning (0008,0104) to support interoperation of the private codes with other systems.
It is highly recommended that local or non-standard Coding Schemes be identified in the Coding Scheme Identification Sequence (0008,0110). Documents or machine readable representations of the Coding Scheme (e.g., CSV or OWL files) can be linked to via a Coding Scheme URL (0008,010E). For appropriate values, see Table 8-1 “Coding Schemes” in PS3.16 .
URN and URL codes usually lack a Coding Scheme Designator (0008,0102).

The Attribute Coding Scheme Version (0008,0103) may be used to identify the version of a Coding Scheme if necessary to resolve ambiguity in Code Value (0008,0100), Long Code Value (0008,0119) or URN Code Value (0008,0120). Coding Scheme Version (0008,0103) is not required for backward-compatible revisions of a Coding Scheme, as the Coding Scheme Designator (0008,0102) identifies the Coding Scheme as a whole as currently published by the responsible organization.

Note

See PS3.16 for a discussion of SNOMED Coding Scheme Designators 99SDM, SNM3, SRT and SCT.
ICD-10, for example, is not a backward-compatible revision of ICD-9, and hence it has a different Coding Scheme Designator, not simply a different Coding Scheme Version.

8.3 Code Meaning

Code Meaning (0008,0104) is text that has meaning to a human and conveys the meaning of the term defined by the combination of Code Value (0008,0100) (or Long Code Value (0008,0119) or URN Code Value (0008,0120)), and Coding Scheme Designator (0008,0102). Though such a meaning can be "looked up" in the dictionary for the Coding Scheme, it is encoded for the convenience of applications that do not have access to such a dictionary.

It should be noted that for a particular Coding Scheme Designator (0008,0102) and Code Value (0008,0100) or Long Code Value (0008,0119), or URN Code Value (0008,0120), several alternative values for Code Meaning (0008,0104) may be defined. These may be synonyms in the same language or translations of the Coding Scheme into other languages. Hence the Value of Code Meaning (0008,0104) shall never be used as a key, index or decision value, rather the combination of Coding Scheme Designator (0008,0102) and Code Value (0008,0100), Long Code Value (0008,0119), or URN Code Value (0008,0120) may be used. Code Meaning (0008,0104) is a purely annotative, descriptive Attribute.

This does not imply that Code Meaning (0008,0104) can be filled with arbitrary free text. Available values from the Coding Scheme or translation in the chosen language shall be used.

8.4 Mapping Resource

The Value of Mapping Resource (0008,0105) denotes the message/terminology Mapping Resource that specifies the Context Group that specifies the Value Set. The Defined Terms for the Value of Mapping Resource (0008,0105) shall be:

Defined Terms:

DCMR: DICOM Content Mapping Resource
SDM: SNOMED DICOM Microglossary (Retired)

PS3.16 specifies the DICOM Content Mapping Resource (DCMR).

Note

Unless otherwise specified, the DCMR is the source of all Context Groups and Templates specified in this Standard.

Mapping Resources may be uniquely identified by Mapping Resource UID (0008,0118).

Private Mapping Resources (those not listed amongst the Defined Terms in this section), may be identified by the prefix "99".

Mapping Resource Name (0008,0122) may contain the name of the Mapping Resource. The value may e.g., denote the Institution or organization that has specified the Value Set.

8.5 Context Group Version

Context Group Version (0008,0106) conveys the version of the Context Group identified by Context Identifier (0008,010F). This Attribute uses VR DT, but for Context Groups defined in PS3.16 the precision of Context Group Version (0008,0106) is limited to the day, and the time zone offset is not used.

8.6 Context Identifier and Context UID

The Value of Context Identifier (0008,010F) identifies the Context Group defined by Mapping Resource (0008,0105) from which the Values of Code Value (0008,0100) (or Long Code Value (0008,0119) or URN Code Value (0008,0120)) and Code Meaning (0008,0104) were selected, or to which Code Value (0008,0100) (or Long Code Value (0008,0119) or URN Code Value (0008,0120)) and Code Meaning (0008,0104) have been added as a private Context Group extension (see Section 8.7). The Context Identifier (0008,010F) uses VR CS, and for Context Groups defined in PS3.16 the Value shall be the Context Group Identifier as a string of digits without leading zeros, and does not include the string "CID".

The Value of Context UID (0008,0117) uniquely identifies the Context Group. See PS3.6.

Note

Privately defined Context Groups may be identified by Context Identifier and Mapping Resource.

8.7 Context Group Extensions

Context Group Extension Flag (0008,010B) may be used to designate a pair of Code Value (0008,0100) (or Long Code Value (0008,0119) or URN Code Value (0008,0120)) and Code Meaning (0008,0104) as a selection from a private extension of a Context Group. If the Context Group Extension Flag (0008,010B) is present, and has a Value of "Y", Context Group Extension Creator UID (0008,010D) shall be used to identify the person or organization who created the extension to the Context Group. Context Group Local Version (0008,0107) conveys an implementation-specific private version DateTime of a Context Group that contains private extensions.

Note

These Attributes provide the means for implementations to extend code sets conveniently, while preserving referential integrity with respect to the original Context Group Version (0008,0106).
The locally-defined (private) Value of Context Group Local Version (0008,0107) typically would be a more recent date than the standard Value of Context Group Version (0008,0106) specified in the standard message/terminology Mapping Resource that defines the Context Group.

8.8 Standard Attribute Sets for Code Sequence Attributes

Table 8.8-1 specifies the default set of Attributes encapsulated in the Items of Code Sequence Attributes. These Attributes comprise the Code Sequence Macro.

Note

The instruction "Include Table 8.8-1 “Code Sequence Macro Attributes” " may be used in an IOD as a concise way to indicate that the Attributes of Table 8.8-1 are included in the specification of the Attribute Set of a Sequence of Items. Additional constraints on the Code Sequence Data Element (such as a Context Group that defines the value set) may be appended to the "Include Table 8.8-1 “Code Sequence Macro Attributes” " instruction.

The default specifications of this Section are overridden within the scope of a Sequence Item or Code Sequence Attribute or IOD by corresponding specifications defined within the scope of that Sequence Item or Code Sequence Attribute or IOD. Additional Attributes may also be specified by the instantiation of the Macro.

The Basic Coded Entry Attributes fully define a Coded Entry. If it is desired to convey the list from which a code has been chosen, then the optional Enhanced Encoding Mode Attributes may also be present.

Table 8.8-1a. Basic Code Sequence Macro Attributes

Attribute Name	Tag	Type	Attribute Description
BASIC CODED ENTRY ATTRIBUTES
Code Value	(0008,0100)	1C	The identifier of the Coded Entry. See Section 8.1. Shall be present if the length of the code value is 16 characters or less, and the code value is not a URN or URL.
Coding Scheme Designator	(0008,0102)	1C	The identifier of the Coding Scheme in which the Coded Entry is defined. See Section 8.2. Shall be present if Code Value (0008,0100) or Long Code Value (0008,0119) is present. May be present otherwise.
Coding Scheme Version	(0008,0103)	1C	An identifier of the version of the Coding Scheme if necessary to resolve ambiguity. See Section 8.2. Required if the Value of Coding Scheme Designator (0008,0102) is present and is not sufficient to identify the Code Value (0008,0100) or Long Code Value (0008,0119) unambiguously. Shall not be present if Coding Scheme Designator (0008,0102) is absent. May be present otherwise.
Code Meaning	(0008,0104)	1	Text that conveys the meaning of the Coded Entry. See Section 8.3.
Long Code Value	(0008,0119)	1C	The identifier of the Coded Entry. See Section 8.1. Shall be present if Code Value (0008,0100) is not present and the Code Value is not a URN or URL.
URN Code Value	(0008,0120)	1C	The identifier of the Coded Entry. See Section 8.1. Shall be present if Code Value (0008,0100) is not present and the Code Value is a URN or URL.

Table 8.8-1b. Enhanced Code Sequence Macro Attributes

Attribute Name	Tag	Type	Attribute Description
Context Identifier	(0008,010F)	3	The identifier of the Context Group from which the Coded Entry was selected. See Section 8.6.
Context UID	(0008,0117)	3	The unique identifier of the Context Group from which the Coded Entry was selected. See Section 8.6.
Mapping Resource	(0008,0105)	1C	The identifier of the Mapping Resource that defines the Context Group from which Coded Entry was selected. See Section 8.4. Required if Context Identifier (0008,010F) is present.
Mapping Resource UID	(0008,0118)	3	The unique identifier of the Mapping Resource that defines the Context Group from which Coded Entry was selected. Note The unique identifier for the DICOM Content Mapping Resource "DCMR" is defined in PS3.6.
Mapping Resource Name	(0008,0122)	3	The name of the Mapping Resource that defines the Context Group from which Coded Entry was selected. See Section 8.4.
Context Group Version	(0008,0106)	1C	The identifier of the version of the Context Group from which the Coded Entry was selected. See Section 8.5. Required if Context Identifier (0008,010F) is present.
Context Group Extension Flag	(0008,010B)	3	Indicates whether the triplet of Code Value (0008,0100) (or Long Code Value (0008,0119) or URN Code Value (0008,0120))/Coding Scheme Designator (0008,0102)/Code Meaning (0008,0104) is selected from a private extension of the Context Group identified in Context Identifier (0008,010F). See Section 8.7. Enumerated Values: Y N
Context Group Local Version	(0008,0107)	1C	An implementation-specific version of a Context Group that contains private extensions. See Section 8.7. Required if the Value of Context Group Extension Flag (0008,010B) is "Y".
Context Group Extension Creator UID	(0008,010D)	1C	Identifies the person or organization who created an extension to the Context Group. See Section 8.7. Required if the Value of Context Group Extension Flag (0008,010B) is "Y".

Table 8.8-1. Code Sequence Macro Attributes

Attribute Name	Tag	Type	Attribute Description
BASIC CODED ENTRY ATTRIBUTES
Include Table 8.8-1a
Equivalent Code Sequence	(0008,0121)	3	Codes that are considered equivalent by the creating system. One or more Items are permitted in this Sequence. See Section 8.9.
>Include Table 8.8-1a
>Include Table 8.8-1b
ENHANCED ENCODING MODE
Include Table 8.8-1b

8.9 Equivalent Code Sequence

The Equivalent Code Sequence (0008,0121) may optionally be used to convey different codes for the same concept.

Equivalence is defined as having the same or similar meaning, and requires that equivalent concepts do not include different aspects, properties, features, characteristics, or parameters.

Note

E.g., the SNOMED and FMA codes for a structure of the breast, (76752008, SCT, "Breast") and (57983, FMA, "Breast") would be considered equivalent. Neither would be equivalent to concepts that pre-coordinated other aspects such as laterality, e.g., (80248007, SCT, "Left breast"), or entire body organ, e.g., (181131000, SCT, "Entire breast").

Some scenarios in which it is helpful for the creating system to send equivalent codes include:

when different representations of the same concept are present in a standard Coding Scheme, such as the SNOMED-CT and SNOMED-RT and CTV3 style identifiers,
when the same concept is present in different standard Coding Schemes, but considered by the creating system to be synonymous, such as anatomical concepts from SNOMED and FMA, and
when the same concept is present in a local as well as a standard Coding Scheme, but considered by the creating system to be synonymous, such as a local private procedure code and the same concept in LOINC or SNOMED or RADLEX.

The Table 8.8-1b may be used to identify a Context Group from which the codes were selected, such as for a particular cross-institutional, cross-application context for trials, research and knowledge-based applications.

8.10 Coded Entry Data Examples

An example of a long SNOMED CT code encoding as an Item in a Sequence:

Nesting	Attribute Name	Tag	VR	Value
%item
>	Coding Scheme Designator	(0008,0102)	SH	SCT
>	Code Meaning	(0008,0104)	LO	Invasive diagnostic procedure
>	Long Code Value	(0008,0119)	UC	621566751000087104
%enditem

Note

SCT:621566751000087104 is not included in the SNOMED CT DICOM Subset and is not present in the SNOMED CT INT release. It is from the Canadian National Extension and is used here only as an example.

An example of a short SNOMED CT with equivalent SNOMED SRT and CTV3 (Read) codes as an Item in a Sequence:

Nesting	Attribute Name	Tag	VR	Value
%item
>	Code Value	(0008,0100)	SH	406400000
>	Coding Scheme Designator	(0008,0102)	SH	SCT
>	Code Meaning	(0008,0104)	LO	Dimeglumine gadopentetate 469.01mg/mL inj soln 15mL pfld syr
>	Equivalent Code Sequence	(0008,0121)	SQ
%sequence
%item
>>	Code Value	(0008,0100)	SH	C-B0478
>>	Coding Scheme Designator	(0008,0102)	SH	SRT
>>	Code Meaning	(0008,0104)	LO	Dimeglumine gadopentetate 469.01mg/mL inj soln 15mL pfld syr
%enditem
%item
>>	Code Value	(0008,0100)	SH	XUaZB
>>	Coding Scheme Designator	(0008,0102)	SH	CTV3
>>	Code Meaning	(0008,0104)	LO	Dimeglumine gadopentetate 469.01mg/mL inj soln 15mL pfld syr
%enditem
%endseq
%enditem

Note

SCT:406400000 is not included in the SNOMED CT DICOM Subset and is used here only as an example.

An example of encoding a long URN as an Item in a Sequence.

Nesting	Attribute Name	Tag	VR	Value
%item
>	Code Meaning	(0008,0104)	LO	HIPAA Privacy Rule
>	URN Code Value	(0008,0120)	UR	urn:lex:us:federal:codified.regulation:2013-04-25;45CFR164
%enditem

8.11 Retired Codes and Expected Behavior

As this Standard and external Coding Schemes are maintained, the codes specified as values for Code Sequence Attributes and in Conditions may change. The previous codes are considered Retired but implementations may continue to send them and receivers will be expected to be able to continue to recognize the Retired codes, including the Code Value (0008,0100) and Coding Scheme Designator (0008,0102) Values, even if the current Standard does not publish them.

A notable example is the change throughout the Standard from using "SNOMED-RT style" code values with a Coding Scheme Designator (0008,0102) of "SRT", "SNM3" or "99SDM", to the use of SNOMED CT numeric code values with a Coding Scheme Designator (0008,0102) of "SCT". Those retired codes may be found in PS3.3-2019a. A mapping of retired to new SNOMED code values is found in Annex O “SNOMED Concept ID to SNOMED ID Mapping” in PS3.16.

9 Template Identification Macro (Retired)

Section 9 was defined in a previous release of the DICOM Standard (see PS3.3-2004). The Section is now retired, and its contents have been consolidated into Section C.18.8.

10 Miscellaneous Macros

10.1 Person Identification Macro

This Macro may be invoked to specify a coded representation of a person such as a healthcare worker, and the organization to which they are responsible.

Note

This Macro is typically invoked within a Sequence Item used to identify an individual such as a physician or a device operator.
The free-text name of the individual is not included in this Macro since there are already widely used specific Attributes to hold such values.
No Baseline, Defined or Enumerated CIDs are defined nor is any particular Coding Scheme specified. In practice, workers are usually identified by using a locally or nationally specific Coding Scheme. For example, a local Coding Scheme Designator might be used and the individual's internal hospital ID number user in Code Value.
The organization is specified by either a coded Sequence or a free text name but not both. A Baseline CID of standard organizations is provided for the purpose of identifying standard organizations responsible for creation of Well Known Instances.

Table 10-1. Person Identification Macro Attributes

Attribute Name	Tag	Type	Attribute Description
Person Identification Code Sequence	(0040,1101)	1	A coded entry that identifies a person. The Code Meaning Attribute, though it will be encoded with a VR of LO, may be encoded according to the rules of the PN VR (e.g., caret '^' delimiters shall separate name components), except that a single component (i.e., the whole name unseparated by caret delimiters) is not permitted. Name component groups for use with multi-byte character sets are permitted, as long as they fit within the 64 characters (the length of the LO VR). One or more Items shall be included in this Sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes”			No Baseline CID is defined.
Person's Address	(0040,1102)	3	Person's mailing address.
Person's Telephone Numbers	(0040,1103)	3	Person's telephone number(s).
Person's Telecom Information	(0040,1104)	3	The person's telecommunication contact information, including telephone, email, or other telecom addresses. Note This Attribute may have internal format or structure in accordance with local agreement or profile. In the absence of such agreement or prior formatting, use of ITU-T E.123 is suggested. It is recommended that this Attribute be treated as equivalent to HL7v2 (v2.5 or later) field ROL-12, and be formatted in accordance with the HL7v2 XTN data type (without escapes for HL7 message structure reserved characters). See additional notes in the Module invoking this Macro.
Institution Name	(0008,0080)	1C	Institution or organization to which the identified individual is responsible or accountable. Required if Institution Code Sequence (0008,0082) is not present. May be present otherwise.
Institution Address	(0008,0081)	3	Mailing address of the institution or organization to which the identified individual is responsible or accountable.
Institution Code Sequence	(0008,0082)	1C	Institution or organization to which the identified individual is responsible or accountable. Required if Institution Name (0008,0080) is not present. May be present otherwise. Only a single Item shall be included in this Sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes”			BCID 5002 “Organization”.
Institutional Department Name	(0008,1040)	3	The Department, Unit or Service within the healthcare facility.
Institutional Department Type Code Sequence	(0008,1041)	3	A coded description of the type of Department or Service within the healthcare facility. Note This might be obtained from a corresponding HL7v2 message containing PV1:10 Hospital Service. Only a single Item is permitted in this Sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes”			BCID 7030 “Institutional Department/Unit/Service”.

10.2 Content Item Macro

A Content Item is a flexible means of encoding attribute identifiers and attribute values using the Code Sequence Macro (see Section 8) for coded terminology defined by a Coding Scheme. The Content Item provides a name-value pair, i.e., a Concept Name, encoded as a Code Sequence, and a Concept Value. The Concept Value may be encoded by any of a set of generic Attributes, as specified by a Value Type, including text, personal name, numeric, and coded concept (Code Sequence) Values.

Note

Comparing a Content Item to a native DICOM Data Element, the Concept Name Code Sequence (0040,A043) corresponds to the Data Element Tag and Attribute Name, the Value Type to the Value Representation, and the Concept Value to the Data Element Value Field. See PS3.5.
The IMAGE Value Type of this Macro does not include the Type 3 Attributes of the IMAGE Value Type defined in Section C.17.3, as they are not required for Acquisition Context or Protocol Context Content Items.

Specific uses of the Content Item may invoke the Content Item Macro defined in this Section, the Document Content Macro of Section C.17.3, or another similar construct. An invocation of the Content Item Macro may constrain the allowed Values of Value Type (0040,A040).

Note

The NUMERIC Value Type of this Macro differs from the NUM Value Type defined in Section C.17.3, since the encoding of the Concept Value is different.
The Value Type uses Enumerated Values so as to assure that non-standard Value Types are not used, and to prevent the nefarious use, for example, of a CONTAINER Value Type in an SR-like manner to create nested content, which is not the intent.
Some invocations of this Macro may use the Content Item Modifier Sequence (0040,0441) to achieve a single level of "nesting". That Attribute is not included in this Macro itself, to prevent recursive inclusion.

See Section 5.4 for the meaning of the Type column in this Macro when applied to Normalized IODs.

Table 10-2. Content Item Macro Attributes

Attribute Name	Tag	Type	Attribute Description
Value Type	(0040,A040)	1	The type of the value encoded in this name-value Item. Enumerated Values: DATE TIME DATETIME PNAME UIDREF TEXT CODE NUMERIC COMPOSITE IMAGE WAVEFORM
Observation DateTime	(0040,A032)	3	The date and time on which this Item was completed. For the purpose of recording measurements or logging events, completion time is defined as the ending time of data acquisition of the measurement, or the ending time of occurrence of the event.
Observation Start DateTime	(0040,A033)	3	The date and time on which this Item was started. For the purpose of recording measurements or logging events, start time is defined as the ending time of data acquisition of the measurement, or the start time of occurrence of the event.
Concept Name Code Sequence	(0040,A043)	1	Coded concept name of this name-value Item. Only a single Item shall be included in this Sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes”			No Baseline CID is defined.
DateTime	(0040,A120)	1C	DateTime value for this name-value Item. Required if Value Type (0040,A040) is DATETIME.
Date	(0040,A121)	1C	Date value for this name-value Item. Required if Value Type (0040,A040) is DATE.
Time	(0040,A122)	1C	Time value for this name-value Item. Required if Value Type (0040,A040) is TIME.
Person Name	(0040,A123)	1C	Person name value for this name-value Item. Required if Value Type (0040,A040) is PNAME.
UID	(0040,A124)	1C	UID value for this name-value Item. Required if Value Type (0040,A040) is UIDREF.
Text Value	(0040,A160)	1C	Text value for this name-value Item. Required if Value Type (0040,A040) is TEXT.
Concept Code Sequence	(0040,A168)	1C	Coded concept value of this name-value Item. Only a single Item shall be included in this Sequence. Required if Value Type (0040,A040) is CODE.
>Include Table 8.8-1 “Code Sequence Macro Attributes”			No Baseline CID is defined.
Numeric Value	(0040,A30A)	1C	Numeric value for this name-value Item. Only a single Value shall be present. Required if Value Type (0040,A040) is NUMERIC.
Floating Point Value	(0040,A161)	1C	The floating point representation of Numeric Value (0040,A30A). The same number of Values as Numeric Value (0040,A30A) shall be present. Required if Numeric Value (0040,A30A) has insufficient precision to represent the value as a string. May be present otherwise.
Rational Numerator Value	(0040,A162)	1C	The integer numerator of a rational representation of Numeric Value (0040,A30A), encoded as a signed integer value. The same number of Values as Numeric Value (0040,A30A) shall be present. Required if Numeric Value (0040,A30A) has insufficient precision to represent a rational value as a string. May be present otherwise.
Rational Denominator Value	(0040,A163)	1C	The integer denominator of a rational representation of Numeric Value (0040,A30A), encoded as a non-zero unsigned integer value. The same number of Values as Numeric Value (0040,A30A) shall be present. Required if Rational Numerator Value (0040,A162) is present.
Measurement Units Code Sequence	(0040,08EA)	1C	Units of measurement for a numeric value in this name-value Item. Only a single Item shall be included in this Sequence. Required if Value Type (0040,A040) is NUMERIC.
>Include Table 8.8-1 “Code Sequence Macro Attributes”			BCID 82 “Measurement Unit”.
Referenced SOP Sequence	(0008,1199)	1C	Composite SOP Instance Reference value for this name-value Item. Only a single Item shall be included in this Sequence. Required if Value Type (0040,A040) is COMPOSITE or IMAGE or WAVEFORM.
>Include Table 10-11 “SOP Instance Reference Macro Attributes”
>Referenced Frame Number	(0008,1160)	1C	Identifies the Frame numbers within the Referenced SOP Instance to which the reference applies. The first Frame shall be denoted as Frame number 1. Note This Attribute may be multi-valued. Required if the Referenced SOP Instance is a Multi-frame Image and the reference does not apply to all Frames, and Referenced Segment Number (0062,000B) is not present.
>Referenced Segment Number	(0062,000B)	1C	Identifies the segments to which the reference applies identified by Segment Number (0062,0004). Required if the Referenced SOP Instance is a Segmentation or Surface Segmentation and the reference does not apply to all segments and Referenced Frame Number (0008,1160) is not present.
>Referenced Waveform Channels	(0040,A0B0)	1C	List of channels in Waveform to which the reference applies. See Section C.18.5.1.1. Required if the Referenced SOP Instance is a Waveform that contains multiple Channels and the reference does not apply to all Channels of all Multiplex Groups.

10.2.1 Content Item With Modifiers Macro

Content Item with Modifiers is a means of describing structured content which needs a Content Item with single optional level of modifiers, i.e. a two-level structure of Content Items. An invocation of the Content Item with Modifiers Macro will usually specify the allowed values using a Protocol Context Template in PS3.16, which allows a single Nesting Level (see in Section 6.1.2 “Nesting Level (NL)” in PS3.16 ). Constraints on the use of this Macro may be specified in PS3.16 Annex C, which may be invoked in IODs in PS3.3.

Table 10.2.1-1. Content Item with Modifiers Macro Attributes

Attribute Name	Tag	Type	Attribute Description
Include Table 10-2 “Content Item Macro Attributes”	No Baseline TID is defined.
Content Item Modifier Sequence	(0040,0441)	3	Specifies modifiers for the Content Item. One or more Items are permitted in this Sequence.
>Include Table 10-2 “Content Item Macro Attributes”	No Baseline TID is defined.

Attribute Name

Tag

Type

Attribute Description

Include Table 10-2 “Content Item Macro Attributes”

No Baseline TID is defined.

Content Item Modifier Sequence

(0040,0441)

Specifies modifiers for the Content Item.

One or more Items are permitted in this Sequence.

>Include Table 10-2 “Content Item Macro Attributes”

No Baseline TID is defined.

10.3 Image SOP Instance Reference Macro

Table 10-3. Image SOP Instance Reference Macro Attributes

Attribute Name	Tag	Type	Attribute Description
Include Table 10-11 “SOP Instance Reference Macro Attributes”
Referenced Frame Number	(0008,1160)	1C	Identifies the Frame numbers within the Referenced SOP Instance to which the reference applies. The first Frame shall be denoted as Frame number 1. Note This Attribute may be multi-valued. Required if the Referenced SOP Instance is a Multi-frame Image and the reference does not apply to all Frames, and Referenced Segment Number (0062,000B) is not present.
Referenced Segment Number	(0062,000B)	1C	Identifies the Segment Number to which the reference applies. Required if the Referenced SOP Instance is a Segmentation or Surface Segmentation and the reference does not apply to all segments and Referenced Frame Number (0008,1160) is not present.

Attribute Name

Tag

Type

Attribute Description

Include Table 10-11 “SOP Instance Reference Macro Attributes”

Referenced Frame Number

(0008,1160)

Identifies the Frame numbers within the Referenced SOP Instance to which the reference applies. The first Frame shall be denoted as Frame number 1.

Note

This Attribute may be multi-valued.

Required if the Referenced SOP Instance is a Multi-frame Image and the reference does not apply to all Frames, and Referenced Segment Number (0062,000B) is not present.

Referenced Segment Number

(0062,000B)

Identifies the Segment Number to which the reference applies.

Required if the Referenced SOP Instance is a Segmentation or Surface Segmentation and the reference does not apply to all segments and Referenced Frame Number (0008,1160) is not present.

Table 10-3b “Referenced Instances and Access Macro Attributes” contains identifiers and access details for a collection of Instances. It is intended to provide sufficient information to retrieve the referenced Instances.

Table 10-3b. Referenced Instances and Access Macro Attributes

Attribute Name	Tag	Type	Attribute Description
Type of Instances	(0040,E020)	1	Type of object Instances referenced. Defined Terms: DICOM CDA
Study Instance UID	(0020,000D)	1C	Unique identifier for the Study. Required if Type of Instances (0040,E020) is DICOM and the Information Model of the referenced Instance contains the Study IE.
Series Instance UID	(0020,000E)	1C	Unique identifier for the Series that is part of the Study identified in Study Instance UID (0020,000D), if present, and contains the referenced object Instance(s). Required if Type of Instances (0040,E020) is DICOM and the Information Model of the referenced Instance contains the Series IE.
Referenced SOP Sequence	(0008,1199)	1	References to object Instances. One or more Items shall be included in this Sequence.
>Referenced SOP Class UID	(0008,1150)	1	Uniquely identifies the referenced SOP Class.
>Referenced SOP Instance UID	(0008,1155)	1	Uniquely identifies the referenced SOP Instance.
>HL7 Instance Identifier	(0040,E001)	1C	Instance Identifier of the encapsulated HL7 Structured Document, encoded as a UID (OID or UUID), concatenated with a caret ("^") and Extension value (if Extension is present in Instance Identifier). Required if Type of Instances (0040,E020) is CDA.
>Referenced Frame Number	(0008,1160)	1C	Identifies the Frame numbers within the Referenced SOP Instance to which the reference applies. The first Frame shall be denoted as Frame number 1. Note This Attribute may be multi-valued. Required if the Referenced SOP Instance is a Multi-frame Image and the reference does not apply to all Frames, and Referenced Segment Number (0062,000B) is not present.
>Referenced Segment Number	(0062,000B)	1C	Identifies the Segment Number to which the reference applies. Required if the Referenced SOP Instance is a Segmentation and the reference does not apply to all segments and Referenced Frame Number (0008,1160) is not present.
DICOM Retrieval Sequence	(0040,E021)	1C	Details for retrieving Instances via the DICOM Retrieve Service. Required if DICOM Media Retrieval Sequence (0040,E022), WADO Retrieval Sequence (0040,E023), WADO-RS Retrieval Sequence (0040,E025) and XDS Retrieval Sequence (0040,E024) are not present. May be present otherwise. This Sequence shall only identify sources known to have Instances referenced in Referenced SOP Sequence (0008,1199). One or more Items shall be included in this Sequence.
>Retrieve AE Title	(0008,0054)	1	Title of a DICOM Application Entity where the referenced Instance(s) may be retrieved on the network.
DICOM Media Retrieval Sequence	(0040,E022)	1C	Details for retrieving Instances from Media. Required if DICOM Retrieval Sequence (0040,E021), WADO Retrieval Sequence (0040,E023), and WADO-RS Retrieval Sequence (0040,E025) and XDS Retrieval Sequence (0040,E024) are not present. May be present otherwise. This Sequence shall only identify media known to have Instances referenced in Referenced SOP Sequence (0008,1199). One or more Items shall be included in this Sequence.
>Storage Media File-Set ID	(0088,0130)	2	The user or implementation specific human readable identifier that identifies the Storage Media on which the referenced Instance(s) reside.
>Storage Media File-Set UID	(0088,0140)	1	Uniquely identifies the Storage Media on which the referenced Instance(s) reside.
WADO Retrieval Sequence	(0040,E023)	1C	Details for retrieving Instances available via WADO-URI. Note This Sequence addresses use of the URI-based Web Access to DICOM Objects. Retrieval via the IHE XDS-I.b RAD-69 Transaction [IHE RAD TF-2] is addressed in the XDS Retrieval Sequence (0040,E024). Required if DICOM Retrieval Sequence (0040,E021), DICOM Media Retrieval Sequence (0040,E022), WADO-RS Retrieval Sequence (0040,E025) and XDS Retrieval Sequence (0040,E024) are not present. May be present otherwise. One or more Items shall be included in this Sequence.
>Retrieve URI	(0040,E010)	1	URI/URL specifying the location of the referenced Instance(s). Includes fully specified scheme, authority, path, and query in accordance with [RFC3986]. Note The VR of this Data Element has changed from UT to UR.
XDS Retrieval Sequence	(0040,E024)	1C	Details for retrieving Instances using the IHE XDS-I.b RAD-69 Transaction. Note Retrieval via WADO-URI is addressed by the WADO Retrieval Sequence (0040,E023). Retrieval via WADO-RS is addressed by the WADO-RS Retrieval Sequence (0040,E025). Required if DICOM Retrieval Sequence (0040,E021), DICOM Media Retrieval Sequence (0040,E022), WADO-RS Retrieval Sequence (0040,E025) and WADO Retrieval Sequence (0040,E023) are not present. May be present otherwise. This Sequence shall only identify repositories known to have Instances referenced in Referenced SOP Sequence (0008,1199). One or more Items shall be included in this Sequence.
>Repository Unique ID	(0040,E030)	1	Uniquely identifies a Repository from which the referenced Instances can be retrieved.
>Home Community ID	(0040,E031)	3	Uniquely identifies a Community to which requests for the referenced Instances can be directed.
WADO-RS Retrieval Sequence	(0040,E025)	1C	Details for retrieving Instances via WADO-RS. Note Retrieval via WADO-URI is addressed in the WADO Retrieval Sequence (0040,E023). Retrieval via the IHE XDS-I.b RAD-69 Transaction [IHE RAD TF-2] is addressed in the XDS Retrieval Sequence (0040,E024). Required if DICOM Retrieval Sequence (0040,E021), DICOM Media Retrieval Sequence (0040,E022), WADO Retrieval Sequence (0040,E023) and XDS Retrieval Sequence (0040,E024) are not present. May be present otherwise. One or more Items shall be included in this Sequence.
>Retrieve URL	(0008,1190)	1	URL specifying the location of the referenced Instance(s).

Table 10-3c “Storage Macro Attributes” contains details for where and how to store Instances. It is intended to provide sufficient information to store Instances to the correct location.

This Macro mirrors Table 10-3b “Referenced Instances and Access Macro Attributes”.

Table 10-3c. Storage Macro Attributes

Attribute Name	Tag	Type	Attribute Description
Referenced SOP Class UID	(0008,1150)	1C	Uniquely identifies the referenced SOP Class. Required if the storage request only applies to a specific SOP Class.
DICOM Storage Sequence	(0040,4071)	1C	Details for storing Instances via the DICOM Storage Service. Required if STOW-RS Storage Sequence (0040,4072) or XDS Storage Sequence (0040,4074) is not present. May be present otherwise. One or more Items shall be included in this Sequence.
>Destination AE	(2100,0140)	1	Title of a DICOM Application Entity to which Instances will be stored.
STOW-RS Storage Sequence	(0040,4072)	1C	Details for storing Instances via STOW-RS. Required if DICOM Storage Sequence (0040,4071) and XDS Storage Sequence (0040,4074) are not present. May be present otherwise. One or more Items shall be included in this Sequence.
>Storage URL	(0040,4073)	1	URI/URL specifying the location of the STOW-RS storage service to which Instances will be stored. The Value shall be a fully specified URI with protocol, authority and path, in accordance with [RFC3986] and Section 10.5 “Store Transaction” in PS3.18.
XDS Storage Sequence	(0040,4074)	1C	Details for storing Instances via the IHE Provide and Register Document Set-b (ITI-41) transaction [IHE ITI TF-2b]. Required if STOW-RS Storage Sequence (0040,4072) and DICOM Storage Sequence (0040,4071) are not present. May be present otherwise. One or more Items shall be included in this Sequence.
>Repository Unique ID	(0040,E030)	1	Uniquely identifies a Repository from which the referenced Instances can be retrieved.
>Home Community ID	(0040,E031)	3	Uniquely identifies a Community to which requests for the referenced Instances can be directed.

10.4 Series and Instance Reference Macro

Table 10-4 specifies the Attributes of the Series and Instance Reference Macro, which lists Series, and SOP Instances within those Series.

Table 10-4. Series and Instance Reference Macro Attributes

Attribute Name	Tag	Type	Attribute Description
Referenced Series Sequence	(0008,1115)	1	Sequence of Items each of which includes the Attributes of one Series. One or more Items shall be included in this Sequence.
>Series Instance UID	(0020,000E)	1	Unique identifier of the Series containing the referenced Instances.
>Referenced Instance Sequence	(0008,114A)	1	Sequence of Items each providing a reference to an Instance that is part of the Series defined by Series Instance UID (0020,000E) in the enclosing Item. One or more Items shall be included in this Sequence.
>>Include Table 10-11 “SOP Instance Reference Macro Attributes”

10.5 General Anatomy Macros

Table 10-5, Table 10-6, Table 10-7 and Table 10-7b specify the Attributes for identifying the general region of the Patient anatomy examined using coded terminology, as well as the principal structure(s) within that region that is the target of the current SOP Instance. The only differences between the Macros are the Type and Number of Items of the Anatomic Region Sequence (0008,2218). Table 10-8 describe the Attributes for the coding of the principal structure only.

The invocation of these Macros may specify Baseline or Defined CIDs for the Anatomic Region Sequence (0008,2218), the Anatomic Region Modifier Sequence (0008,2220), and/or the Primary Anatomic Structure Sequence (0008,2228).

The general region of the body (e.g., the anatomic region, organ, or body cavity being examined) is identified by the Anatomic Region Sequence (0008,2218). Characteristics of the anatomic region being examined, such as sub-region (e.g., medial, lateral, superior, inferior, lobe, quadrant) and laterality (e.g., right, left, both), may be refined by the Anatomic Region Modifier Sequence (0008,2220).

Note

These Attributes allow the specification of the information encoded by the Body Part Examined (0018,0015) in the General Series Module in a more robust, consistent way.

The specific anatomic structures of interest within the image (e.g., a particular artery within the anatomic region) is identified by the Primary Anatomic Structure Sequence (0008,2228). Characteristics of the anatomic structure, such as its location (e.g., subcapsular, peripheral, central), configuration (e.g., distended, contracted), and laterality (e.g., right, left, both), and so on, may be refined by the Primary Anatomic Structure Modifier Sequence (0008,2230).

Note

Laterality is often encoded in a separate Attribute, Image Laterality (0020,0062) or Frame Laterality (0020,9072), rather than in Anatomic Region Modifier Sequence (0008,2220) or Primary Anatomic Structure Modifier Sequence (0008,2230). The correspondence between the values is as follows:

Image Laterality (0020,0062) or Frame Laterality (0020,9072)	Coded Modifier
L	(7771000, SCT, "Left")
R	(24028007, SCT, "Right")
U	(66459002, SCT, "Unilateral")
B	(51440002, SCT, "Bilateral")

The codes illustrated are from CID 244 “Laterality”.

Whether or not various anatomical structures may be paired or unpaired (have laterality) is illustrated in Table L-5 “Pairedness of Anatomic Concepts” in PS3.16.

Table 10-5. General Anatomy Mandatory Macro Attributes

Attribute Name	Tag	Type	Attribute Description
Anatomic Region Sequence	(0008,2218)	1	Sequence that identifies the anatomic region of interest in this Instance (i.e., external anatomy, surface anatomy, or general region of the body). Only a single Item shall be included in this Sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes”			CID may be defined in the Macro invocation.
>Anatomic Region Modifier Sequence	(0008,2220)	3	Sequence of Items that modifies the anatomic region of interest of this Instance. One or more Items are permitted in this Sequence.
>>Include Table 8.8-1 “Code Sequence Macro Attributes”			DCID 2 “Anatomic Modifier”, unless otherwise defined in the Macro invocation.
Include Table 10-8 “Primary Anatomic Structure Macro Attributes”			CID may be defined in the Macro invocation.

Table 10-6. General Anatomy Required Macro Attributes

Attribute Name	Tag	Type	Attribute Description
Anatomic Region Sequence	(0008,2218)	2	Sequence that identifies the anatomic region of interest in this Instance (i.e., external anatomy, surface anatomy, or general region of the body). Zero or one Item shall be included in this Sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes”			CID may be defined in the Macro invocation.
>Anatomic Region Modifier Sequence	(0008,2220)	3	Sequence of Items that modifies the anatomic region of interest of this Instance One or more Items are permitted in this Sequence.
>>Include Table 8.8-1 “Code Sequence Macro Attributes”			DCID 2 “Anatomic Modifier”, unless otherwise defined in the Macro invocation.
Include Table 10-8 “Primary Anatomic Structure Macro Attributes”			CID may be defined in the Macro invocation.

Table 10-7. General Anatomy Optional Macro Attributes

Attribute Name	Tag	Type	Attribute Description
Anatomic Region Sequence	(0008,2218)	3	Sequence that identifies the anatomic region of interest in this Instance (i.e., external anatomy, surface anatomy, or general region of the body). Only a single Item is permitted in this Sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes”			CID may be defined in the Macro invocation.
>Anatomic Region Modifier Sequence	(0008,2220)	3	Sequence of Items that modifies the anatomic region of interest of this Instance One or more Items are permitted in this Sequence.
>>Include Table 8.8-1 “Code Sequence Macro Attributes”			DCID 2 “Anatomic Modifier”, unless otherwise defined in the Macro invocation.
Include Table 10-8 “Primary Anatomic Structure Macro Attributes”			CID may be defined in the Macro invocation.

Table 10-7b. Multiple Site General Anatomy Optional Macro Attributes

Attribute Name	Tag	Type	Attribute Description
Anatomic Region Sequence	(0008,2218)	3	Sequence that identifies the anatomic region of interest in this Instance (i.e., external anatomy, surface anatomy, or general region of the body). One or more Items are permitted in this Sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes”			CID may be defined in the Macro invocation.
>Anatomic Region Modifier Sequence	(0008,2220)	3	Sequence of Items that modifies the anatomic region of interest in this Instance One or more Items are permitted in this Sequence.
>>Include Table 8.8-1 “Code Sequence Macro Attributes”			DCID 2 “Anatomic Modifier”, unless otherwise defined in the Macro invocation.
Include Table 10-8 “Primary Anatomic Structure Macro Attributes”			CID may be defined in the Macro invocation.

Table 10-8. Primary Anatomic Structure Macro Attributes

Attribute Name	Tag	Type	Attribute Description
Primary Anatomic Structure Sequence	(0008,2228)	3	Sequence of Items that identifies the primary anatomic structure(s) of interest in this Instance. One or more Items are permitted in this Sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes”			CID may be defined in the Macro invocation.
>Primary Anatomic Structure Modifier Sequence	(0008,2230)	3	Sequence of Items that modifies the primary anatomic structure of interest in this Instance. One or more Items are permitted in this Sequence.
>>Include Table 8.8-1 “Code Sequence Macro Attributes”			DCID 2 “Anatomic Modifier”.

10.6 Request Attributes Macro

Table 10-9. Request Attributes Macro Attributes

Attribute Name	Tag	Type	Attribute Description
Requested Procedure ID	(0040,1001)	1C	Identifier that identifies the Requested Procedure in the Imaging Service Request. Required if procedure was scheduled. May be present otherwise. Note The condition is to allow the contents of this Macro to be present (e.g., to convey the reason for the procedure, such as whether a mammogram is for screening or diagnostic purposes) even when the procedure was not formally scheduled and a value for this identifier is unknown, rather than making up a dummy value.
Accession Number	(0008,0050)	3	A departmental Information System generated number that identifies the Imaging Service Request.
Issuer of Accession Number Sequence	(0008,0051)	3	Identifier of the Assigning Authority that issued the Accession Number. Only a single Item is permitted in this Sequence.
>Include Table 10-17 “HL7v2 Hierarchic Designator Macro Attributes”
Study Instance UID	(0020,000D)	3	The unique identifier for the Study provided for this Requested Procedure.
Referenced Study Sequence	(0008,1110)	3	Uniquely identifies the Studies associated with this SOP Instance. One or more Items are permitted in this Sequence. See Section 10.6.1.
>Include Table 10-11 “SOP Instance Reference Macro Attributes”
Requested Procedure Description	(0032,1060)	3	Institution-generated administrative description or classification of Requested Procedure.
Requested Procedure Code Sequence	(0032,1064)	3	A Sequence that conveys the Procedure Type of the requested procedure. Only a single Item is permitted in this Sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes”			No Baseline CID is defined.
Reason for the Requested Procedure	(0040,1002)	3	Reason for requesting this procedure.
Reason for Requested Procedure Code Sequence	(0040,100A)	3	Coded Reason for requesting this procedure. One or more Items are permitted in this Sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes”			CID may be defined in the Macro invocation.
Scheduled Procedure Step ID	(0040,0009)	1C	Identifier that identifies the Scheduled Procedure Step. Required if procedure was scheduled. Note The condition is to allow the contents of this Macro to be present (e.g., to convey the reason for the procedure, such as whether a mammogram is for screening or diagnostic purposes) even when the procedure step was not formally scheduled and a value for this identifier is unknown, rather than making up a dummy value.
Scheduled Procedure Step Description	(0040,0007)	3	Institution-generated description or classification of the Scheduled Procedure Step to be performed.
Scheduled Protocol Code Sequence	(0040,0008)	3	Sequence describing the Scheduled Protocol following a specific Coding Scheme. One or more Items are permitted in this Sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes”			CID may be defined in the Macro invocation.
>Protocol Context Sequence	(0040,0440)	3	Sequence that specifies the context for the Scheduled Protocol Code Sequence (0040,0008) Item. One or more Items are permitted in this Sequence.
>>Include Table 10-2 “Content Item Macro Attributes”			CID may be defined in the Macro invocation.
>>Content Item Modifier Sequence	(0040,0441)	3	Sequence that specifies modifiers for a Protocol Context Content Item. One or more Items are permitted in this Sequence. See Section C.4.10.1.
>>>Include Table 10-2 “Content Item Macro Attributes”			CID may be defined in the Macro invocation.

10.6.1 SOP Class UID in Referenced Study Sequence

Since Referenced Study Sequence (0008,1110) is Type 2 or 3 in each usage, the Attribute may be zero length or omitted, respectively.

If Referenced Study Sequence (0008,1110) is present with an Item, the SOP Class UID of the Detached Study Management SOP Class (Retired) may be used in Referenced SOP Class UID (0008,1150).

10.7 Basic Pixel Spacing Calibration Macro

Table 10-10 specifies the Attributes of the Basic Pixel Spacing Calibration Macro.

Table 10-10. Basic Pixel Spacing Calibration Macro Attributes

Attribute Name	Tag	Type	Attribute Description
Pixel Spacing	(0028,0030)	1C	Physical distance in the Patient between the center of each pixel, specified by a numeric pair - adjacent row spacing (delimiter) adjacent column spacing in mm. See Section 10.7.1.1 and Section 10.7.1.3. Required if the image has been calibrated. May be present otherwise.
Pixel Spacing Calibration Type	(0028,0A02)	3	The type of correction for the effect of geometric magnification or calibration against an object of known size, if any. See Section 10.7.1.2.
Pixel Spacing Calibration Description	(0028,0A04)	1C	A free text description of the type of correction or calibration performed. Note In the case of correction, the text might include description of the assumptions made about the body part and geometry and depth within the Patient. In the case of calibration, the text might include a description of the fiducial and where it is located (e.g., "XYZ device applied to the skin over the greater trochanter"). Though it is not required, the Device Module may be used to describe the specific characteristics and size of the calibration device. Required if Pixel Spacing Calibration Type (0028,0A02) is present.

Attribute Name

Tag

Type

Attribute Description

Pixel Spacing

(0028,0030)

Physical distance in the Patient between the center of each pixel, specified by a numeric pair - adjacent row spacing (delimiter) adjacent column spacing in mm. See Section 10.7.1.1 and Section 10.7.1.3. Required if the image has been calibrated. May be present otherwise.

Pixel Spacing Calibration Type

(0028,0A02)

The type of correction for the effect of geometric magnification or calibration against an object of known size, if any. See Section 10.7.1.2.

Pixel Spacing Calibration Description

(0028,0A04)

A free text description of the type of correction or calibration performed.

Note

In the case of correction, the text might include description of the assumptions made about the body part and geometry and depth within the Patient.
In the case of calibration, the text might include a description of the fiducial and where it is located (e.g., "XYZ device applied to the skin over the greater trochanter").
Though it is not required, the Device Module may be used to describe the specific characteristics and size of the calibration device.

Required if Pixel Spacing Calibration Type (0028,0A02) is present.

10.7.1 Basic Pixel Spacing Calibration Macro Attribute Descriptions

10.7.1.1 Pixel Spacing

Pixel Spacing (0028,0030) specifies the physical distance in the Patient between the center of each pixel.

If Pixel Spacing (0028,0030) is present and the image has not been calibrated to correct for the effect of geometric magnification, the Values of this Attribute shall be the same as in Imager Pixel Spacing (0018,1164) or Nominal Scanned Pixel Spacing (0018,2010), if either of those Attributes are present.

If Pixel Spacing (0028,0030) is present and the Values are different from those in Imager Pixel Spacing (0018,1164) or Nominal Scanned Pixel Spacing (0018,2010), then the image has been corrected for known or assumed geometric magnification or calibrated with respect to some object of known size at known depth within the Patient.

If Pixel Spacing Calibration Type (0028,0A02) and Imager Pixel Spacing (0018,1164) and Nominal Scanned Pixel Spacing (0018,2010) are absent, then it cannot be determined whether or not correction or calibration have been performed.

Note

Imager Pixel Spacing (0018,1164) is a required Attribute in DX family IODs.
Nominal Scanned Pixel Spacing (0018,2010) is a required Attribute in Multi-frame SC family IODs

10.7.1.2 Pixel Spacing Calibration Type

The Pixel Spacing Calibration Type (0028,0A02) specifies the type of correction for the effect of geometric magnification or calibration against an object of known size, if any.

Enumerated Values:

GEOMETRY: The Pixel Spacing (0028,0030) Values account for assumed or known geometric magnification effects and correspond to some unspecified depth within the Patient; the Pixel Spacing (0028,0030) Values may thus be used for measurements of objects located close to the central ray and at the same depth.
FIDUCIAL: The Pixel Spacing (0028,0030) Values have been calibrated by the operator or image processing software by measurement of an object (fiducial) that is visible in the pixel data and is of known size and is located close to the central ray; the Pixel Spacing (0028,0030) Values may thus be used for measurements of objects located close to the central ray and located at the same depth within the Patient as the fiducial.

10.7.1.3 Pixel Spacing Value Order and Valid Values

All pixel spacing related Attributes are encoded as the physical distance between the centers of each two-dimensional pixel, specified by two numeric Values.

The first Value is the row spacing in mm, that is the spacing between the centers of adjacent rows, or vertical spacing.

The second Value is the column spacing in mm, that is the spacing between the centers of adjacent columns, or horizontal spacing.

To illustrate, consider the example shown in Figure 10.7.1.3-1.

Figure 10.7.1.3-1. Example of Pixel Spacing Value Order

Pixel Spacing = Row Spacing \ Column Spacing = 0.30\0.25.

All pixel spacing related Attributes shall have positive non-zero Values, except when there is only a single row or column or pixel of data present, in which case the corresponding Value may be zero.

Note

A single row or column or "pixel" may occur in MR Spectroscopy Instances. If the Value is non-zero, its purpose may be to convey the dimensions of a single row or column or pixel, such as in single voxel MR Spectroscopy; there is no other mechanism for conveying this.

This description applies to:

Pixel Spacing (0028,0030)
Imager Pixel Spacing (0018,1164)
Nominal Scanned Pixel Spacing (0018,2010)
Image Plane Pixel Spacing (3002,0011)
Compensator Pixel Spacing (300A,00E9)
Detector Element Spacing (0018,7022)
Presentation Pixel Spacing (0070,0101)
Printer Pixel Spacing (2010,0376)
Object Pixel Spacing in Center of Beam (0018,9404)

10.8 SOP Instance Reference Macro

Table 10-11 specifies the Attributes of the SOP Instance Reference Macro, which references a SOP Instance.

Table 10-11. SOP Instance Reference Macro Attributes

Attribute Name	Tag	Type	Attribute Description
Referenced SOP Class UID	(0008,1150)	1	Uniquely identifies the referenced SOP Class.
Referenced SOP Instance UID	(0008,1155)	1	Uniquely identifies the referenced SOP Instance.

10.9 Content Identification Macro

Table 10-12 specifies the Attributes of the Content Identification Macro, which identify and describe a SOP Instance potentially created by a human user interacting with an application.

Table 10-12. Content Identification Macro Attributes

Attribute Name	Tag	Type	Attribute Description
Instance Number	(0020,0013)	1	A number that identifies this SOP Instance.
Content Label	(0070,0080)	1	A label that is used to identify this SOP Instance.
Content Description	(0070,0081)	2	A description of the content of the SOP Instance.
Concept Name Code Sequence	(0040,A043)	3	A coded description of the content of the SOP Instance. Only a single Item is permitted in this Sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes”			No Baseline CID is defined.
Alternate Content Description Sequence	(0070,0087)	3	A Sequence containing alternate descriptions suitable for presentation to the user, e.g., in different languages. One or more Items are permitted in this Sequence. Note The Values of Specific Character Set for the entire Data Set need to be sufficient to encode all Items of this Sequence correctly, e.g., using a single Value with broad support such as UTF-8, or multiple Values with escape sequences.
>Content Description	(0070,0081)	1	An alternate description that is used to identify this SOP Instance.
>Language Code Sequence	(0008,0006)	1	The language in which Content Description (0070,0081) within this Item is written. A single Item shall be present.
>>Include Table 8.8-1 “Code Sequence Macro Attributes”			DCID 5000 “Language”.
>Concept Name Code Sequence	(0040,A043)	3	An alternate coded description of the content of the SOP Instance. Only a single Item is permitted in this Sequence.
>>Include Table 8.8-1 “Code Sequence Macro Attributes”			No Baseline CID is defined.
Include Table 10.9.3-1 “Content Creator Macro Attributes”

10.9.1 Enhanced Content Identification Macro

Table 10.9.1-1 specifies the Attributes of the Enhanced Content Identification Macro, which identifies content using a label supporting lower case characters and specified character sets. If a Code String is required, see Section 10.9 “Content Identification Macro”.

Table 10.9.1-1. Enhanced Content Identification Macro Attributes

Attribute Name	Tag	Type	Attribute Description
User Content Label	(3010,0033)	1	User-defined label for this SOP Instance. See Section 10.9.1.1.1.
Content Description	(0070,0081)	2	User-defined description for the content of this SOP Instance. See Section 10.9.1.1.1.
Include Table 10.9.3-1 “Content Creator Macro Attributes”

Attribute Name

Tag

Type

Attribute Description

User Content Label

(3010,0033)

User-defined label for this SOP Instance.

See Section 10.9.1.1.1.

Content Description

(0070,0081)

User-defined description for the content of this SOP Instance.

See Section 10.9.1.1.1.

Include Table 10.9.3-1 “Content Creator Macro Attributes”

10.9.1.1 Enhanced Content Identification Macro Attribute Descriptions

10.9.1.1.1 User Content Label and Content Description

User Content Label (3010,0033) shall represent a user-defined short free text providing the primary identification of this entity to other users. Content Description (0070,0081) allows a longer string containing additional descriptive identifying text.

This information is intended for display to human readers. Shall not be used for structured processing.

10.9.2 Extended Content Identification Macro

Table 10.9.2-1 specifies the Attributes of the Extended Content Identification Macro, which identifies content using a label supporting lower case characters and specified character sets. If a Code String is required, see Section 10.9 “Content Identification Macro”.

Table 10.9.2-1. Extended Content Identification Macro Attributes

Attribute Name	Tag	Type	Attribute Description
User Content Long Label	(3010,0034)	1	User-defined label for the content of this SOP Instance. See Section 10.9.2.1.1.
Content Description	(0070,0081)	2	User-defined description for the content of this SOP Instance. See Section 10.9.2.1.1.
Include Table 10.9.3-1 “Content Creator Macro Attributes”

Attribute Name

Tag

Type

Attribute Description

User Content Long Label

(3010,0034)

User-defined label for the content of this SOP Instance.

See Section 10.9.2.1.1.

Content Description

(0070,0081)

User-defined description for the content of this SOP Instance.

See Section 10.9.2.1.1.

Include Table 10.9.3-1 “Content Creator Macro Attributes”

10.9.2.1 Extended Content Identification Macro Attribute Descriptions

10.9.2.1.1 User Content Long Label and Content Description

User Content Long Label (3010,0034) shall represent a user-defined free text providing the primary identification of this entity to other users. Content Description (0070,0081) allows a longer string containing additional descriptive identifying text.

This information is intended for display to human readers. Shall not be used for structured processing.

10.9.3 Content Creator Macro

Table 10.9.3-1. Content Creator Macro Attributes

Attribute Name	Tag	Type	Attribute Description
Content Creator's Name	(0070,0084)	3	Name of operator (such as a technologist or physician) creating the content of the SOP Instance.
Content Creator's Identification Code Sequence	(0070,0086)	3	Identification of the person who created the content. Only a single Item is permitted in this Sequence.
>Include Table 10-1 “Person Identification Macro Attributes”

Attribute Name

Tag

Type

Attribute Description

Content Creator's Name

(0070,0084)

Name of operator (such as a technologist or physician) creating the content of the SOP Instance.

Content Creator's Identification Code Sequence

(0070,0086)

Identification of the person who created the content.

Only a single Item is permitted in this Sequence.

>Include Table 10-1 “Person Identification Macro Attributes”

10.10 General Contributing Sources Macro

Table 10-13 specifies the Attributes of the General Contributing Sources Macro, which describe the general characteristics of the contributing sources used to create a new SOP Instance.

Table 10-13. General Contributing Sources Macro Attributes

Attribute Name	Tag	Type	Attribute Description
Contributing SOP Instances Reference Sequence	(0020,9529)	1C	A Sequence that identifies the contributing SOP Instances. Required if this SOP Instance is created from other DICOM SOP Instances. Note The Attribute is absent in the case where the sources used to create this SOP Instance are not SOP Instances, e.g., a volume that was directly generated by an acquisition system. One or more Items shall be included in this Sequence.
>Study Instance UID	(0020,000D)	1	Unique identifier for the Study of the Contributing SOP Instances.
>Referenced Series Sequence	(0008,1115)	1	Sequence of Items each of which includes the Attributes of one Series. One or more Items shall be included in this Sequence.
>>Series Instance UID	(0020,000E)	1	Unique identifier of the Series containing the referenced Instances.
>>Series Number	(0020,0011)	2	A number that identifies this Series.
>>Referenced Instance Sequence	(0008,114A)	1	Sequence of Items each providing a reference to an Instance that is part of the Series defined by Series Instance UID (0020,000E) in the enclosing Item. One or more Items shall be included in this Sequence.
>>>Include Table 10-11 “SOP Instance Reference Macro Attributes”
>>>Instance Number	(0020,0013)	2	A number that identifies this Instance.
Manufacturer	(0008,0070)	2	Manufacturer of the equipment that produced the sources.
Manufacturer's Model Name	(0008,1090)	1C	Manufacturer's model name of the equipment that produced the sources. Required if present and consistent in the contributing SOP Instances.
Device Serial Number	(0018,1000)	1C	Manufacturer's serial number of the equipment that produced the sources. Required if present and consistent in the contributing SOP Instances.
Software Versions	(0018,1020)	1C	Manufacturer's designation of software version of the equipment that produced the sources. See Section C.7.5.1.1.3. Required if present and consistent in the contributing SOP Instances.
Date of Manufacture	(0018,1204)	3	The date the equipment that produced the sources was originally manufactured or re-manufactured (as opposed to refurbished).
Date of Installation	(0018,1205)	3	The date the equipment that produced the sources was installed in its current location. The device may or may not have been used prior to installation in its current location.
Acquisition DateTime	(0008,002A)	1C	The time the acquisition of data that resulted in sources started. The Value shall be the start date and time of the first contributing SOP Instance of the group specified by the Contributing SOP Instances Reference Sequence (0020,9529). Required if present and consistent in the contributing SOP Instances. Note The Acquisition DateTime may be created by combining the Values of Acquisition Date (0008,0022) and Acquisition Time (0008,0032) in the contributing SOP Instances.
Station Name	(0008,1010)	1C	User defined name identifying the machine that produced the sources. Required if present and consistent in the contributing SOP Instances.
Operators' Name	(0008,1070)	1C	Name(s) of the operator(s) supporting the Series. Required if present and consistent in the contributing SOP Instances.
Operator Identification Sequence	(0008,1072)	1C	Identification of the operator(s) supporting the Series. One or more Items shall be included in this Sequence. If more than one Item, the number and order shall correspond to the Value of Operators' Name (0008,1070), if present. Required if present and consistent in the contributing SOP Instances.
>Include Table 10-1 “Person Identification Macro Attributes”
Protocol Name	(0018,1030)	1C	User-defined description of the conditions under which the Series was performed. Required if present and consistent in the contributing SOP Instances. Note This Attribute conveys Series-specific protocol identification and may or may not be identical to the one presented in the Performed Protocol Code Sequence (0040,0260).
Performed Protocol Code Sequence	(0040,0260)	1C	Sequence describing the Protocol performed for the Procedure Step creating the sources. One or more Items shall be included in this Sequence. Required if present and consistent in the contributing SOP Instances.
>Include Table 8.8-1 “Code Sequence Macro Attributes”			No Baseline CID is defined.
Acquisition Protocol Name	(0018,9423)	1C	User defined name of the protocol used to acquire this image. Required if present and consistent in the contributing SOP Instances.

Note

The Attributes at the first level of the General Contributing Sources Macro contain information that is common to all the Referenced SOP Instances included in the Contributing SOP Instances Reference Sequence. This allows to not duplicate information when the contributing Instances are single-frame objects and/or when they are in different Series with the same protocol and manufacturer information.

Typically the General Contributing Sources Macro is invoked from inside another Sequence. Therefore, if the "common" Attributes of the Macro are different among the Referenced SOP Instances, like different acquisition protocols, software versions etc., the invoking Sequence will contain several Items.

10.11 Contributing Image Sources Macro

Table 10-14 specifies the Attributes of the Contributing Image Sources Macro, which describe the image related characteristics of the contributing image sources used to create a new SOP Instance (e.g., a volume SOP Instance).

Table 10-14. Contributing Image Sources Macro Attributes

Attribute Name	Tag	Type	Attribute Description
Rows	(0028,0010)	1	Number of rows in the images.
Columns	(0028,0011)	1	Number of columns in the images.
Bits Stored	(0028,0101)	1	Number of bits stored for each pixel sample. Each sample shall have the same number of bits stored. See PS3.5 for further explanation.
Lossy Image Compression	(0028,2110)	1C	Specifies whether the Source Images have undergone lossy compression (at a point in their lifetime). Enumerated Values: 00 Image has not been subjected to lossy compression. 01 Image has been subjected to lossy compression. See Section C.7.6.1.1.5. Required if it is known whether or not Lossy Compression has been performed on the Images. Note In some SOP Class definitions the Lossy Image Compression Attribute is optional.
Lossy Image Compression Ratio	(0028,2112)	1C	Describes the approximate lossy compression ratio(s) that have been applied to this image. See Section C.7.6.1.1.5.2. Required if Lossy Image Compression (0028,2110) is "01".
Lossy Image Compression Method	(0028,2114)	1C	A label for the lossy compression method(s) that have been applied to the source images. See Section C.7.6.1.1.5.1. Required if Lossy Image Compression (0028,2110) is "01".

10.12 Patient Orientation Macro

Table 10-15 specifies the Attributes of the Patient Orientation Macro, which describe the Patient Orientation related to gravity and equipment.

Table 10-15. Patient Orientation Macro Attributes

Attribute Name	Tag	Type	Attribute Description
Patient Orientation Code Sequence	(0054,0410)	1	Description of the orientation of the Patient with respect to gravity. See Section C.8.4.6.1.1 and Section C.8.11.5.1.2 for further explanation. Only a single Item shall be included in this Sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes”			BCID 19 “Patient Orientation”.
>Patient Orientation Modifier Code Sequence	(0054,0412)	1C	Patient orientation modifier. Required if needed to fully specify the orientation of the Patient with respect to gravity. Only a single Item shall be included in this Sequence.
>>Include Table 8.8-1 “Code Sequence Macro Attributes”			BCID 20 “Patient Orientation Modifier”.
Patient Gantry Relationship Code Sequence	(0054,0414)	3	Description of the orientation of the Patient with respect to the gantry. See Section C.8.4.6.1.3 for further explanation. Only a single Item is permitted in this Sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes”			BCID 21 “Patient Equipment Relationship”.

Table 10-15a contains Attributes that describe the Patient Orientation related to gravity and the mandatory relationship to the equipment.

Table 10-15a. Patient Orientation and Equipment Relationship Macro Attributes

Attribute Name	Tag	Type	Attribute Description
Patient Orientation Code Sequence	(0054,0410)	1	Sequence that describes the orientation of the Patient with respect to gravity. See Section C.8.4.6.1.1 and Section C.8.11.5.1.2 for further explanation. Only a single Item shall be included in this Sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes”			BCID 19 “Patient Orientation”.
>Patient Orientation Modifier Code Sequence	(0054,0412)	1C	Patient orientation modifier. Required if needed to fully specify the orientation of the Patient with respect to gravity. Only a single Item shall be included in this Sequence.
>>Include Table 8.8-1 “Code Sequence Macro Attributes”			BCID 20 “Patient Orientation Modifier”.
Patient Equipment Relationship Code Sequence	(3010,0030)	1	Description of the orientation of the Patient with respect to the equipment. See Section C.36.6.1.8 for further explanation. Only a single Item shall be included in this Sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes”			BCID 21 “Patient Equipment Relationship”.

10.12.1 Relation With Other Positioning Attributes

The Attributes of this Macro may be used to correlate the Patient-Based Coordinate System (see Section C.7.6.2) and the equipment.

Note

The Patient Orientation Code Sequence (0054,0410) allows a more precise and comprehensive positioning than Patient Position (0018,5100). If this Sequence is present Patient Position (0018,5100) is not used.

10.13 Performed Procedure Step Summary Macro

Table 10-16. Performed Procedure Step Summary Macro Attributes

Attribute Name	Tag	Type	Attribute Description
Performed Procedure Step ID	(0040,0253)	3	User or equipment generated identifier of that part of a Procedure that has been carried out within this step.
Performed Procedure Step Start Date	(0040,0244)	3	Date on which the Performed Procedure Step started.
Performed Procedure Step Start Time	(0040,0245)	3	Time on which the Performed Procedure Step started.
Performed Procedure Step End Date	(0040,0250)	3	Date on which the Performed Procedure Step ended.
Performed Procedure Step End Time	(0040,0251)	3	Time at which the Performed Procedure Step ended.
Performed Procedure Step Description	(0040,0254)	3	Institution-generated description or classification of the Procedure Step that was performed.
Performed Protocol Code Sequence	(0040,0260)	3	Sequence describing the Protocol performed for this Procedure Step. One or more Items are permitted in this Sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes”			CID may be defined in the Macro invocation.
>Protocol Context Sequence	(0040,0440)	3	Sequence that specifies the context for the Performed Protocol Code Sequence (0040,0260) Item. One or more Items are permitted in this Sequence.
>>Include Table 10-2 “Content Item Macro Attributes”			CID may be defined in the Macro invocation.
>>Content Item Modifier Sequence	(0040,0441)	3	Sequence that specifies modifiers for a Protocol Context Content Item. One or more Items are permitted in this Sequence. See Section C.4.10.1.
>>>Include Table 10-2 “Content Item Macro Attributes”			CID may be defined in the Macro invocation.
Comments on the Performed Procedure Step	(0040,0280)	3	User-defined comments on the Performed Procedure Step.

10.14 HL7v2 Hierarchic Designator Macro

Table 10-17 specifies the Attributes of the HL7v2 Hierarchic Designator Macro, which identify an entity (system, organization, agency, or department) that has responsibility for managing or assigning a defined set of instance identifiers (such as placer or filler number, Patient identifiers, provider identifiers, etc.). This entity could be a particular health care application such as a registration system that assigns Patient identifiers, a governmental entity such as a licensing authority that assigns professional identifiers or drivers' license numbers, or a facility where such identifiers are assigned.

Note

This definition is identical to HL7 v2.5, Section 2.A.33, with only minor changes for editorial style.

These Attributes are equivalent to the components of the HL7 v2 Hierarchic Designator (HD) and Entity Identifier (EI) data types (see HL7 v2 Chapter 2.A).

If both Local Namespace Entity ID (0040,0031) and Universal Entity ID (0040,0032) are present, they shall refer to the same entity.

Table 10-17. HL7v2 Hierarchic Designator Macro Attributes

Attribute Name	Tag	Type	Attribute Description
Local Namespace Entity ID	(0040,0031)	1C	Identifies an entity within the local namespace or domain. Required if Universal Entity ID (0040,0032) is not present; may be present otherwise.
Universal Entity ID	(0040,0032)	1C	Universal or unique identifier for an entity. Required if Local Namespace Entity ID (0040,0031) is not present; may be present otherwise.
Universal Entity ID Type	(0040,0033)	1C	Standard defining the format of the Universal Entity ID. Required if Universal Entity ID (0040,0032) is present. Enumerated Values: DNS An Internet dotted name. Either in ASCII or as integers EUI64 An IEEE Extended Unique Identifier ISO An International Standards Organization Object Identifier URI Uniform Resource Identifier UUID The DCE Universal Unique Identifier X400 An X.400 MHS identifier X500 An X.500 directory name

10.15 Issuer of Patient ID Macro

Table 10-18 specifies the Attributes of the Issuer of Patient ID Macro, which identify the source of Patient ID (0010,0020).

These Attributes are equivalent to components of the HL7 v2 Extended Composite ID with Check Digit (CX) data type (see HL7 v2 Chapter 2.A.14), as used in the HL7 v2 PID-3 Patient Identifier List field.

Table 10-18. Issuer of Patient ID Macro Attributes

Attribute Name	Tag	Type	Attribute Description
Issuer of Patient ID	(0010,0021)	3	Identifier of the Assigning Authority (system, organization, agency, or department) that issued the Patient ID. Note Equivalent to HL7 v2 CX component 4 subcomponent 1.
Issuer of Patient ID Qualifiers Sequence	(0010,0024)	3	Attributes specifying or qualifying the identity of the issuer of the Patient ID, or scoping the Patient ID. Only a single Item is permitted in this Sequence.
>Universal Entity ID	(0040,0032)	3	Universal or unique identifier for the Patient ID Assigning Authority. The authority identified by this Attribute shall be the same as that of Issuer of Patient ID (0010,0021), if present. Note Equivalent to HL7 v2 CX component 4 subcomponent 2 (Universal ID).
>Universal Entity ID Type	(0040,0033)	1C	Standard defining the format of the Universal Entity ID (0040,0032). Required if Universal Entity ID (0040,0032) is present. Note Equivalent to HL7 v2 CX component 4 subcomponent 3 (Universal ID Type). See Section 10.14 for Defined Terms.
>Identifier Type Code	(0040,0035)	3	Type of Patient ID. Refer to HL7 v2 Table 0203 for Defined Terms. Note Equivalent to HL7 v2 CX component 5 (Identifier Type Code).
>Assigning Facility Sequence	(0040,0036)	3	The place or location identifier where the identifier was first assigned to the Patient. This component is not an inherent part of the identifier but rather part of the history of the identifier. Only a single Item is permitted in this Sequence. Note Equivalent to HL7 v2 CX component 6 (Assigning Facility).
>>Include Table 10-17 “HL7v2 Hierarchic Designator Macro Attributes”
>Assigning Jurisdiction Code Sequence	(0040,0039)	3	The geo-political body that assigned the Patient identifier. Typically a code for a country or a state/province. Only a single Item is permitted in this Sequence. Note Equivalent to HL7 v2 CX component 9 (Assigning Jurisdiction).
>>Include Table 8.8-1 “Code Sequence Macro Attributes”			BCID 5001 “Country” for country codes.
>Assigning Agency or Department Code Sequence	(0040,003A)	3	The agency or department that assigned the Patient identifier. Only a single Item is permitted in this Sequence. Note Equivalent to HL7 v2 CX component 10 (Assigning Agency or Department).
>>Include Table 8.8-1 “Code Sequence Macro Attributes”			No Baseline CID is defined.

10.16 Algorithm Identification Macro

Table 10-19 specifies the Attributes of the Algorithm Identification Macro, which identifies and describes the algorithm used to create or derive a SOP Instance contents. An algorithm is described by the Algorithm Family, a specific Algorithm Name, and an Algorithm Version. A character string containing parameters that were used in the algorithm can be included.

Table 10-19. Algorithm Identification Macro Attributes

Attribute Name	Tag	Type	Attribute Description
Algorithm Family Code Sequence	(0066,002F)	1	The family of algorithm(s) that best describes the software algorithm used. Only a single Item shall be included in this Sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes”			CID may be defined in the Macro invocation.
Algorithm Name Code Sequence	(0066,0030)	3	The code assigned by a manufacturer to a specific software algorithm. Only a single Item is permitted in this Sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes”			No Baseline CID is defined.
Algorithm Name	(0066,0036)	1	The name assigned by a manufacturer to a specific software algorithm.
Algorithm Version	(0066,0031)	1	The software version identifier assigned by a manufacturer to a specific software algorithm.
Algorithm Parameters	(0066,0032)	3	The input parameters used by a manufacturer to configure the behavior of a specific software algorithm.
Algorithm Source	(0024,0202)	3	Source of the algorithm, e.g., the name of the manufacturer, researcher, university, etc.

10.17 Selector Attribute Macro

Table 10-20 specifies the Attributes of the Selector Attribute Macro, which identify either a particular Value of an Attribute, all Values of an Attribute, a specific Item in a Sequence, or all Items in a Sequence. The Attribute or Item may be nested within one or more Sequences, and/or a Private Attribute.

The invocation of the Selector Attribute Macro may define additional semantics. E.g., if the Selector Attribute Macro is used to select "all" Values of an Attribute and then test that set of Value against some condition, then an invocation might define whether it is required that at least one Value in the set meet the condition or whether all Values in the set must meet the condition.

Table 10-20a extends the Selector Attribute Macro with additional Attribute descriptors.

Table 10-20. Selector Attribute Macro Attributes

Attribute Name	Tag	Type	Attribute Description
Selector Attribute	(0072,0026)	1C	Data Element Tag of the Attribute to be referenced. Required if the selected content is not a Sequence Item.
Selector Value Number	(0072,0028)	1C	Non-negative integer identifying which Value of a multi-valued Attribute identified by Selector Attribute (0072,0026) is to be referenced. The Value 1 identifies the first Value. The Value 0 identifies all Values. When the Value Multiplicity of the Selector Attribute (0072,0026) is 1 then the Value of this Attribute shall be 1. Required if the selected content is a single Attribute of any VR other than SQ.
Selector Sequence Pointer	(0072,0052)	1C	Contains the Data Element Tags of the path to the Sequence that contains the Attribute that is identified by Selector Attribute (0072,0026) or to the Item(s) to be selected in Selector Sequence Pointer Items (0074,1057). This Attribute shall have the same number of Values as the level of nesting of Selector Attribute (0072,0026) or the selected Item(s). Required if Selector Attribute (0072,0026) is nested in one or more Sequences or is absent. See Section 10.17.1.1.
Selector Sequence Pointer Private Creator	(0072,0054)	1C	Identification of the creator of a group of Private Data Elements used to encode Attributes in the Selector Sequence Pointer (0072,0052). This Attribute shall have the same number of Values as Selector Sequence Pointer (0072,0052). For Values of the Selector Sequence Pointer (0072,0052) that are not the Data Element Tag of a Private Attribute, the corresponding Value in Selector Sequence Pointer Private Creator (0072,0054) shall be empty. Required if Selector Sequence Pointer (0072,0052) is present and one or more of the Values of Selector Sequence Pointer (0072,0052) is the Data Element Tag of a Private Attribute. See Section 10.17.1.2.
Selector Sequence Pointer Items	(0074,1057)	1C	Identification of the Item indices in the Selector Sequence Pointer (0072,0052). This Attribute shall have the same number of Values as the Selector Sequence Pointer (0072,0052). The Value 1 identifies the first Item of the corresponding Sequence. The Value 0 identifies all Items of the corresponding Sequence. Required if Selector Sequence Pointer (0072,0052) is present. See Section 10.17.1.1.
Selector Attribute Private Creator	(0072,0056)	1C	Identification of the creator of a group of Private Data Elements. Required if the Selector Attribute (0072,0026) Value is the Data Element Tag of a Private Attribute. See Section 10.17.1.2.

Table 10-20a. Extended Selector Attribute Macro Attributes

Attribute Name	Tag	Type	Attribute Description
Selector Attribute Name	(0082,0018)	1	Name of the Selector Attribute (0072,0026). For Standard Data Elements, this shall be the Value in the Name column of Table 6-1 in PS3.6.
Selector Attribute Keyword	(0082,0019)	3	Keyword of the Selector Attribute (0072,0026). For Standard Data Elements, this shall be the Value in the Keyword column of Table 6-1 in PS3.6.
Selector Attribute VR	(0072,0050)	1	Value Representation of the Selector Attribute (0072,0026). For Standard Data Elements, this shall be the Value in the VR column of Table 6-1 in PS3.6.
Include Table 10-20 “Selector Attribute Macro Attributes”

10.17.1 Selector Attribute Macro Attribute Descriptions

10.17.1.1 Referencing Nested Elements

Examples of use are shown in Table 10-21.

The examples include the selection of a top level Attribute, a nested Attribute, one Item in a top level Sequence, all Items in a nested Sequence or a specific Item in all Items of a parent Sequence.

Table 10-21. Selector Attribute Macro Example

Example	Selector Attribute (0072,0026)	Selector Value Number (0072,0028)	Selector Sequence Pointer (0072,0052)	Selector Sequence Pointer Items (0074,1057)
Patient's Name (0010,0010)	(0010,0010)	1	absent	absent
Second Value (e.g., PRIMARY or SECONDARY) in Image Type (0008,0008)	(0008,0008)	2	absent	absent
RT Beam Limiting Device Type (300A,00B8) for the second jaw in Beam Limiting Device Sequence (300A,00B6) specified for the first Beam in the Beam Sequence (300A,00B0) of an RT Plan	(300A,00B8)	1	(300A,00B0)\(300A,00B6)	1\2
Code Value (0008,0100) for the first Item in View Code Sequence (0054,0220)	(0008,0100)	1	(0054,0220)	1
The second Item in the Patient Setup Sequence (300A,0180) in the top level Data Set	absent	absent	(300A,0180)	2
The second Item in the Beam Limiting Device Sequence (300A,00B6) in third Item in the Beam Sequence (300A,00B0) of an RT Plan	absent	absent	(300A,00B0)\(300A,00B6)	3\2
All Items in the Beam Limiting Device Sequence (300A,00B6) in third Item in the Beam Sequence (300A,00B0) of an RT Plan	absent	absent	(300A,00B0)\(300A,00B6)	3\0
The second Item in the Beam Limiting Device Sequence (300A,00B6) in all Items in the Beam Sequence (300A,00B0) of an RT Plan	absent	absent	(300A,00B0)\(300A,00B6)	0\2

10.17.1.2 Private Attribute References

The Selector Sequence Pointer Private Creator (0072,0054) and the Selector Attribute Private Creator (0072,0056) each have a Value that corresponds to the Private Creator Data Element numbers (gggg,00pp), where gggg is odd and pp ranges from 10 to FF. These identify a block of Private Data Elements within the block (gggg,ppxx). When Selector Attribute (0072,0026) or Selector Sequence Pointer (0072,0052) points to a Private Data Element (gggg,ppxx), it shall have the Value (gggg,00xx).

10.18 Externally-Sourced Data Set Identification Macro

Table 10-22 specifies the Attributes of the Externally-Sourced Data Set Identification Macro, which identify an Externally-Sourced Data Set.

Table 10-22. Externally-Sourced Data Set Identification Macro Attributes

Attribute Name	Tag	Type	Attribute Description
Data Set Name	(0024,0306)	1	The name assigned to the Externally-Sourced Data Set.
Data Set Version	(0024,0307)	1	The software version identifier assigned to the Externally-Sourced Data Set.
Data Set Source	(0024,0308)	1	Source of the Externally-Sourced Data Set. E.g., the name of the manufacturer, researcher, university, etc.
Data Set Description	(0024,0309)	3	Description of the Externally-Sourced Data Set.

10.19 Exposure Index Macro

Table 10-23 specifies the Attributes of the Section 10.19 Exposure Index Macro, which describe the Exposure Index for single projection X-Ray images, as described by IEC 62494-1 and the report of AAPM Task Group 116.

Table 10-23. Exposure Index Macro Attributes

Attribute Name	Tag	Type	Attribute Description
Exposure Index	(0018,1411)	3	Measure of the detector response to radiation in the relevant image region of an image acquired with a digital X-Ray imaging system as defined in IEC 62494-1. Note A string rather than binary Value Representation is used for this Attribute, in order to allow the sender to control the precision of the value as suggested in the report of AAPM Task Group 116. This index value is scaled as defined by IEC 62494-1.
Target Exposure Index	(0018,1412)	3	The target value used to calculate Deviation Index (0018,1413) as defined in IEC 62494-1.
Deviation Index	(0018,1413)	3	A scaled representation of the difference of the Exposure Index compared to the Target Exposure Index as defined in IEC 62494-1 and the report of AAPM TG 116.

10.20 Mandatory View and Slice Progression Direction Macro

Table 10-24 specifies the Attributes of the Mandatory View and Slice Progression Direction Macro, which describe the view, and in the case of cardiac views, the direction of the slices relative to the cardiac anatomy.

Table 10-24. Mandatory View and Slice Progression Direction Macro Attributes

Attribute Name	Tag	Type	Attribute Description
View Code Sequence	(0054,0220)	1	Sequence that describes the projection of the anatomic region of interest. Only a single Item shall be included in this Sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes”			BCID 26 “Nuclear Medicine Projection” unless otherwise specified in invocation.
>View Modifier Code Sequence	(0054,0222)	2C	View Modifier. Required if needed to fully specify the View. Zero or more Items shall be included in this Sequence.
>>Include Table 8.8-1 “Code Sequence Macro Attributes”			BCID 23 “Cranio-Caudad Angulation” unless otherwise specified in invocation.
Slice Progression Direction	(0054,0500)	1C	Describes the anatomical direction in which a set of slices is progressing (see Section 10.20.1.1). Meaningful only for cardiac images. Enumerated Values are defined in Section 10.20.1.1. Required if View Code Sequence (0054,0220) equals (103340004, SCT, "Short Axis") or (131185001, SCT, "Vertical Long Axis") or (131186000, SCT, "Horizontal Long Axis"). May be present otherwise.

10.20.1 Mandatory View and Slice Progression Direction Macro Attribute Descriptions

10.20.1.1 Slice Progression Direction

The image or Frame order to which the Slice Progression Direction (0054,0500) applies depends on the IOD:

In the case of Enhanced Multi-frame IODs, in which a Stack ID (0020,9056) may be defined, Stack ID (0020,9056) shall be used, and the slices are considered in order by In Stack Position Number (0020,9057)
In the case of Multi-frame Image IODs that are not Enhanced, the slices are considered in encoded Frame order
In the case of Single-frame Image IODs, the order is defined by increasing Values of Instance Number

The Enumerated Values depend on the view:

If View Code Sequence (0054,0220) indicates a short axis view, such as when it equals (103340004, SCT, "Short Axis"):

Enumerated Values

APEX_TO_BASE

BASE_TO_APEX
If View Code Sequence (0054,0220) indicates a vertical long axis view, such as when it equals (131185001, SCT, "Vertical Long Axis"):

Enumerated Values

ANT_TO_INF

Anterior to Inferior

INF_TO_ANT

Inferior to Anterior
If View Code Sequence (0054,0220) indicates a horizontal long axis view, such as when it equals (131186000, SCT, "Horizontal Long Axis"):

Enumerated Values

SEPTUM_TO_WALL

Septum to Lateral Wall

WALL_TO_SEPTUM

Lateral Wall to Septum

Note

The conditions on the choice of Enumerated Values are relatively general, rather than specific to a single coded view, in order to accommodate the echocardiography views defined in CID 12226 “Echocardiography Image View” in PS3.16 , in addition to the views for CT, MR, NM and PET defined in CID 26 “Nuclear Medicine Projection” in PS3.16 .

10.21 Optional View and Slice Progression Direction Macro

Table 10-25 specifies the Attributes of the Optional View and Slice Progression Direction Macro, which describe the view, and in the case of cardiac views, the direction of the slices relative to the cardiac anatomy.

Table 10-25. Optional View and Slice Progression Direction Macro Attributes

Attribute Name	Tag	Type	Attribute Description
View Code Sequence	(0054,0220)	3	Sequence that describes the projection of the anatomic region of interest. Only a single Item is permitted in this Sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes”			BCID 26 “Nuclear Medicine Projection” unless otherwise specified in invocation.
>View Modifier Code Sequence	(0054,0222)	3	View Modifier. One or more Items are permitted in this Sequence.
>>Include Table 8.8-1 “Code Sequence Macro Attributes”			BCID 23 “Cranio-Caudad Angulation” unless otherwise specified in invocation.
Slice Progression Direction	(0054,0500)	3	Describes the anatomical direction in which a set of slices is progressing (see Section 10.20.1.1). Meaningful only for cardiac images. Enumerated Values are defined in Section 10.20.1.1.

10.22 Numeric Value Macro

Table 10-26 specifies the Attributes of the Numeric Value Macro, which is used to relate and convey a numeric value to a coded concept.

Table 10-26. Numeric Value Macro Attributes

Attribute Name	Tag	Type	Attribute Description
Concept Name Code Sequence	(0040,A043)	1	Coded concept name of this name-value Item. Only a single Item shall be included in this Sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes”			No Context ID is defined.
Numeric Value	(0040,A30A)	1	Numeric value for this name-value Item.
Measurement Units Code Sequence	(0040,08EA)	1	Units of Numeric Value (0040,A30A) in this name-value Item. Only a single Item shall be included in this Sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes”			DCID 82 “Measurement Unit”.

10.23 RT Equipment Correlation Macro (Retired)

Retired. See PS3.3-2024b.

10.24 Device Motion Control Macro

Table 10-28 specifies the Attributes of the Device Motion Control Macro, which describe requirements on performing the movement of a device from an actual to a desired position.

Table 10-28. Device Motion Control Macro Attributes

Attribute Name	Tag	Type	Attribute Description
Device Motion Control Sequence	(300A,0450)	3	Device Motion Control Definitions for each degree of freedom. One or more Items are permitted in this Sequence.
>Device Motion Parameter Code Sequence	(300A,0453)	1	The parameter for which the Device Motion Control shall be applied.
>>Include Table 8.8-1 “Code Sequence Macro Attributes”			DCID 9401 “IEC61217 Device Position Parameter”
>Device Motion Execution Mode	(300A,0451)	1C	Permitted Motion Execution Mode for movement. Required if Device Motion Observation Mode (300A,0452) is absent. May be present otherwise. See Section 10.24.1.1.
>Device Motion Observation Mode	(300A,0452)	1C	Required Motion Observation Mode for movement. Required if Device Motion Execution Mode (300A,0451) is absent. May be present otherwise. See Section 10.24.1.2.

10.24.1 Device Motion Control Macro Attribute Descriptions

10.24.1.1 Device Motion Execution Mode

Device Motion Execution Mode (300A,0451) identifies how the operator invokes and controls the motion.

Enumerated Values:

CONTINUOUS: The device must be moved while the operator is activating one or more switches on the machine during the whole period of movement to prevent any uncontrolled movement.
TRIGGERED: The device can be moved automatically to the desired position, triggered by a one-time command of the operator, without the need to constantly activate any switch.
AUTOMATIC: The device movement can be initiated and performed automatically by the device to the desired position.

10.24.1.2 Device Motion Observation Mode

Device Motion Observation Mode (300A,0452) describes the presence of the operator in the room, observing the motion.

Enumerated Values:

INROOM: The movement of the device is only allowed when the operator is present in the treatment room.
REMOTE: The device can be moved by a command of the operator not being present in the treatment room, that is, from a device outside the treatment room.

10.25 Attribute Value Constraint Macro

Table 10.25-1 specifies the Attributes of the Attribute Value Constraint Macro, which allows an Attribute to be identified and to have constraints placed on acceptable Values for that Attribute. An Attribute being constrained is referred to in the Macro as a Selector Attribute.

Note

This Macro does not handle mutual constraints between multiple Attributes. For example constraining the ratio between two Attributes to a specific Value is not possible unless there is a third Attribute that encodes that ratio so the third Attribute could then be constrained.
The SOP Instance containing this Macro defines the purpose of the constraints, which may include constraining Attribute Values in other SOP Instances.

Table 10.25-1. Attribute Value Constraint Macro Attributes

Attribute Name	Tag	Type	Attribute Description
Include Table 10-20a “Extended Selector Attribute Macro Attributes”
Constraint Type	(0082,0032)	1	Describes how the Value(s) specified in the Constraint Value Sequence (0082,0034) shall be used to determine the acceptability of a given Value for the Attribute identified by Selector Attribute (0072,0026) See Section 10.25.1. Enumerated Values: RANGE_INCL RANGE_EXCL GREATER_OR_EQUAL LESS_OR_EQUAL GREATER_THAN LESS_THAN EQUAL MEMBER_OF NOT_MEMBER_OF MEMBER_OF_CID UNCONSTRAINED
Constraint Violation Significance	(0082,0036)	3	Level of significance of a Selector Attribute Value exceeding this constraint. See Section 10.25.2. Enumerated Values: FAILURE WARNING INFORMATIVE
Constraint Violation Condition	(0082,0037)	1C	Conditionality of the constraint violation significance. If the condition is not met, the violation has no significance. The condition may be expressed as a mathematical expression, a human readable text or other form. Required if Constraint Violation Significance (0082,0036) is only significant under certain conditions.
Constraint Value Sequence	(0082,0034)	1C	Value(s) used to constrain the contents of the Attribute referenced by the Selector Attribute (0072,0026). Required if Constraint Type (0082,0032) is not UNCONSTRAINED. If the Constraint Type (0082,0032) is GREATER_OR_EQUAL, LESS_OR_EQUAL, GREATER_THAN, LESS_THAN, EQUAL or MEMBER_OF_CID only a single Item shall be included in this Sequence. If the Constraint Type (0082,0032) is RANGE_INCL or RANGE_EXCL, exactly two Items shall be included in this Sequence, the first of which is less than or equal to the second. If the Constraint Type (0082,0032) is MEMBER_OF or NOT_MEMBER_OF, one or more Items shall be included in this Sequence.
>Include Table 10.26-1 “Attribute Value Macro Attributes”			Any sub-Sequences in the Constraint Value Sequence (0082,0034) shall only contain one Item. Any Attribute in the Sequence Item(s) shall contain a single Value. If Constraint Type (0082,0032) is MEMBER_OF_CID, this shall be a Selector UI Value (0072,007F), despite the Selector Attribute VR (0072,0050) being SQ. See Section 10.25.1.1
Recommended Default Value Sequence	(0082,0035)	3	Contains a default Value for the contents of the Selector Attribute (0072,0026). Only a single Item is permitted in this Sequence.
>Include Table 10.26-1 “Attribute Value Macro Attributes”
Measurement Units Code Sequence	(0040,08EA)	3	Units of measurement for the Values in the Item(s) in the Constraint Value Sequence (0082,0034) and the Recommended Default Value Sequence (0082,0035). Only a single Item is permitted in this Sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes”			BCID 82 “Measurement Unit”.
Specification Selection Guidance	(0082,0033)	3	Brief guidance that a human operator may consider when selecting an appropriate value for the Selector Attribute (0072,0026) within the constraints defined.

10.25.1 Constraint Type

The use of the specified value(s) in the Constraint Value Sequence (0082,0034) to constrain the Value of the Attribute referenced by the Selector Attribute (0072,0026) shall depend on the Value of Constraint Type (0082,0032) as follows:

RANGE_INCL: the value is constrained to lie between the specified values, or be equal to one of the specified values
RANGE_EXCL: the value is constrained to lie outside (i.e., not between) the specified values
GREATER_OR_EQUAL: the value is constrained to be greater than or equal to the specified value
LESS_OR_EQUAL: the value is constrained to be less than or equal to the specified value
GREATER_THAN: the value is constrained to be greater than the specified value
LESS_THAN: the value is constrained to be less than the specified value
EQUAL: the value is constrained to be equal to the specified value
MEMBER_OF: the value is constrained to be equal to one of the specified values
NOT_MEMBER_OF: the value is constrained to be not equal to any of the specified values
MEMBER_OF_CID: the value is constrained to be equal to a member of the specified CID
UNCONSTRAINED: the Value of the Selector Attribute (0072,0026) is not constrained

For MEMBER_OF_CID, Constraint Value Sequence (0082,0034) shall contain a single Selector UI Value (0072,007F), containing a Context Group UID (see Table A-3 Context Group UID Values in PS3.6 ).

RANGE_INCL, RANGE_EXCL, GREATER_OR_EQUAL, LESS_OR_EQUAL, GREATER_THAN or LESS_THAN shall only be specified if the Selector Attribute (0072,0026) is AS, DA, DS, DT, FD, FL, IS, SL, SS, TM, UL or US.

See Section C.2.2.2 in PS3.4 for further guidance on value comparison.

Note

MEMBER_OF with a single Item in the Constraint Value Sequence (0082,0034) is valid and is equivalent to EQUAL.

10.25.1.1 Multi-valued Attribute Constraints

If the Attribute referenced by the Selector Attribute (0072,0026) has a Value Multiplicity of greater than 1 and the Value of Selector Value Number (0072,0028) is 0, all Values in the selected Attribute shall be compared to the single specified Value. The constraint is violated if any of the multiple Values do not satisfy the comparison.

10.25.2 Constraint Violation Significance

The violation of some constraints may be more significant than others. Constraint Violation Significance (0082,0036) differentiates three levels of significance.

Specific behaviors associated with each level may be defined by the SOP Class or may be left to implementations. For example, violation of a constraint with a significance of FAILURE might require operator intervention, special auditing or rejection of the target Instance being evaluated; violation of a constraint with a significance of WARNING might require the operator be notified or a warning message be logged; violation of a constraint with a significance of INFORMATIVE might require an informational message be logged, or nothing at all if the constraint represents a preference not a significant concern.

Note

Violation of a constraint does not imply that the Selector Attribute Value is non-conformant to the Standard or is not clinically appropriate.

10.26 Attribute Value Macro

Table 10.26-1 specifies the Attributes of the Attribute Value Macro, which includes an Attribute to store a Value of a specified VR.

Table 10.26-1. Attribute Value Macro Attributes

Attribute Name	Tag	Type	Attribute Description
Selector AE Value	(0072,005E)	1C	The Value(s) of the Attribute identified by Selector Attribute (0072,0026). Required if Selector Attribute VR (0072,0050) is present and the Value is AE.
Selector AS Value	(0072,005F)	1C	The Value(s) of the Attribute identified by Selector Attribute (0072,0026). Required if Selector Attribute VR (0072,0050) is present and the Value is AS.
Selector AT Value	(0072,0060)	1C	The Value(s) of the Attribute identified by Selector Attribute (0072,0026). Required if Selector Attribute VR (0072,0050) is present and the Value is AT.
Selector CS Value	(0072,0062)	1C	The Value(s) of the Attribute identified by Selector Attribute (0072,0026). Required if Selector Attribute VR (0072,0050) is present and the Value is CS.
Selector DA Value	(0072,0061)	1C	The Value(s) of the Attribute identified by Selector Attribute (0072,0026). Required if Selector Attribute VR (0072,0050) is present and the Value is DA. See Note 2.
Selector DS Value	(0072,0072)	1C	The Value(s) of the Attribute identified by Selector Attribute (0072,0026). Required if Selector Attribute VR (0072,0050) is present and the Value is DS. See Note 1 and Note 2.
Selector DT Value	(0072,0063)	1C	The Value(s) of the Attribute identified by Selector Attribute (0072,0026). Required if Selector Attribute VR (0072,0050) is present and the Value is DT. See Note 1 and Note 2.
Selector FD Value	(0072,0074)	1C	The Value(s) of the Attribute identified by Selector Attribute (0072,0026). Required if Selector Attribute VR (0072,0050) is present and the Value is FD. See Note 2.
Selector FL Value	(0072,0076)	1C	The Value(s) of the Attribute identified by Selector Attribute (0072,0026). Required if Selector Attribute VR (0072,0050) is present and the Value is FL. See Note 2.
Selector IS Value	(0072,0064)	1C	The Value(s) of the Attribute identified by Selector Attribute (0072,0026). Required if Selector Attribute VR (0072,0050) is present and the Value is IS.
Selector LO Value	(0072,0066)	1C	The Value(s) of the Attribute identified by Selector Attribute (0072,0026). Required if Selector Attribute VR (0072,0050) is present and the Value is LO.
Selector LT Value	(0072,0068)	1C	The Value of the Attribute identified by Selector Attribute (0072,0026). Required if Selector Attribute VR (0072,0050) is present and the Value is LT.
Selector OB Value	(0072,0065)	1C	The Value of the Attribute identified by Selector Attribute (0072,0026). Required if Selector Attribute VR (0072,0050) is present and the Value is OB.
Selector OD Value	(0072,0073)	1C	The Value of the Attribute identified by Selector Attribute (0072,0026). Required if Selector Attribute VR (0072,0050) is present and the Value is OD.
Selector OF Value	(0072,0067)	1C	The Value of the Attribute identified by Selector Attribute (0072,0026). Required if Selector Attribute VR (0072,0050) is present and the Value is OF.
Selector OL Value	(0072,0075)	1C	The Value of the Attribute identified by Selector Attribute (0072,0026). Required if Selector Attribute VR (0072,0050) is present and the Value is OL.
Selector OV Value	(0072,0081)	1C	The Value of the Attribute identified by Selector Attribute (0072,0026). Required if Selector Attribute VR (0072,0050) is present and the Value is OV.
Selector OW Value	(0072,0069)	1C	The Value of the Attribute identified by Selector Attribute (0072,0026). Required if Selector Attribute VR (0072,0050) is present and the Value is OW.
Selector PN Value	(0072,006A)	1C	The Value(s) of the Attribute identified by Selector Attribute (0072,0026). Required if Selector Attribute VR (0072,0050) is present and the Value is PN.
Selector SH Value	(0072,006C)	1C	The Value(s) of the Attribute identified by Selector Attribute (0072,0026). Required if Selector Attribute VR (0072,0050) is present and the Value is SH.
Selector SL Value	(0072,007C)	1C	The Value(s) of the Attribute identified by Selector Attribute (0072,0026). Required if Selector Attribute VR (0072,0050) is present and the Value is SL.
Selector SS Value	(0072,007E)	1C	The Value(s) of the Attribute identified by Selector Attribute (0072,0026). Required if Selector Attribute VR (0072,0050) is present and the Value is SS.
Selector ST Value	(0072,006E)	1C	The Value of the Attribute identified by Selector Attribute (0072,0026). Required if Selector Attribute VR (0072,0050) is present and the Value is ST.
Selector SV Value	(0072,0082)	1C	The Value of the Attribute identified by Selector Attribute (0072,0026). Required if Selector Attribute VR (0072,0050) is present and the Value is SV.
Selector TM Value	(0072,006B)	1C	The Value(s) of the Attribute identified by Selector Attribute (0072,0026). Required if Selector Attribute VR (0072,0050) is present and the Value is TM. See Note 1 and Note 2.
Selector UC Value	(0072,006F)	1C	The Value(s) of the Attribute identified by Selector Attribute (0072,0026). Required if Selector Attribute VR (0072,0050) is present and the Value is UC.
Selector UI Value	(0072,007F)	1C	The Value(s) of the Attribute identified by Selector Attribute (0072,0026). Required if Selector Attribute VR (0072,0050) is present and the Value is UI.
Selector UL Value	(0072,0078)	1C	The Value(s) of the Attribute identified by Selector Attribute (0072,0026). Required if Selector Attribute VR (0072,0050) is present and the Value is UL.
Selector UN Value	(0072,006D)	1C	The Value of the Attribute identified by Selector Attribute (0072,0026). Required if Selector Attribute VR (0072,0050) is present and the Value is UN.
Selector UR Value	(0072,0071)	1C	The Value of the Attribute identified by Selector Attribute (0072,0026). Required if Selector Attribute VR (0072,0050) is present and the Value is UR.
Selector US Value	(0072,007A)	1C	The Value(s) of the Attribute identified by Selector Attribute (0072,0026). Required if Selector Attribute VR (0072,0050) is present and the Value is US.
Selector UT Value	(0072,0070)	1C	The Value of the Attribute identified by Selector Attribute (0072,0026). Required if Selector Attribute VR (0072,0050) is present and the Value is UT.
Selector UV Value	(0072,0083)	1C	The Value of the Attribute identified by Selector Attribute (0072,0026). Required if Selector Attribute VR (0072,0050) is present and the Value is UV.
Selector Code Sequence Value	(0072,0080)	1C	The Value(s) of the Attribute identified by Selector Attribute (0072,0026). One or more Items shall be included in this Sequence. See Section C.23.4.2.1.2. Required if Selector Attribute VR (0072,0050) is present and the Value is SQ and the Attribute referenced by the Selector Attribute (0072,0026) is a Code Sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes”			No Baseline CID is defined.

Note

For string Value Representations, the meaning of the Value in the Standard shall be used, not the literal string. E.g. "1.0E+3" equals "1000" and "1000.0".
Some leniency will be required by the application in precision when matching this selector Value to an Attribute Value.

10.27 Reference Location Macro

Table 10.27-1 specifies the Attributes of the Reference Location Macro, which allows a reference location in the context of a Patient or scan to be identified and described. E.g., the Macro may describe an anatomically defined location along the axis of a CT scan to prescribe the extent of a scan or reconstruction. The location might be internal to the Patient (and appear on a localizer image) or might be an external landmark (on which a laser is aligned).

Table 10.27-1. Reference Location Macro Attributes

Attribute Name	Tag	Type	Attribute Description
Reference Location Label	(0018,9900)	1	Brief user-readable label for the location.
Reference Location Description	(0018,9901)	3	Further elaboration of the Reference Location. The Value may include a description of the relative anatomical location, the appearance of the feature or landmark, or how it can be identified.
Reference Basis Code Sequence	(0018,9902)	1	The anatomical feature or point of reference on which the reference location is based. Only a single Item shall be included in this Sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes”			CID may be defined in the Macro invocation.
Reference Geometry Code Sequence	(0018,9903)	1	Characterizes the geometry of the reference location (e.g., a plane or point). Only a single Item shall be included in this Sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes”			CID may be defined in the Macro invocation.
Offset Distance	(0018,9904)	3	Positive offset (in mm) from the Reference Basis to the actual Reference Location. See Section 10.27.1.
Offset Direction	(0018,9905)	1C	Direction of the offset (in terms of patient position) from the Reference Basis to the Reference Location. Enumerated Values: SUPERIOR INFERIOR ANTERIOR POSTERIOR LEFT RIGHT PROXIMAL DISTAL MEDIAL LATERAL Required if Offset Distance (0018,9904) is present.

10.27.1 Offset Distance and Direction

An example of the use of offsets might be:

Reference Location Label	(0018,9900)	"1cm above Liver"
Reference Location Description	(0018,9901)	"1cm above the uppermost extent of the liver"
Reference Basis Code Sequence	(0018,9902)	(10200004, SCT, "Liver")
Reference Geometry Code Sequence	(0018,9903)	(128120, DCM, "Plane through Superior Extent")
Offset Distance	(0018,9904)	10
Offset Direction	(0018,9905)	SUPERIOR

10.28 Protocol Element Identification Macro

Table 10.28-1 specifies the Attributes of the Protocol Element Identification Macro, which identifies and describes an element in a protocol such as an acquisition protocol, a reconstruction protocol or a storage protocol.

Table 10.28-1. Protocol Element Identification Macro Attributes

Attribute Name	Tag	Type	Attribute Description
Protocol Element Number	(0018,9921)	1	Identifies the protocol element and the order in which the elements are performed in the Protocol. The Value shall start at 1 and increase monotonically by 1.
Protocol Element Name	(0018,9922)	2	Name for this protocol element.
Protocol Element Purpose	(0018,9924)	3	Description of the purpose this element serves in the protocol. Note This is intended for use by the radiologist, technologist and/or physicist during management of the Protocol to understand the purpose the Protocol Element serves in the Protocol. It is not intended to be copied into the Series Description. Rather there is an Attribute in the Performed Storage Module called Requested Series Description (0018,9937) that is intended to be copied into the Series Description of the stored Instances.
Protocol Element Characteristics Summary	(0018,9923)	3	Summary description of characteristics of this element. Note This is intended for use by the radiologist, technologist and/or physicist during management of the Protocol to understand the characteristics of the Protocol Element. It is not intended to be copied into the Series Description. Rather there is an Attribute in the Performed Storage Module called Requested Series Description (0018,9937) that is intended to be copied into the Series Description of the stored Instances.

10.29 UDI Macro

Table 10.29-1 specifies the Attributes of the UDI Macro, which records details associated with a Unique Device Identifier (UDI).

Table 10.29-1. UDI Macro Attributes

Attribute Name

Tag

Type

Attribute Description

Unique Device Identifier

(0018,1009)

The entire Human Readable Form of the UDI as defined by the Issuing Agency.

See Section 10.29.1.

Device Description

(0050,0020)

Further description in free form text describing the device.

This can be used to distinguish between Items when multiple UDIs are recorded in a Sequence.

10.29.1 Unique Device Identifier

The UDI is a combination of the Device Identifier and the Production Identifier.

The format of the string is defined by a corresponding Issuing Agency, such as:

Details for encoding a valid device identifier are managed by the Issuing Agency. For full documentation, refer to issuer materials.

The United States FDA requires the Issuing Agency to use only characters and numbers from the invariant character set of ISO/IEC 646 (ISO 7-bit coded character set also known as ISO IR 6). DICOM puts no constraints on the length of the string or the character sets beyond the UT Value Representation. Implementations should be prepared to handle very large strings and unusual characters.

10.30 Assertion Macro

Table 10.30-1 specifies the Attributes of the Assertion Macro, which is used to record Assertions made by a person or device about the content of a SOP Instance. The nature of the Assertion is defined by the Assertion Code.

The scope of the Assertion (e.g., whether it applies to the whole Instance, to a specific Item in a Sequence, etc.) is described at the point where the Macro is included. It is also expected that when this Macro is included, the Baseline CID for the Assertion Code Sequence (0044,0101) will be constrained.

Table 10.30-1. Assertion Macro Attributes

Attribute Name	Tag	Type	Attribute Description
Assertion Code Sequence	(0044,0101)	1	The Assertion being made. Only a single Item shall be included in this Sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes”			No Baseline CID defined
Assertion UID	(0044,0102)	1	Unique identification of this Assertion.
Asserter Identification Sequence	(0044,0103)	1	The person or device making the Assertion. Only a single Item shall be included in this Sequence. Note Multiple asserters wishing to make the same Assertion may be recorded as multiple Assertions, each with a single asserter.
>Include Table C.17-3b “Identified Person or Device Macro Attributes”			Organizational Role BCID 7452 “Organizational Role”.
Assertion DateTime	(0044,0104)	1	Date and time at which the Assertion was made.
Assertion Expiration DateTime	(0044,0105)	3	Date and time at which the Assertion expires. If this Attribute is absent or empty, it means the Assertion does not have a pre-determined date and time at which it expires.
Assertion Comments	(0044,0106)	3	Comments on the nature, extent or basis of the Assertion.
Pertinent Documents Sequence	(0038,0100)	3	Reference to document(s) that describe the Assertion semantics, or provide the basis for making the Assertion. Items shall not be empty. One or more Items are permitted in this Sequence.
>Referenced SOP Class UID	(0008,1150)	3	Unique identifier for the class of the referenced document.
>Referenced SOP Instance UID	(0008,1155)	3	Unique identifier for the referenced document as used in DICOM Instance references (see Section C.12.1.1.6).
>HL7 Instance Identifier	(0040,E001)	3	Instance Identifier of the referenced document, encoded as a UID (OID or UUID), concatenated with a caret ("^") and Extension value (if Extension is present in Instance Identifier).
>Retrieve URI	(0040,E010)	3	Retrieval access path to the referenced document. Includes fully specified scheme, authority, path, and query in accordance with [RFC3986].
Related Assertion Sequence	(0044,0107)	3	Other Assertions which may be of interest to systems examining this Assertion. One or more Items are permitted in this Sequence. Note For example, an Assertion that overrides a previous Assertion or disapproves a previously approved protocol, could reference the prior approval Instance making it easier to find/correlate/confirm.
>Referenced Assertion UID	(0044,0108)	1	Uniquely identifies a related Assertion.

10.31 Entity Labeling Macro

Table 10.31-1 specifies the Attributes of the Entity Labeling Macro, which provides identification of an entity to a user.

This information is intended for display to human readers. Shall not be used for structured processing.

Table 10.31-1. Entity Labeling Macro Attributes

Attribute Name

Tag

Type

Attribute Description

Entity Label

(3010,0035)

User-defined label for this entity.

See Section 10.31.1.1.

Entity Name

(3010,0036)

User-defined name for this entity.

See Section 10.31.1.2.

Entity Description

(3010,0037)

User-defined description for this entity.

See Section 10.31.1.2.

10.31.1 Entity Labeling Macro Attribute Descriptions

10.31.1.1 Entity Label

The Entity Label (3010,0035) represents a user-defined short free text providing the primary identification of this entity to other users.

10.31.1.2 Entity Name and Entity Description

The optional Attribute Entity Name (3010,0036) allows a longer string containing additional descriptive identifying text. The optional Attribute Entity Description (3010,0037) provides additional information when needed.

10.32 Entity Long Labeling Macro

Table 10.32-1 specifies the Attributes of the Entity Long Labeling Macro, which provides identification of an entity to a user.

This information is intended for display to human readers. Shall not be used for structured processing.

Table 10.32-1. Entity Long Labeling Macro Attributes

Attribute Name

Tag

Type

Attribute Description

Entity Long Label

(3010,0038)

User-defined label for this entity.

See Section 10.32.2.1.

Entity Description

(3010,0037)

User-defined description for this entity.

See Section 10.31.1.2.

10.32.2 Entity Long Labeling Macro Attribute Descriptions

10.32.2.1 Entity Long Label

The Entity Long Label (3010,0038) represents a user-defined free text providing the primary identification of this entity to other users.

10.33 Conceptual Volume Macro

Table 10.33-1 specifies the Attributes of the Conceptual Volume Macro. A Conceptual Volume is an abstract entity used to identify an anatomic region (such as a planning target volume or a combination of multiple anatomic volumes) or non-anatomic volumes such as a bolus or a marker. A Conceptual Volume can be established without necessarily defining its spatial extent (for example a Conceptual Volume for a tumor can be established prior to segmenting it). The spatial extent of a Conceptual Volume may change over time (for example as treatment proceeds the tumor volume corresponding to the Conceptual Volume will change).

The spatial extent of a Conceptual Volume may be defined by any general-purpose entity that represents geometric information (such as Segmentation, Surface Segmentation, RT Structure Set SOP Instance and alike) or a combination thereof, although the Conceptual Volume does exist independently of a specific definition of its spatial extent.

A Conceptual Volume may also be defined as a combination of other Conceptual Volumes.

Examples for Conceptual Volumes:

A Conceptual Volume (with a Conceptual Volume UID (3010,0006) can be used to represent the treatment target in an RT Physician Intent SOP Instance based upon a diagnostic image set, although the actual delineation of a specific target volume has not yet taken place. Later, the target volume is contoured. The RT Segment Annotation SOP Instance references the volume contours and associates it with the Conceptual Volume via the Conceptual Volume UID (3010,0006).
In an adaptive workflow, the anatomic volume may change over time. The Conceptual Volume on the other hand does not change. Multiple RT Segment Annotation SOP Instances, each referencing different Segmentation Instances, can be associated with the same Conceptual Volume via the Conceptual Volume UID (3010,0006), making it possible to track the volume over time.
A Conceptual Volume may represent targets and/or anatomic regions for which manually calculated doses are tracked (for example, in emergency treatments). In this case, Conceptual Volumes may be instantiated first in an RT Physician Intent SOP Instance and subsequently used in RT Radiation SOP Instances, or may be first instantiated in the Radiation SOP Instances. After treatment, these Conceptual Volumes will be used in RT Radiation Records to track the delivered dose. Such Conceptual Volumes may never reference a segmentation, but serve as a key for referencing the Conceptual Volume across these different SOP Instances.

Table 10.33-1. Conceptual Volume Macro Attributes

Attribute Name	Tag	Type	Attribute Description
Conceptual Volume UID	(3010,0006)	1	A UID identifying the Conceptual Volume.
Originating SOP Instance Reference Sequence	(3010,0007)	1C	Reference to the SOP Instance that contains the original definition of this Conceptual Volume identified by Conceptual Volume UID (3010,0006). Required when Conceptual Volume UID (3010,0006) was not issued in the current SOP Instance, but read from another SOP Instance. Only a single Item shall be included in this Sequence.
>Include Table 10-11 “SOP Instance Reference Macro Attributes”
Equivalent Conceptual Volumes Sequence	(3010,000A)	3	References one or more existing Conceptual Volumes that represent the same concept as the current Conceptual Volume. This Sequence might be used when Conceptual Volume references of existing SOP Instances are retrospectively identified as representing the same entity. One or more Items are permitted in this Sequence. See Section 10.33.1.1.
>Referenced Conceptual Volume UID	(3010,000B)	1	A UID identifying the Conceptual Volume.
>Equivalent Conceptual Volume Instance Reference Sequence	(3010,0009)	1	Reference to a SOP Instance that contains the Referenced Conceptual Volume UID (3010,000B) of the Equivalent Conceptual Volume. Only a single Item shall be included in this Sequence.
>>Include Table 10-11 “SOP Instance Reference Macro Attributes”
Derivation Conceptual Volume Sequence	(3010,0014)	3	Description of a Conceptual Volume that was used to derive this Conceptual Volume. Only a single Item is permitted in this Sequence.
>Derivation Description	(0008,2111)	3	A user-readable text description of how this Conceptual Volume was derived.
>Source Conceptual Volume Sequence	(3010,0018)	1	The set of Conceptual Volumes that were used to derive this Conceptual Volume. One or more Items shall be included in this Sequence.
>>Source Conceptual Volume UID	(3010,0015)	1	UID identifying the Conceptual Volume that was used to derive this Conceptual Volume.
>>Conceptual Volume Constituent Index	(3010,000D)	1	Index of the constituent in the Source Conceptual Volume Sequence. The Value shall start at 1 and increase monotonically by 1.
>>Conceptual Volume Constituent Segmentation Reference Sequence	(3010,0012)	2	Contains the reference to the constituents of the RT Segment Annotation Instance from which Conceptual Volume is derived. Zero or one Item shall be included in this Sequence.
>>>Referenced Direct Segment Instance Sequence	(3010,004A)	1	Reference to the SOP Instance that contains the Direct Segment Reference Sequence (3010,0023). Only a single Item shall be included in this Sequence. See Section 10.34.1.3.
>>>>Include Table 10-11 “SOP Instance Reference Macro Attributes”
>>>Referenced Segment Reference Index	(3010,0020)	1	The Segment Reference Index (3010,0022) in the Segment Reference Sequence (3010,0021) corresponding to the segment representing this Conceptual Volume. Shall reference only segment Items that contain the Direct Segment Reference Sequence (3010,0023).
>Conceptual Volume Derivation Algorithm Sequence	(3010,0016)	3	Algorithm used to derive this Conceptual Volume. One or more Items are permitted in this Sequence.
>>Include Table 10-19 “Algorithm Identification Macro Attributes”

10.33.1 Conceptual Volume Macro Attribute Descriptions

10.33.1.1 Equivalent Conceptual Volumes

Conceptual Volumes can be declared to be equivalent to other Conceptual Volumes. In such cases, the Equivalent Conceptual Volumes Sequence (3010,000A) is used in derived SOP Instances which are aware of other SOP Instances defining a semantically equivalent volume, but using different Conceptual Volume UIDs (3010,0006).

10.33.1.2 Derivation Conceptual Volume Sequence

The Derivation Conceptual Volume Sequence (3010,0014) may be used to describe how a Conceptual Volume is derived from one or more other Conceptual Volumes in cases where it may not be possible to describe the method of the derivation completely. Since the Conceptual Volume cannot be mathematically constructed from a derivation description, it will be defined explicitly by a segmentation.

The specification of derivation is different from combining Conceptual Volumes as defined in Section 10.34 “Conceptual Volume Segmentation Reference and Combination Macro”.

10.34 Conceptual Volume Segmentation Reference and Combination Macro

Table 10.34-1 specifies the Attributes of the Conceptual Volume Segmentation Reference and Combination Macro, which allows the combination of Conceptual Volumes as constituents of a combined volume. A representative example is to have the Left Lung and the Right Lung segmented, and then to declare the Lungs as a combined Conceptual Volume, for which prescription constraints can be defined.

The Macro also allows reference to RT Segment Annotation SOP Instances, which contain a segmented representation of the Conceptual Volume. At the invocation of this Macro it is declared, whether this segmented representation is required or not.

Figure 10.34-1. Conceptual Volume References

Figure 10.34-1 describes an RT Physician Intent Instance where Conceptual Volumes "Lung, left" and "Lung, right" are referenced, but not defined. In this example, the RT Segmentation Annotation Instances then define the volumetric information of the Conceptual Volumes by referencing a specific segment of a Segmentation Instance and a specific ROI in an RT Structure Set Instance.

Figure 10.34-2. Conceptual Volume Combination References

Figure 10.34-1 describes an RT Physician Intent Instance defining Conceptual Volumes "Lung, left" and "Lung, right" and Conceptual Volume "Lung" as a combination of the first two without a direct reference to a volume definition.

Table 10.34-1. Conceptual Volume Segmentation Reference And Combination Macro Attributes

Attribute Name	Tag	Type	Attribute Description
Include Table 10.33-1 “Conceptual Volume Macro Attributes”
Conceptual Volume Combination Flag	(3010,000E)	1	Indication that this Conceptual Volume is a combination of other Conceptual Volumes. Enumerated Values: YES NO
Conceptual Volume Constituent Sequence	(3010,0008)	1C	References to Conceptual Volumes which are constituents of this Conceptual Volume. See Section 10.34.1.1. Required if Conceptual Volume Combination Flag (3010,000E) equals YES. One or more Items shall be included in this Sequence. The combined Conceptual Volume UID shall not be included in the Sequence.
>Conceptual Volume Constituent Index	(3010,000D)	1	An index referenced in the Conceptual Volume Combination Expression (3010,000C) identifying the Conceptual Volume Constituent. The Value shall start at 1 and increase monotonically by 1.
>Constituent Conceptual Volume UID	(3010,0013)	1	UID identifying the Conceptual Volume that is a constituent of the combined Conceptual Volume.
>Originating SOP Instance Reference Sequence	(3010,0007)	1	Reference to the SOP Instance that contains the original definition of the Conceptual Volume constituent identified by Constituent Conceptual Volume UID (3010,0013) in this Sequence. If this Conceptual Volume originated in the current SOP Instance, then the referenced SOP Instance UID is the current SOP Instance UID. Only a single Item shall be included in this Sequence.
>>Include Table 10-11 “SOP Instance Reference Macro Attributes”
>Conceptual Volume Constituent Segmentation Reference Sequence	(3010,0012)	1C	Contains a segmented representation of the Conceptual Volume constituent. Required if the Conceptual Volume Segmentation Defined Flag (3010,0010) equals YES and the Conceptual Volume is not a Combination of other Conceptual Volumes. Only a single Item shall be included in this Sequence. See Section 10.34.1.2.
>>Referenced Direct Segment Instance Sequence	(3010,004A)	1	Reference to the SOP Instance that contains the Direct Segment Reference Sequence (3010,0023). Only a single Item shall be included in this Sequence. See Section 10.34.1.3.
>>>Include Table 10-11 “SOP Instance Reference Macro Attributes”
>>Referenced Segment Reference Index	(3010,0020)	1	The Segment Reference Index (3010,0022) in the Segment Reference Sequence (3010,0021) corresponding to the segment representing this Conceptual Volume. Shall reference only segment Items that contain the Direct Segment Reference Sequence (3010,0023).
Conceptual Volume Combination Expression	(3010,000C)	1C	Symbolic expression specifying the combination of Conceptual Volumes as a text string consisting of Conceptual Volume Constituent Index (3010,000D) Values, combination operators and parentheses. Required if Conceptual Volume Combination Flag (3010,000E) equals YES. See Section 10.34.1.1.
Conceptual Volume Combination Description	(3010,000F)	2C	Human-readable description of the combination of Conceptual Volumes. This information is intended for display and shall not be used for structured processing. Required if Conceptual Volume Combination Flag (3010,000E) equals YES.
Conceptual Volume Segmentation Defined Flag	(3010,0010)	1	Indication that there are defined segmentations for this Conceptual Volume. Enumerated Values: YES NO
Conceptual Volume Segmentation Reference Sequence	(3010,0011)	1C	Contains a segmented representation of the Conceptual Volume. Required when Conceptual Volume Segmentation Defined Flag (3010,0010) equals YES and Conceptual Volume Combination Flag (3010,000E) equals NO. Only a single Item shall be included in this Sequence. See Section 10.34.1.4.
>Referenced Direct Segment Instance Sequence	(3010,004A)	1	Reference to the SOP Instance that contains the Segment Reference Sequence (3010,0021) in which the segment is defined. Only a single Item shall be included in this Sequence. See Section 10.34.1.3.
>>Include Table 10-11 “SOP Instance Reference Macro Attributes”
>Referenced Segment Reference Index	(3010,0020)	1	The Segment Reference Index (3010,0022) in the Segment Reference Sequence (3010,0021) corresponding to the segment representing this Conceptual Volume. In the segment Item referenced, the Direct Segment Reference Sequence (3010,0023) shall be present.

10.34.1 Conceptual Volume Segmentation Reference and Combination Macro Attribute Description

10.34.1.1 Conceptual Volume Combination Expression

For Conceptual Volumes specified as a combination of other Conceptual Volumes, the combination logic is specified by the text string Value of the Conceptual Volume Combination Expression (3010,000C).

A nested list notation is used to apply geometric operators to a set of Conceptual Volumes.

The first element of the list shall be one of the following geometric operators:

UNION: geometric union of two or more arguments
INTERSECTION: geometric intersection of two or more arguments
NEGATION: geometric inverse of a single argument
SUBTRACTION: geometric subtraction of second argument from the first
XOR: geometric exclusive disjunction of two arguments

Note

The result of a NEGATION operation is well-defined only if used as an operand to an INTERSECTION. NEGATION without context to an INTERSECTION results in an infinite Volume.

Subsequent elements shall specify arguments of the geometric operator. An argument is either a Conceptual Volume Constituent Index (3010,000D) Value (i.e., positive integer) or a parenthesized list of operations.

The grammar for the Conceptual Volume Combination Expression (<sexpr>) is shown below in BNF (Backus Naur Form) :

<sexpr>         :: <cv> | <list>
<cv>            :: 1 | 2 | 3 | …
<list>          :: ( <op1><sp><sexpr> ) |
                   ( <op2><sp><sexpr><sp><sexpr> ) |
                   ( <op3><sp><args> )
<args>          :: <sexpr><sp><sexpr> | <args><sp><sexpr>
<op1>           :: NEGATION
<op2>           :: SUBTRACTION | XOR
<op3>           :: UNION | INTERSECTION
<sp>            :: 0x20

Examples:

Union of paired organs 1 and 2 (disjoint)

Figure 10.34.1.1-1. Conceptual Volume Example of Union of Disjoint Volumes

Conceptual Volume Combination Expression (3010,000C):

(UNION 1 2)

Items in Conceptual Volume Constituent Sequence (3010,0008):

Table 10.34.1.1-1. Conceptual Volume Example of Union of Disjoint Volumes

Conceptual Volume Constituent Index (3010,000D)	Conceptual Volume
1	Right Lung
2	Left Lung

Union of paired organs 1 and 2 (non-disjoint)

Figure 10.34.1.1-2. Conceptual Volume Example of Union of Non-disjoint Volumes

Conceptual Volume Combination Expression (3010,000C):

(UNION 1 2)

Items in Conceptual Volume Constituent Sequence (3010,0008) :

Table 10.34.1.1-2. Conceptual Volume Example of Union of non-disjoint Volumes

Conceptual Volume Constituent Index (3010,000D)	Conceptual Volume
1	Spinal Cord PRV
2	Left Lung

Union of two organs 1 and 2 with excluded volume 3 using NEGATION

Figure 10.34.1.1-3. Conceptual Volume Example of Intersection and Negation

Conceptual Volume Combination Expression (3010,000C):

(INTERSECTION (UNION 1 2) (NEGATION 3) )

Items in Conceptual Volume Constituent Sequence (3010,0008):

Table 10.34.1.1-3. Conceptual Volume Example of Intersection and Negation

Conceptual Volume Constituent Index (3010,000D)	Conceptual Volume
1	Heart
2	Left Lung
3	CTV

Union of paired organs 1 and 2, with exclusion of multiple volumes 3, 4 and 5

Figure 10.34.1.1-4. Conceptual Volume Example of Intersection and Union

Conceptual Volume Combination Expression (3010,000C):

(INTERSECTION (UNION 1 2) (NEGATION (UNION 3 4 5) ))

Note

This combination can be expressed alternatively as:

(SUBTRACTION (UNION 1 2) (UNION 3 4 5) )

Items in Conceptual Volume Constituent Sequence (3010,0008):

Table 10.34.1.1-4. Conceptual Volume Example of Intersection and Union

Conceptual Volume Constituent Index (3010,000D)	Conceptual Volume
1	R Lung
2	L Lung
3	Node 1
4	Node 2
5	CTV

Intersection of overlapping volumes 1 and 2

Figure 10.34.1.1-5. Conceptual Volume Example of Intersection of Non-disjunct Volumes

Conceptual Volume Combination Expression (3010,000C):

(INTERSECTION 1 2)

Items in Conceptual Volume Constituent Sequence (3010,0008):

Table 10.34.1.1-5. Conceptual Volume Example of Intersection of non-disjunct Volumes

Conceptual Volume Constituent Index (3010,000D)	Conceptual Volume
1	Rectum
2	Prostate PTV

Intersection of disjoint volumes 1 and 2

Figure 10.34.1.1-6. Conceptual Volume Example of Intersection of Non-disjunct Volumes

Conceptual Volume Combination Expression (3010,000C):

(INTERSECTION 1 2)

Items in Conceptual Volume Constituent Sequence (3010,0008):

Table 10.34.1.1-6. Conceptual Volume Example of Intersection of disjunct Volumes

Conceptual Volume Constituent Index (3010,000D)	Conceptual Volume
1	Bladder
2	Prostate

10.34.1.2 Conceptual Volume Segmentation Reference Sequence

The Conceptual Volume Constituent Segmentation Reference Sequence (3010,0012) contains a reference to a segmentation which represents the volume of this constituent geometrically. The referenced segmentations of the constituents of a combined Conceptual Volume may be in one or more Frames of References.

The Conceptual Volume constituents shall not include the combined Conceptual Volume being defined. Applications that wish to combine existing segmentations within the same Conceptual Volume must create a new Segmentation Instance.

10.34.1.3 Referenced Direct Segment Instance Sequence

A SOP Instance may only be referenced in this Sequence if it belongs to a SOP Class that includes the Section C.36.9 Segment Reference Module.

10.34.1.4 Conceptual Volume Segmentation Reference Sequence

The Conceptual Volume Segmentation Reference Sequence (3010,0011) contains a reference to a segmentation which represents this volume geometrically.

10.35 Device Model Macro

Table 10.35-1 specifies the Attributes of the Device Model Macro, which contains general Attributes needed to specify a device model other than the device creating the SOP Instance.

Table 10.35-1. Device Model Macro Attributes

Attribute Name	Tag	Type	Attribute Description
Manufacturer	(0008,0070)	2	Manufacturer of the device.
Manufacturer's Model Name	(0008,1090)	2	Manufacturer's model name of the device.
Manufacturer's Model Version	(3010,001A)	2	A version number of the Manufacturer's model of the device.

10.36 Device Identification Macro

Table 10.36-1 specifies the Attributes of the Device Identification Macro, which identifies a (physical or virtual) device.

Table 10.36-1. Device Identification Macro Attributes

Attribute Name	Tag	Type	Attribute Description
Device Type Code Sequence	(3010,002E)	1	The type of the device. Only a single Item shall be included in this Sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes”			CID may be defined in the Macro invocation.
Device Label	(3010,002D)	1	User-defined label for this device.
Long Device Description	(0050,0021)	3	User-defined description for this device.
Device Serial Number	(0018,1000)	2	Manufacturer's serial number of the device.
Software Versions	(0018,1020)	2	Manufacturer's designation of software version of the equipment.
Date of Manufacture	(0018,1204)	3	The date the device was originally manufactured or re-manufactured (as opposed to refurbished).
Date of Installation	(0018,1205)	3	The date the device was installed in its current location. The device may or may not have been used prior to installation in its current location.
UDI Sequence	(0018,100A)	3	Unique Device Identifier (UDI) of the device. One or more Items are permitted in this Sequence. Note Multiple Items may be present if the entire equipment has UDIs issued by different Issuing Authorities.
>Include Table 10.29-1 “UDI Macro Attributes”
Manufacturer's Device Identifier	(3010,0043)	2	An identifier issued by the manufacturer. See Note.
Device Alternate Identifier	(3010,001B)	2	An identifier intended to be read by a device such as a bar code reader.
Device Alternate Identifier Type	(3010,001C)	1C	Defines the type of Device Alternate Identifier. Required if Device Alternate Identifier (3010,001B) has a Value. Defined Terms: BARCODE RFID
Device Alternate Identifier Format	(3010,001D)	1C	Description of the format in which the Device Alternate Identifier (3010,001B) is issued. Required if Device Alternate Identifier (3010,001B) has a Value. See Section 10.36.1.1.

Note

Typically, the Device Identifier is a code which can be electronically read by the machine utilizing that device, e.g. to verify the presence of that device.

10.36.1 Device Component Identification Macro Attribute Descriptions

10.36.1.1 Device Alternate Identifier Format

The Device Alternate Identifier Format (3010,001D) specifies the format of the Value of the Device Alternate Identifier (3010,001B).

If the Value of Device Alternate Identifier Type (3010,001C) is RFID, a big variety of RFID formats exists (some examples are DOD-96, DOD-64 UID, GID-96, sgtin-96). Supported format values shall be defined in the Conformance Statement.

For Device Alternate Identifier Type (3010,001C) = BARCODE, see Section C.22.1.1.

10.37 Related Information Entities Macro

Table 10.37-1 specifies the Attributes of the Related Information Entities Macro, which defines references to entities and their purpose of reference. References can be made at the Study level, Series level, Instance level or Frame Level.

The Attributes Pertinent SOP Classes in Study (3010,0052) and Pertinent SOP Classes in Series (3010,0053) allow the specification of the relevant SOP Classes for the given purpose. These Attributes support filtering for certain SOP Classes, specification of corresponding query keys, and allowing the receiving application to assess its capabilities to handle the specified objects.

All referenced Studies, Series and Instances share the same single Purpose of Reference.

Table 10.37-1. Related Information Entities Macro Attributes

Attribute Name	Tag	Type	Attribute Description
Purpose of Reference Code Sequence	(0040,A170)	1	Describes the purpose for which the references are made. Only a single Item shall be included in this Sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes”			CID may be defined in the Macro invocation.
Referenced Study Sequence	(0008,1110)	1	Studies which are relevant for the invocation context. One or more Items shall be included in this Sequence.
>Study Instance UID	(0020,000D)	1	Uniquely identifies the referenced Study.
>Pertinent SOP Classes in Study	(3010,0052)	3	The SOP Classes in the Study which are relevant for the invocation context. If not present, all SOP Instances included in the referenced Study are considered relevant.
>Referenced Series Sequence	(0008,1115)	3	Series which are relevant for the invocation context. One or more Items are permitted in this Sequence.
>>Series Instance UID	(0020,000E)	1	Uniquely identifies the referenced Series.
>>Pertinent SOP Classes in Series	(3010,0053)	3	The SOP Classes in the Series which are relevant for the invocation context. If not present, all SOP Instances included in the referenced Series are considered relevant.
>>Referenced Image Sequence	(0008,1140)	3	Image SOP Instances which are relevant in the invocation context. One or more Items are permitted for this Sequence.
>>>Include Table 10-3 “Image SOP Instance Reference Macro Attributes”
>>Referenced Instance Sequence	(0008,114A)	3	Non-Image SOP Instances which are relevant in the invocation context. One or more Items are permitted for this Sequence.
>>>Include Table 10-11 “SOP Instance Reference Macro Attributes”

10.38 Outline Definition Macro

Table 10.38-1 specifies the Attributes of the Outline Definition Macro, which describes a 2D outline in a given coordinate system.

Table 10.38-1. Outline Definition Macro Attributes

Attribute Name	Tag	Type	Attribute Description
Outline Shape Type	(0018,1630)	1	Type of shape of the outline. Enumerated Values: RECTANGULAR CIRCULAR POLYGONAL See Section 10.38.1.1.
Outline Left Vertical Edge	(0018,1631)	1C	X-coordinate in mm of the left edge of the rectangular outline (parallel to the y-axis of the coordinate system). Required if Outline Shape Type (0018,1630) is RECTANGULAR. See Section 10.38.1.2.
Outline Right Vertical Edge	(0018,1632)	1C	X-coordinate in mm of the right edge of the rectangular outline (parallel to the y-axis of the coordinate system). Required if Outline Shape Type (0018,1630) is RECTANGULAR. See Section 10.38.1.2.
Outline Upper Horizontal Edge	(0018,1633)	1C	Y-coordinate in mm of the upper edge of the rectangular outline (parallel to the x-axis of the coordinate system). Required if Outline Shape Type (0018,1630) is RECTANGULAR. See Section 10.38.1.2.
Outline Lower Horizontal Edge	(0018,1634)	1C	Y-coordinate in mm of the lower edge of the rectangular outline (parallel to the x-axis of the coordinate system). Required if Outline Shape Type (0018,1630) is RECTANGULAR. See Section 10.38.1.2.
Center of Circular Outline	(0018,1635)	1C	Location (x,y) in mm of the center of the circular outline. Required if Outline Shape Type (0018,1630) is CIRCULAR. See Section 10.38.1.2.
Diameter of Circular Outline	(0018,1636)	1C	Diameter in mm of the circular outline. Required if Outline Shape Type (0018,1630) is CIRCULAR. See Section 10.38.1.2.
Number of Polygonal Vertices	(0018,1637)	1C	Number of Vertices in Vertices of the Polygonal Outline (0018,1638). Required if Outline Shape Type (0018,1630) is POLYGONAL.
Vertices of the Polygonal Outline	(0018,1638)	1C	A data stream of pairs of x and y in mm. Polygonal outlines are implicitly closed from the last vertex to the origin vertex and all edges shall be non-intersecting except at the vertices. Any given vertex shall occur only once in the data stream. Required if Outline Shape Type (0018,1630) is POLYGONAL. The number of pairs in this data stream shall equal the Value of Number of Polygonal Vertices (0018,1637). See Section 10.38.1.2.

10.38.1 Outline Definition Macro Attribute Description

10.38.1.1 Outline Shape Type

When outline shape is a rectangle or a circle per design, the Outline Shape Type (0018,1630) shall have the Value RECTANGULAR or CIRCULAR respectively and the outline shall not be represented as a polyline.

10.38.1.2 Coordinate Definitions

The values are defined in a plane that is declared in the invocation of the Macro.

10.39 Patient to Equipment Relationship Macro

Table 10.39-1 specifies the Attributes of the Patient to Equipment Relationship Macro, which describes the position of the patient with respect to a device. The position is defined by means of a transformation matrix between a Patient Frame of Reference and an Equipment Frame of Reference.

Table 10.39-1. Patient to Equipment Relationship Macro Attributes

Attribute Name	Tag	Type	Attribute Description
Image to Equipment Mapping Matrix	(0028,9520)	1	A rigid, homogeneous 4x4 transformation matrix that maps the patient coordinate space in the Frame of Reference used for the patient model to the coordinate system defined by the equipment. Matrix elements shall be listed in row-major order. See Section 10.39.1.1, Section 10.39.1.2 and Section C.7.6.21.1.
Frame of Reference Transformation Comment	(3006,00C8)	3	Comments entered by a human operator about the relationship between the patient Frame of Reference and the equipment. For display purposes only, shall not be used for other purposes.
Patient Location Coordinates Sequence	(3006,00C9)	2	Specific points in the patient coordinate system which further characterize the position of the patient with respect to the equipment. Zero or more Items shall be included in this Sequence.
>3D Point Coordinates	(0068,6590)	1	Coordinate (x,y,z) in mm describing the location in the patient Frame of Reference that will be transformed to the Equipment Frame of Reference by using the Image to Equipment Mapping Matrix (0028,9520).
>Patient Location Coordinates Code Sequence	(3006,00CA)	1	Identifies the type of Patient Location Coordinate. One or more Items shall be included in this Sequence.
>>Include Table 8.8-1 “Code Sequence Macro Attributes”.			CID is specified at invocation.
Patient Support Position Sequence	(3006,00CB)	2	Actual Patient Support Position parameters. Shall be consistent with the Image to Equipment Mapping Matrix (0028,9520). See Section 10.39.1.2. Zero or one Item shall be included in this Sequence.
>Include Table 10.40-1 “Patient Support Position Macro Attributes”.

10.39.1 Patient to Equipment Relationship Macro Attributes Description

10.39.1.1 Equipment Coordinate System

A piece of equipment has an Equipment Coordinate System which can be used for expressing geometric concepts such as locations and orientations. The coordinate system is characterized by the location of the origin and the orientation of coordinate axes with respect to the equipment. The Equipment Coordinate System is a right-handed coordinate system.

Equipment Coordinate Systems are typically based on a standardized definition of axes. The choice of origin is often device-specific or device-type-specific. It may be any significant location on the machine such as the manufacturer-dependent machine isocenter.

The Equipment Coordinate System can be used as the parent for derived coordinate systems.

10.39.1.2 Image to Equipment Mapping Matrix and Patient Support Position Macro

The Image to Equipment Mapping Matrix (0028,9520) describes the relationship between the Patient-oriented coordinate system and an Equipment Coordinate System. This matrix ^AM _Bdescribes a rigid transformation of a point ( ^Bx, ^By, ^Bz) with respect to the Patient coordinate system into ( ^Ax, ^Ay, ^Az) with respect to the Equipment Coordinate System as defined in Section C.7.6.21.1.

The Equipment Coordinate System is identified by the Equipment Frame of Reference UID (300A,0675). For further information on the definition of the Equipment Frame of Reference, see Section 10.39.1.1. The patient-oriented coordinate system is identified by the Frame of Reference UID (0020,0052) of the SOP Instance it is used within. Both coordinate systems are expressed in millimeters.

The Patient Support Position Macro invoked by Patient Support Position Sequence (3006,00CB) allows the exchange of device-specific parameters for the patient support device. Applications designed to guide a specific patient support device will be able to de-compose the transformation into device-specific parameters or derive a transformation matrix out of these parameters. Applications that are unable to know the decomposition of the transformation to those parameters and vice versa will still be able to display the native labels and numerical values of those parameters to human readers.

The Patient Support Position Sequence (3006,00CB) may be present to annotate the matrix and display the decomposed matrix contents. The content of the Patient Support Position Macro shall be used for display purposes only. It shall not be used for other purposes. The content of this Macro shall not be used as a substitute for the Image to Equipment Mapping Matrix (0028,9520). In general, there is more than one way to reach the point in space that is described by the Image to Equipment Mapping Matrix (0028,9520). Hence it is explicitly not implied how this position is reached.

In some cases (e.g., emergency treatments in Radiotherapy), the Patient Frame of Reference is not defined by an image series. In this case an arbitrary Frame of Reference is used for the patient coordinate system in the Frame of Reference Module of the SOP Instance. The Image to Equipment Mapping Matrix (0028,9520) has the same meaning as in the case of image-based Patient Frame of Reference.

When a Frame of Reference of a patient model is not available, the well-known Frame of Reference of a patient support device may be used.

The well-known Frame of Reference and its origin and orientation with respect to the device shall be documented in the Conformance Statement. Note that the orientation of the axes of the well-known Frame of Reference are tied to the device and not to the patient.

As an example, the initial position needs to be specified for the patient setup, prior to any imaging. For a treatment table whose origin and orientation are defined by [IEC 61217], the well-known Frame of Reference UID "1.2.840.10008.1.4.3.3" may be used.

If the Image to Equipment Mapping Matrix (0028,9520) and the Patient Support Position Sequence (3006,00CB) are both present, the information in both locations shall be consistent.

10.40 Patient Support Position Macro

Table 10.40-1 specifies the Attributes of the Patient Support Position Macro, which provides the device-specific geometric settings for the Patient Support device.

The information is intended for display to human readers and to support non-image-based patient positioning; however, the definition of the patient position with respect to the device is contained in the Image to Equipment Mapping Matrix (0028,9520).

Table 10.40-1. Patient Support Position Macro Attributes

Attribute Name	Tag	Type	Attribute Description
Patient Support Position Specification Method	(300A,065C)	1	Method of specification for patient support parameters. Enumerated Values: ABSENT No parameters are specified. GLOBAL Parameters are specified using a globally known method, irrespective of the device in use. DEVICE_SPECIFIC Parameters are specified using a device-specific method.
Patient Support Position Device Parameter Sequence	(300A,065D)	1C	Translational and rotational parameters for Patient Support devices. Required if Patient Support Position Specification Method (300A,065C) does not equal ABSENT. One or more Items shall be included in this Sequence if Patient Support Position Specification Method (300A,065C) equals DEVICE_SPECIFIC. Only one Item shall be included in this Sequence if Patient Support Position Specification Method (300A,065C) equals GLOBAL.
>Referenced Device Index	(300A,0607)	1C	The Value of Device Index (3010,0039) in Patient Support Devices Sequence (300A,0686) corresponding to the Patient Support Device in use. Required if Patient Support Position Specification Method (300A,065C) equals DEVICE_SPECIFIC.
>Device Order Index	(300A,065E)	1C	Index defining the order in which the Items in the Patient Support Position Device Parameter Sequence (300A,065D) are applied. The Value shall start at 1 and increase monotonically by 1. Required if Patient Support Position Specification Method (300A,065C) equals DEVICE_SPECIFIC. See Section 10.40.1.
>Patient Support Position Parameter Sequence	(300A,065B)	1	Translational and rotational parameters for a particular Patient Support device. One or more Items shall be included in this Sequence.
>>Patient Support Position Parameter Order Index	(300A,065F)	1C	Index defining the order in which the Items in the Patient Support Position Parameter Sequence (300A,065B) are applied. The Value shall start at 1 and increase monotonically by 1. Required if Patient Support Position Specification Method (300A,065C) equals DEVICE_SPECIFIC. See Section 10.40.1.
>>Include Table 10-2 “Content Item Macro Attributes”.			DTID 15302 “Patient Support Position Parameters”.

10.40.1 Position Parameters and Order Index

The Device Order Index (300A,065E) and the Patient Support Position Parameter Order Index (300A,065F) are applied sequentially, meaning all the Items in a Patient Support Position Parameter Sequence (300A,065B) are applied before proceeding to the Item in the Patient Support Position Device Parameter Sequence (300A,065D) specified by the next Device Order Index (300A,065E) Value.

A vendor may specify codes that are not included in TID 175001 and/or a set of codes which is not identical with the set defined in Section 10.40.1.1 or Section 10.40.1.2. The vendor shall document the codes used in this Macro in the Conformance Statement, as well as the corresponding parameters, their geometric interpretation, and the order in which they will be applied. These parameters shall use UCUM units of mm for lengths and degrees for angles.

10.40.1.1 IEC 61217 Patient Support Device

Devices using the [IEC 61217] coordinate systems to define geometric settings for the Patient Support device shall use the codes in Table 10.40-2 in the order specified in column Patient Support Position Parameter Order Index (300A,065F). Other codes shall not be used.

Table 10.40-2. IEC 61217 Patient Support Position Parameter Order Index

Code Value (0008,0100)	Code Meaning (0008,0104)	Patient Support Position Parameter Order Index (300A,065F)
126801	IEC61217 Patient Support Continuous Yaw Angle	1
126806	IEC61217 Table Top Lateral Position	2
126807	IEC61217 Table Top Longitudinal Position	3
126808	IEC61217 Table Top Vertical Position	4
126802	IEC61217 Table Top Support Continuous Pitch Angle	5
126803	IEC61217 Table Top Support Continuous Roll Angle	6

10.40.1.2 Isocentric Patient Support Device

Devices using an isocentric representation to define geometric settings for the Patient Support device shall use the codes in Table 10.40-3 in the order specified in column Patient Support Position Parameter Order Index (300A,065F). Other codes shall not be used.

Table 10.40-3. Isocentric Patient Support Position Parameter Order Index

Code Value (0008,0100)	Code Meaning (0008,0104)	Patient Support Position Parameter Order Index (300A,065F)
126814	Isocentric Patient Support Continuous Yaw Angle	1
126812	Isocentric Patient Support Continuous Pitch Angle	2
126813	Isocentric Patient Support Continuous Roll Angle	3
126815	Isocentric Patient Support Lateral Position	4
126816	Isocentric Patient Support Longitudinal Position	5
126817	Isocentric Patient Support Vertical Position	6

10.41 General Procedure Protocol Reference Macro

Table 10.41-1 specifies the Attributes of the General Procedure Protocol Reference Macro, which identifies the Procedure Protocol SOP Instance and the Protocol Element related to the creation of an Instance.

Note

Because all the Instances in a Series are often generated from the same acquisition/reconstruction protocol, protocol is often considered at the Series level (Protocol Name (0018,1030) is in the General Series Module). It is however valid to have several Instances in the same Series where each Instance was generated using a different protocol and/or a different protocol element.

Table 10.41-1. General Procedure Protocol Reference Macro Attributes

Attribute Name	Tag	Type	Attribute Description
Referenced Defined Protocol Sequence	(0018,990C)	1C	Defined Procedure Protocol SOP Instance(s) that were used for this Instance. Required if this instance is a Performed Procedure Protocol that resulted from a Defined Procedure Protocol. May be present otherwise. One or more Items shall be included in this Sequence. See Section 10.41.1.
>Include Table 10-11 “SOP Instance Reference Macro Attributes”
>Source Acquisition Protocol Element Number	(0018,9938)	3	A single Value corresponding to the Protocol Element Number (0018,9921) of the Acquisition Protocol Element Specification Sequence (0018,991F) that corresponds to this Instance. Shall not be present if Source Reconstruction Protocol Element Number (0018,993A) is present.
>Source Reconstruction Protocol Element Number	(0018,993A)	3	A single Value corresponding to the Protocol Element Number (0018,9921) of the Reconstruction Protocol Element Specification Sequence (0018,9933) that corresponds to this Instance. Shall not be present if Source Acquisition Protocol Element Number (0018,9938) is present.
Referenced Performed Protocol Sequence	(0018,990D)	1C	Performed Procedure Protocol SOP Instance(s) that describe the conditions by which this Instance was generated. Required if a related Performed Procedure Protocol SOP Instance was created. One or more Items shall be included in this Sequence. See Section 10.41.1.
>Include Table 10-11 “SOP Instance Reference Macro Attributes”
>Source Acquisition Protocol Element Number	(0018,9938)	3	A single Value corresponding to the Protocol Element Number (0018,9921) of the Acquisition Protocol Element Sequence (0018,9920) that corresponds to this Instance. Shall not be present if Source Reconstruction Protocol Element Number (0018,993A) is present.
>Source Reconstruction Protocol Element Number	(0018,993A)	3	A single Value corresponding to the Protocol Element Number (0018,9921) of the Reconstruction Protocol Element Sequence (0018,9934) that corresponds to this Instance. Shall not be present if Source Acquisition Protocol Element Number (0018,9938) is present.

10.41.1 General Procedure Protocol Reference

The Referenced Defined Protocol Sequence (0018,990C) contains a reference to the Defined Procedure Protocol SOP Instance(s) and protocol element that were used to generate this Instance. The Referenced Performed Protocol Sequence (0018,990D) contains a reference to the Performed Procedure Protocol SOP Instance(s) and protocol element that describe the conditions by which this Instance was generated.

Multiple Items in the Referenced Defined Protocol Sequence (0018,990C) may represent a group case where several Defined Procedure Protocols were performed together as a single Performed Procedure Protocol.

Multiple Items in the Referenced Performed Protocol Sequence (0018,990D) are recommended if the acquisition and reconstruction were recorded in separate Performed Procedure Protocol SOP Instances. However, it is not intended that this Sequence references Defined or prior Performed Protocol SOP Instances on which the current Performed Procedure Protocol SOP Instance was based. Such references may be found inside the current Performed Procedure Protocol SOP Instance itself.

In case where the acquisition and the reconstruction are done in two separate devices connected through the network, the reconstruction device can use the Source Acquisition Protocol Element of the Referenced Defined Protocol to determine the images that will be reconstructed with a given reconstruction protocol element.

10.42 Hierarchical Evidence Reference Macro

Table 10.42-1 specifies the Attributes of the Hierarchical Evidence Reference Macro.

Table 10.42-1. Hierarchical Evidence Reference Macro Attributes

Attribute Name	Tag	Type	Attribute Description
Referenced Raw Data Sequence	(0008,9121)	3	The Raw data that was used to derive this Image. One or more Items are permitted in this Sequence. Note The Items of in this Sequence may identify raw data that has not been stored or encoded as a DICOM object. This allows recognition that images and spectra in different Instances have been reconstructed from the same raw data. For such Items the Referenced SOP Class UID (0008,1150) may be "1.2.840.10008.5.1.4.1.1.66" (Raw Data Storage).
>Include Table C.17-3 “Hierarchical SOP Instance Reference Macro Attributes”
Referenced Waveform Sequence	(0008,113A)	3	References to waveforms acquired in conjunction with this image. These Waveforms may or may not be temporally synchronized with this image. One or more Items are permitted in this Sequence.
>Include Table C.17-3 “Hierarchical SOP Instance Reference Macro Attributes”
Referenced Image Evidence Sequence	(0008,9092)	1C	Full set of Composite SOP Instances referred to inside the Referenced Image Sequences of this Instance. See Section 10.42.1.1 for further explanation. One or more Items shall be included in this Sequence. Required if the Referenced Image Sequence (0008,1140) is present and not empty, and the SOP Class UID (0008,0016) of the referencing SOP Instance is not a legacy converted SOP Class ("1.2.840.10008.5.1.4.1.1.2.2" (Legacy Converted Enhanced CT Image Storage), "1.2.840.10008.5.1.4.1.1.4.4" (Legacy Converted Enhanced MR Image Storage), "1.2.840.10008.5.1.4.1.1.128.1" (Legacy Converted Enhanced PET Image Storage)). May be present otherwise.
>Include Table C.17-3 “Hierarchical SOP Instance Reference Macro Attributes”
Source Image Evidence Sequence	(0008,9154)	1C	Full set of Composite SOP Instances referred to inside the Source Image Sequences of this Instance. See Section 10.42.1.1 for further explanation. One or more Items shall be included in this Sequence. Required if the Source Image Sequence (0008,2112) is present and not empty, and the SOP Class UID (0008,0016) of the referencing SOP Instance is not a legacy converted SOP Class ("1.2.840.10008.5.1.4.1.1.2.2" (Legacy Converted Enhanced CT Image Storage), "1.2.840.10008.5.1.4.1.1.4.4" (Legacy Converted Enhanced MR Image Storage), "1.2.840.10008.5.1.4.1.1.128.1" (Legacy Converted Enhanced PET Image Storage)). May be present otherwise.
>Include Table C.17-3 “Hierarchical SOP Instance Reference Macro Attributes”
Referenced Presentation State Sequence	(0008,9237)	1C	References to Presentation State instances created together with this instance Note This Sequence does not reference Presentation States generated after image creation, such as during interpretation. One or more Items shall be included in this Sequence. Required if Presentation State is created together with the images.
>Include Table C.17-3 “Hierarchical SOP Instance Reference Macro Attributes”

10.42.1 Hierarchical Evidence Reference Macro Attribute Descriptions

10.42.1.1 Evidence Sequence Attributes

The intent of the Referenced Image Evidence Sequence (0008,9092) and Source Image Evidence Sequence (0008,9154) is to provide a list of all unique SOP Instances listed in the Referenced Image Sequence (0008,1140) and Source Image Sequence (0008,2112) respectively.

A Composite Information Object Definitions (Normative)

A.1 Elements of An Information Object Definition

Each Composite IOD is composed of the following Sections

IOD Description
IOD Entity-Relationship Model
IOD Module Table
Optionally, a Functional Group Macros Table used by the Multi-frame Functional Groups Module

Section A.1.1, Section A.1.2 and Section A.1.3 define the requirements of a) through d) above.

A.1.1 IOD Description

This Section provides a brief description of the IOD. Specifically, this description includes:

The Real-World Object that is represented by the IOD
Information as to the scope of the represented object if appropriate

A.1.2 IOD Entity-Relationship Model

This Section of an IOD provides the Entity-Relationship (E-R) Model that depicts the relationships of the components or Information Entities (IE) of the specified IOD. It forms an IOD specific information model. This E-R model provides the complete context of how the Composite Instance information shall be interpreted when a Composite Instance is exchanged between two DICOM Application Entities; in particular, an IOD will specify a single IE at the level below the Series IE.

Even though Composite Instances are encoded as discrete individual components, each Composite Instance IOD E-R Model requires that all Composite Instances that are part of a specific Study shall share the same context. That is, all Composite Instances within a specific Patient Study share the same Patient and Study information; all Composite Instances within the same Series share the same Series information; etc.

Figure A.1-1 is the DICOM Composite Instance IOD Information Model. It applies to all Patient-related Composite Instance IODs defined in Annex A. However, a subset of this model may be specified by each individual Composite Instance IOD to accurately define the context for specific Composite Instance exchange.

The sub-sections of this Section describe the Information Entities (IE) that comprise the Composite Instance IODs defined in this Annex.

Figure A.1-1. DICOM Composite Instance IOD Information Model

A.1.2.1 Patient IE

The Patient IE defines the characteristics of a Patient who is the subject of one or more medical Studies.

Note

A Patient may be a human or a non-human organism.

The Patient IE is modality independent.

A.1.2.2 Study IE

The Study IE defines the characteristics of a medical Study performed on a Patient. A Study is a collection of one or more Series of medical images, presentation states, and/or SR documents that are logically related for the purpose of diagnosing a Patient. Each Study is associated with exactly one Patient.

A Study may include Composite Instances that are created by a single modality, multiple modalities or by multiple devices of the same modality.

The Study IE is modality independent.

A.1.2.3 Series IE

The Series IE defines the Attributes that are used to group Composite Instances into distinct logical sets. Each Series is associated with exactly one Study.

The following criteria group Composite Instances into a specific Series:

All Composite Instances within a Series must be of the same modality
Each Series may be associated with exactly one Frame of Reference IE, and if so associated all Composite Instances within the Series shall be spatially or temporally related to each other
All Composite Instances within the Series shall be created by the same equipment; therefore, each Series is associated with exactly one Equipment IE
All Composite Instances within a Series shall have the same Series information

Presentation States shall be grouped into one or more Series without Images or Waveforms (i.e., in a different Series from the Series containing the Images or Waveforms to which they refer).

Note

The Series containing Grayscale, Color and Pseudo-Color Softcopy Presentation States and the Series containing the Images to which they refer are both contained within the same Study, except for Blended Presentation States, which may refer to images from different Studies.
The Series containing the Waveform Presentation State and the Series containing the Waveforms to which they refer are both contained within the same Study.
The Series containing the Waveform Presentation State and the Series containing Waveform Annotation SRs to which they refer are both contained in the same Study but in different Series.

Waveforms shall be grouped into Series without Images. A Frame of Reference IE may apply to both Waveform Series and Image Series.

SR Documents shall be grouped into Series without Images. The Frame of Reference IE may apply to SR Document Series, for SR Documents that contain 3D spatial coordinates relative to one or more spatial Frames of Reference, or temporal coordinates that require a temporal Frame of Reference.

A.1.2.4 Equipment IE

The Equipment IE describes the particular device that produced the Series of Composite Instances. A device may produce one or more Series within a Study. The Equipment IE does not describe the data acquisition or image creation Attributes used to generate the Composite Instances within a Series. These Attributes are described in the Composite Instance specific IEs (e.g., the Image IE).

A.1.2.5 Frame of Reference IE

The Frame of Reference IE identifies the coordinate system that conveys spatial and/or temporal information of Composite Instances in a Series.

When present, a Frame of Reference IE may be related to one or more Series. In this case, it provides the ability to spatially or temporally relate multiple Series to each other. In such cases, the Series may share the UID of the Frame of Reference, or alternatively, a Registration SOP Instance may specify the spatial relationship explicitly, as a spatial transformation. A Frame of Reference IE may also spatially register a Frame of Reference to an atlas.

A.1.2.6 Image IE

The Image IE defines the Attributes that describe the pixel data of an image. The pixel data may be generated as a direct result of Patient scanning (termed an Original Image) or the pixel data may be derived from the pixel data of one or more other images (termed a Derived Image). An image is defined by its image plane, pixel data characteristics, gray scale and/or color mapping characteristics and modality specific characteristics (acquisition parameters and image creation information).

An image is related to a single Series within a single Study.

The pixel data within an Image IE may be represented as a single Frame of pixels or as multiple Frames of pixel data. The Frames of a Multi-frame Image (a Cine Run or the slices of a volume) are sequentially ordered and share a number of common properties. A few Attributes may vary between Frames (e.g., Time, Angular Displacement, Slice Increment). All common Image IE Attributes refer to the first Frame of a Multi-frame Image.

Overlay, Modality and Value of Interest Lookup Table and Real World Value Mapping data may be included within an Image IE only if this information is directly associated with the image.

A.1.2.6.1 Overlay Data

Overlay data represents graphics or text in a bit-map format, and is used to indicate such items as region of interest, reference marks and annotations.

A.1.2.6.2 Modality LUT Data

Modality LUT data describes the transformation of manufacturer dependent pixel values into pixel values that are manufacturer independent (e.g., Hounsfield units for CT, Optical Density for film digitizers, etc.). The transformation may be linear, described by Rescale Slope (0028,1053) and Rescale Intercept (0028,1052), or non-linear, described by a Lookup Table (LUT).

A.1.2.6.3 Value of Interest LUT Data

The Value of Interest (VOI) LUT data describes the transformation of the modality pixel values into pixel values that are meaningful for print, display, etc. This transformation is applied after any Modality LUT. The transformation may be linear, described by Window Center and Window Width, or non-linear, described by a Lookup Table. A non-linear interpretation of Window Center and Window Width may be defined by VOI LUT Function.

A.1.2.6.4 Real World Value Mapping Data

The Real World Value Mapping data describes the transformation of the image pixel values into Real World Values in defined units. There may be multiple transformations, each scoped by a range of input pixel values. Each transformation may be linear, described by Slope and Intercept, or non-linear, described by a Lookup Table.

A.1.2.7 Overlay IE (Retired)

Retired. See PS3.3-2016a.

Note

Overlays were previously modeled as independent Information Entities; in the current model they are considered Attributes within the Image IE or Presentation State IE. See A.1.2.6.1.

A.1.2.8 Curve IE (Retired)

Retired. See PS3.3-2004.

A.1.2.9 Modality LUT IE (Retired)

Retired. See PS3.3-2016a.

Note

Modality LUTs were previously modeled as independent Information Entities; in the current model they are considered Attributes within the Image IE or Presentation State IE. See A.1.2.6.2.

A.1.2.10 VOI LUT IE (Retired)

Retired. See PS3.3-2016a.

Note

VOI LUTs were previously modeled as independent Information Entities; in the current model they are considered Attributes within the Image IE or Presentation State IE. See A.1.2.6.3.

A.1.2.11 Presentation State IE

The Presentation State IE defines how a referenced image (or images) will be presented (e.g., displayed) in a device independent grayscale space (i.e., in P-Values) or color space (i.e., in PCS-values), and what graphical annotations and spatial and grayscale contrast transformations will be applied to the referenced image pixel data.

Overlay, Modality LUT, and VOI LUT data (see A.1.2.6.1, A.1.2.6.2, and A.1.2.6.3) may be included within a Presentation State IE if this information is to be applied to the referenced image(s).

A.1.2.12 Waveform IE

The Waveform IE represents a multi-channel time-based digitized waveform. The waveform consists of measurements of some physical qualities (e.g., electrical voltage, pressure, gas concentration, or sound), sampled at constant time intervals. The measured qualities may originate, for example, in any of the following sources:

the anatomy of the Patient,
therapeutic equipment (e.g., a cardiac pacing signal or a radio frequency ablation signal),
equipment for diagnostic synchronization (e.g., a clock or timing signal used between distinct devices),
the physician's voice (e.g., a dictated report).

The sample data within a Waveform IE may represent one or more acquired channels. Several signal channels acquired at the same sampling rate can be multiplexed (by interleaving samples) in a single multiplex group. (see also Annex C “Waveforms (Informative)” in PS3.17.)

A.1.2.13 SR Document IE

The SR Document IE defines the Attributes that describe the content of an SR Document. These include semantic context as well as Attributes related to document completion, verification and other characteristics. An SR Document SOP Instance is related to a single Series within a single Study.

A.1.2.14 Spectroscopy IE

The Spectroscopy IE defines the Attributes that describe the data of a spectroscopy acquisition created by a magnetic resonance spectroscopy device.

A.1.2.15 Raw Data IE

The Raw Data IE defines the Attributes that describe a collection of data that may be used for further processing to produce image data or other data.

Note

For example, raw data may be used with CT and MR systems to reconstruct sets of images or for MR to reconstruct spectroscopic data. The format of the raw data is vendor specific.

A.1.2.16 Encapsulated Document IE

The Encapsulated Document IE defines the Attributes that describe the content of a non-DICOM formatted document that is encapsulated in a DICOM Attribute. These include Attributes related to document origin, title, and other characteristics. An Encapsulated Document SOP Instance is related to a single Series within a single Study.

A.1.2.17 Real World Value Mapping IE

The Real World Value Mapping IE defines the Attributes that describe the mapping of stored pixel data to Real World values (see A.1.2.6.4).

A.1.2.18 Surface IE

The Surface IE defines the Attributes that describe a surface in a spatial coordinate system. A surface is defined by its shape and can be further defined by normals on that shape. The surface may be reconstructed from either spatial scans (e.g., laser scanners) or based on images. A surface is described by its finite volume and manifold property, gray scale and color mapping characteristics, presentation type, opacity, and modality specific characteristics.

A surface is related to a single Series.

A.1.2.19 Measurements IE

The Measurements IE defines the Attributes that describe the measurements taken by medical instruments.

A.1.2.20 Tractography Results IE

The Tractography Results IE defines the Attributes that describe the results of a tractography application.

Note

The term tractogram is not used because it does not include all types of tractography results.

A.1.2.21 Plan IE

The Plan IE defines the parameters and instructions to deliver treatment, particularly Radiotherapy, to the Patient. The entity includes the set of machine and positioning parameters to be applied during treatment delivery and instructions guiding the treatment workflow.

A.1.2.22 Content Assessment Result IE

The Content Assessment Result IE contains the results of an assessment of the content of a SOP Instance.

An assessment is part of a process within a clinical workflow, conducted by users or devices, which have the role of assessing the validity and suitability of the content in question, based on subjective or objective criteria. The specific nature of such a process is outside of the scope of this Standard.

A.1.2.23 Spatial Fiducials IE

The Spatial Fiducials IE identifies one or more geometric locations or shapes within a Frame of Reference or image pixel/voxel space that may be correlated with similar locations or shapes within different Frames of Reference or image pixel/voxel spaces.

A.1.2.24 Dose IE

The Dose IE describes dose distributions calculated by radiotherapy treatment planning systems. These distributions may be represented as 2D or 3D grids, as isodose curves, or as named or unnamed dose points scattered throughout a volume.

A.1.2.25 Structure Set IE

The Structure Set IE describes Regions of Interest (ROI) within a referenced 2D (image) or 3D (volumetric) space. These ROIs may be represented as geometric contours.

A.1.2.26 Treatment Record IE

The Treatment Record IE describes treatments, particularly radiotherapy, for a Patient.

A.1.2.27 Stereometric Relationship IE

The Stereometric Relationship IE defines how referenced images are related as stereometric pairs.

A.1.2.28 Procedure Protocol IE

The Procedure Protocol IE defines the Attributes that describe a Protocol. This IE may encode a Defined Procedure Protocol or a Performed Procedure Protocol.

A.1.2.29 Acquisition IE

The Acquisition IE defines the Attributes that describe a single continuous gathering of data.

An Acquisition may result in more than one Series, and a Series may contain Instances from more than one Acquisition.

A.1.2.30 Multi-Resolution Pyramid IE

The Multi-Resolution Pyramid IE describes a set of Images that encode the same image data at different spatial resolutions, i.e., a base (highest resolution) layer that is successively smoothed and down-sampled to create additional lower resolution layers (a multi-resolution decomposition).

Note

No specific method of filtering or down-sampling is specified by the Standard, nor is there a requirement for any specific down-sampling factor between layers, nor that an integer factor be used.

Each layer is encoded as a separate DICOM Image, each of which has a uniform resolution (same Value for Pixel Spacing (0028,0030)). Layers may be tiled, with each tile encoded as a Frame of a Multi-frame Image.

All DICOM Image SOP Instances that constitute a single Multi-Resolution Pyramid shall share the same Frame of Reference, and shall be contained in the same Series.

Only one Multi-Resolution Pyramid shall be contained in a Series (i.e., each such Multi-Resolution Pyramid will be in a different Series).

Note

In historical usage, there is no Multi-Resolution Pyramid IE and thus a Series is not constrained to contain only a single conceptual pyramid. However, any instantiation of the Multi-Resolution Pyramid in a Series constrains the Series to one Multi-Resolution Pyramid.
Each Multi-Resolution Pyramid may be accompanied in the same Series by LABEL, OVERVIEW and THUMBNAIL images if they share the same Frame of Reference (but not otherwise, per the definition of the Series IE). The THUMBNAIL image rather than a VOLUME image may be the apex (lowest resolution layer) of the Multi-Resolution Pyramid.
A unique identifier, Pyramid UID (0008,0019) will be assigned to an instance of a Multi-Resolution Pyramid, and will be shared by all of the layers that constitute that instance of a Multi-Resolution Pyramid, whether or not a particular resolution layer (usually the highest resolution) is deemed to be ORIGINAL, and the lower resolution layers DERIVED (e.g., by some down-sampling image processing operation). By definition, the absence of Pyramid UID (0008,0019) implies the absence of instantiation of the Multi-Resolution Pyramid IE.

That use is distinct from the Pyramid UID (0008,0019) of different Multi-Resolution Pyramids that may be further derived from a Multi-Resolution Pyramid. In otherwords, the Pyramid UID (0008,0019) of a Multi-Resolution Pyramid will not be shared between two pyramids that contain different pixel data (other than differences due to lossless representation of the same pixel data in different Transfer Syntaxes).

A.1.2.31 Waveform Presentation State IE

The Waveform Presentation State IE defines how referenced waveforms will be presented.

The Waveform Presentation State IE comprises text annotations, segments of interest, and montages including filters, colors, gain, and vertical sizes of waveform channels if this information is to be applied to the referenced waveform(s). It might also contain display information for structured annotations related to the referenced waveform(s).

A.1.3 IOD Module Table and Functional Group Macro Table

This Section of each IOD defines in a tabular form the Modules comprising the IOD. The following information must be specified for each Module in the table:

The name of the Module or Functional Group
A reference to the Section in Annex C that defines the Module or Functional Group
The usage of the Module or Functional Group; whether it is:
- Mandatory (see Section A.1.3.1), abbreviated M
- Conditional (see Section A.1.3.2), abbreviated C
- User Option (see Section A.1.3.3), abbreviated U

The Modules referenced are defined in Annex C.

A.1.3.1 Mandatory Modules

For each IOD, Mandatory Modules shall be supported per the definitions, semantics and requirements defined in Annex C.

A.1.3.2 Conditional Modules

Conditional Modules are Mandatory Modules if specific conditions are met. If the specified conditions are not met, this Module shall not be supported; that is, no information defined in that Module shall be present.

A.1.3.3 User Option Modules

User Option Modules may or may not be supported. If an optional Module is supported, the Attribute Types specified in the Modules in Annex C shall be supported.

A.1.4 Overview of the Composite IOD Module Content

The Tables in this Section provide an overview of the Modules used throughout the Composite IODs. This table is for informative purposes only. It is based on the IOD definitions found in the remaining Sections of Annex A that are normative.

Table A.1-1a. Composite Information Object Modules Overview - Images

IODs Modules	CR	CT	Enh CT	MR	Enh MR	Enh MR Col	NM	US	US MF	Enh US Vol	PA	SC	SC MF SB	SC MF GB	SC MF GW	SC MF TC	PT	Enh PT
Patient	M	M	M	M	M	M	M	M	M	M	M	M	M	M	M	M	M	M
Clinical Trial Subject	U	U	U	U	U	U	U	U	U	U	U	U	U	U	U	U	U	U
General Study	M	M	M	M	M	M	M	M	M	M	M	M	M	M	M	M	M	M
Patient Study	U	U	U	U	U	U	U	U	U	U	U	U	U	U	U	U	U	U
Clinical Trial Study	U	U	U	U	U	U	U	U	U	U	U	U	U	U	U	U	U	U
General Series	M	M	M	M	M	M	M	M	M	M	M	M	M	M	M	M	M	M
Clinical Trial Series	U	U	U	U	U	U	U	U	U	U	U	U	U	U	U	U	U	U
Enhanced Series											M
CR Series	M
NM/PET Patient Orientation							M										M
Enhanced Patient Orientation		U	U	U	U	U						U	U	U	U	U		U
PET Series																	M
PET Isotope																	M
PET Multi-gated Acquisition																	C
Enhanced PET Series																		M
Enhanced US Series										M
Frame of Reference		M	M	M	M	M	U	U	U	M	M			C	C	C	M	M
Ultrasound Frame of Reference										M	M
Synchronization		C	C		C	C	C	U	U	M	M			U	U	U	C	C
Cardiac Synchronization			C		C	C				C								C
Respiratory Synchronization			C		C	C				C								C
Bulk Motion Synchronization					C	C
General Equipment	M	M	M	M	M	M	M	M	M	M	M	U	U	U	U	U	M	M
Enhanced General Equipment			M		M	M				M	M							M
SC Equipment												M	M	M	M	M
Acquisition	M	M		M			M	M	M	M		M	M	M	M	M	M
General Image	M	M		M			M	M*	M	M	M	M	M	M	M	M	M
General Reference	U	U		U			U	U	U	U	U	U	U	U	U	U	U
Image Plane		M		M													M
Image Pixel	M	M	M	M	M	M	M	M*	M	M	M	M	M	M	M	M	M	M
NM Image Pixel							M
Palette Color Lookup Table								C	C
Supplemental Palette Color Lookup Table			C		C						C
Enhanced Palette Color Lookup Table										U
Contrast/Bolus	C	C		C				C*	C
Enhanced Contrast/Bolus			C		C	C				C	C
Cine									M				C	C	C	C
Multi-frame							M		M		M		M	M	M	M
NM Multi-frame							M
Frame Pointers									U				U	U	U	U
Multi-frame Functional Groups			M		M	M				M	M			U	U	U		M
Multi-frame Dimension			M		M	M				M	M			U	U	U		M
Excluded Intervals										U
Display Shutter	U
Device	U	U	U	U	U	U	U	U	U	U	U	U	U	U	U	U	U
Intervention																		U
Specimen	U	U	U	U	U	C	U	U	U	U	U	U	U	U	U	U	U	U
CR Image	M
CT Image		M
Enhanced CT Image			M
MR Image				M
Enhanced MR Image					M	M
MR Pulse Sequence					C	C
NM Image							M
NM Isotope							M
NM Detector							M
NM TOMO Acquisition							C
NM Multi-Gated Acquisition							C
NM Phase							C
NM Reconstruction							C
US Region Calibration								U*	U
US Image								M*	M
Enhanced US Image										M
IVUS Image										C
SC Image												M	U	U	U	U
SC Multi-frame Image													M	M	M	M
SC Multi-frame Vector													C	C	C	C
PET Image																	M
Enhanced PET Isotope																		M
Enhanced PET Acquisition																		M
Enhanced PET Image																		M
Photoacoustic Image											M
Photoacoustic Acquisition Parameters											M
Photoacoustic Transducer											U
Photoacoustic Reconstruction											U
Overlay Plane	U	U		U			U	U*	U			U					U
Multi-frame Overlay							U		U
Modality LUT	U											U
VOI LUT	U	U		U			U	U*	U			U		C	C		U
Common Instance Reference	U	U	U	U	U	U	U	U	U	U	U	U	U	U	U	U	U	U
Acquisition Context			M		M	M	U			M	M						U	M
ICC Profile			U		U	M	U	U	U	U	C	U				U
SOP Common	M	M	M	M	M	M	M	M*	M*	M	M	M	M	M	M	M	M	M
Frame Extraction			C		C	C	C		C	C	C		C	C	C	C		C

* The notation next to M and U indicates a special condition for these Modules. Refer to the corresponding IODs in this Annex for details.

Note

The original Ultrasound Image IOD and Ultrasound Multi-frame IOD, and the associated Ultrasound Image Storage SOP Class UID and Ultrasound Multi-frame Image Storage SOP Class UID have been retired. A new Ultrasound Image IOD and a new Ultrasound Multi-frame Image IOD are defined, as shown in Table A.1-1a, which includes the Palette Color Lookup Table Module.
The original Nuclear Medicine Image IOD and the associated Nuclear Medicine Image Storage SOP Class UID have been retired. A completely new Nuclear Medicine Image IOD is defined, as shown in Table A.1-1a.

Table A.1-1b. Composite Information Object Modules Overview - More Images

IODs Modules	XA	Enh XA	RF	Enh RF	3D XA	3D CF	Br Tomo	Br Proj	RT IM	DX	MG	IO	Par Map
Patient	M	M	M	M	M	M	M	M	M	M	M	M	M
Clinical Trial Subject	U	U	U	U	U	U	U	U	U	U	U	U	U
General Study	M	M	M	M	M	M	M	M	M	M	M	M	M
Patient Study	U	U	U	U	U	U	U	U	U	U	U	U	U
Clinical Trial Study	U	U	U	U	U	U	U	U	U	U	U	U	U
General Series	M	M	M	M	M	M	M	M		M	M	M	M
Clinical Trial Series	U	U	U	U	U	U	U	U	U	U	U	U	U
Enhanced Series					M	M
RT Series									M
DX Series								M		M	M	M
Mammo Series											M
Enhanced Mammo Series							M	M
Intra-Oral Series												M
XA/XRF Series		M		M
Parametric Map Series													M
Frame of Reference		C		U	M	M	M	M	U	U	C	U	M
Synchronization	U	C	U	C	U		C	C					U
Cardiac Synchronization		C		C	C
Respiratory Synchronization		C		C	C
General Equipment	M	M	M	M	M	M	M	M	M	M	M	M	M
Enhanced General Equipment		M		M	M	M	M	M					M
Acquisition	M		M						M	M	M	M	U
Multi-Resolution Pyramid													U
General Image	M		M						M	M	M	M	M
General Reference	U		U						U	U	U	U	U
Image Pixel	M	M	M	M	M	M	M	M	M	M	M	M	C
Microscope Slide Layer Tile Organization													C
Floating Point Image Pixel													C
Double Floating Point Image Pixel													C
Palette Color Lookup Table													C
Contrast/Bolus	C		C						C	U	U	U
Enhanced Contrast/Bolus		C		C	C	C	C	C
Cine	C		C						C
Multi-frame	C		C						C
Frame Pointers	U		U
Multi-frame Functional Groups		M		M	M	M	M	M					M
Multi-frame Dimension		U		U	U	U	U	U					M
Mask	C	U	C	U
Display Shutter	U		U							U	U	U
Device	U	U	U	U	U	U	U	U	U	U	U	U	U
Intervention	U	U	U	U	U	U	U	U		U	U	U
Specimen	U	U	U	U	U	U	U	U		U	U	U	U
Patient Orientation					U	U		M
Image - Equipment Coordinate Relationship					U	U	U
Cardiac Synchronization													U
Respiratory Synchronization													U
Bulk Motion Synchronization													U
X-Ray Image	M		M
Enhanced XA/XRF Image		M		M
X-Ray Acquisition	M		M
XA/XRF Acquisition		C		C
X-Ray Collimator	U		U							U	U	U
X-Ray Table	C		U
XRF Positioner			U
X-Ray Tomography Acquisition			C	U						U	U	U
X-Ray Acquisition Dose										U	U	U
X-Ray Generation										U	U	U
X-Ray Filtration		U		U						U	U	U
X-Ray Grid		U		U						U	U	U
XA Positioner	M
X-Ray Image Intensifier		C		C
X-Ray Detector		C		C
XA/XRF Multi-frame Presentation		U		U
X-Ray 3D Image					M	M	M
X-Ray 3D Angiographic Image Contributing Sources					U
X-Ray 3D Craniofacial Image Contributing Sources						U
Breast Tomosynthesis Contributing Sources							U
X-Ray 3D Angiographic Acquisition					U
X-Ray 3D Craniofacial Acquisition						U
Breast Tomosynthesis Acquisition							U
X-Ray 3D Reconstruction					U	U	U
Enhanced Mammography Image								M
Breast View							M	M
DX Anatomy Imaged										M	M	M
DX Image										M	M	M
DX Detector	U		U							M	M	M
DX Positioning										U	U	U
Mammo Image											M
Intra-Oral Image												M
RT Image									M
Parametric Map Image													M
Approval									U
Overlay Plane	U		U							C	C	C
Multi-frame Overlay	C		C
Modality LUT	C*		C*						U
VOI LUT	U		U						U	C	C	C
Image Histogram										U	U	U
Common Instance Reference	U	U	U	U	U	U	U	U	U	U	U	U	C
Acquisition Context		M		M	M	M	M	M		M	M	M	M
SOP Common	M	M	M	M	M	M	M	M	M	M	M	M	M
Frame Extraction	C	C	C	C	C	C	C	C	C				C

Table A.1-1c. Composite Information Object Modules Overview - More Images

IODs Modules	VL EN	VL MC	VL SL	VL WS	VL PH	DMS PH	CFM	CFM TP	Vid VL EN	Vid VL MC	Vid VL PH
Patient	M	M	M	M	M	M	M	M	M	M	M
Clinical Trial Subject	U	U	U	U	U	U	U	U	U	U	U
General Study	M	M	M	M	M	M	M	M	M	M	M
Patient Study	U	U	U	U	U	U	U	U	U	U	U
Clinical Trial Study	U	U	U	U	U	U	U	U	U	U	U
General Series	M	M	M	M	M	M	M	M	M	M	M
Clinical Trial Series	U	U	U	U	U	U	U	U	U	U	U
Whole Slide Microscopy Series				M
Frame of Reference			M	M		U	M	M
Synchronization							C	C			U
General Equipment	M	M	M	M	M	M	M	M	M	M	M
Enhanced General Equipment				M		M	M	M
VL Photographic Equipment					U	U
Acquisition	M	M	M	M	M	M	M	M	M	M	M
Multi-Resolution Pyramid				U				U
General Image	M	M	M	M	M	M	M	M	M	M	M
General Reference	U	U	U	U	U	U	U	U	U	U	U
Microscope Slide Layer Tile Organization				M				C
Image Pixel	M	M	M	M	M	M	M	M	M	M	M
Cine									M	M	M
Multi-frame									M	M	M
Multi-frame Functional Groups				M			M	M
Multi-frame Dimension				M			M	M
Device	U	U	U		U				U	U	U
Specimen	U	C	M	M	C		C	C	C	C	C
VL Image	M	M	M		M	M			M	M	M
VL Photographic Acquisition					U	U
VL Photographic Geolocation					U
Slide Coordinates			M
Whole Slide Microscopy Image				M
Optical Path		U	U	M			M	M
Slide Label				C
Dermoscopic Image						M
Confocal Microscopy Image							M	M
Confocal Microscopy Tiled Pyramidal Image								M
Cutaneous Confocal Microscopy Image Acquisition Parameters							C	C
Overlay Plane	U	U	U		U
Common Instance Reference	U	U	U	M	U	U	U	U	U	U	U
Acquisition Context	M	M	M	M	M	M	M	M	M	M	M
ICC Profile	U	U	U	U	U	U			U	U	U
SOP Common	M	M	M	M	M	M	M	M	M	M	M
Frame Extraction				C			C	C	C	C	C

Table A.1-1d. Composite Information Object Modules Overview - More Images

IODs Modules	Oph 8 Bit	Oph 16 Bit	WF Oph St	WF Oph 3DC	OPT	OCT ENF	OCT BSV	OPM	CM
Patient	M	M	M	M	M	M	M	M	M
Clinical Trial Subject	U	U	U	U	U	U	U	U	U
General Study	M	M	M	M	M	M	M	M	M
Patient Study	U	U	U	U	U	U	U	U	U
Clinical Trial Study	U	U	U	U	U	U	U	U	U
General Series	M	M	M	M	M	M	M	M	M
Clinical Trial Series	U	U	U	U	U	U	U	U	U
Ophthalmic Tomography Series					M
Ophthalmic Tomography En Face Series						M
Ophthalmic Tomography B-scan Volume Analysis Series							M
Ophthalmic Thickness Map Series								M
Corneal Topography Map Series									M
Frame of Reference			M	M	C	M	M		M
Synchronization	M	M	M	M	C
Cardiac Synchronization					C
General Equipment	M	M	M	M	M	M	M	M	M
Enhanced General Equipment			M	M	M	M	M	M	M
Acquisition	M	M	M	M		M		M	M
General Image	M	M	M	M		M		M	M
General Reference	U	U	U	U				U	U
Image Pixel	M	M	M	M	M	M	M	M	M
Palette Color Lookup Table						C			M
Supplemental Palette Color Lookup Table								C
Enhanced Contrast/Bolus	C	C	C	C	C
Cine	C	C	C	C
Multi-frame	M	M	M	M
Multi-frame Functional Groups					M		M
Multi-frame Dimension					M		M
Bitmap Display Shutter								C
Device	U	U
Ophthalmic Photography Image	M	M	M	M
Wide Field Ophthalmic Photography Stereographic Projection			M
Wide Field Ophthalmic Photography 3D Coordinates				M
Wide Field Ophthalmic Photography Quality Rating			C	C
Ocular Region Imaged	M	M	M	M	M	M
Ophthalmic Photography Acquisition Parameters	M	M	M	M				M	M
Ophthalmic Photographic Parameters	M	M	M	M
Ophthalmic Tomography Image					M
Ophthalmic Tomography Parameters					M
Ophthalmic Tomography Acquisition Parameters					M
Ophthalmic Thickness Map								M
Ophthalmic Thickness Map Quality Rating								C
Corneal Topography Map Image									M
Corneal Topography Map Analysis									M
Ophthalmic Optical Coherence Tomography En Face Image						M
Ophthalmic Optical Coherence Tomography B-scan Volume Analysis Image							M
Ophthalmic Optical Coherence Tomography En Face Image Quality Rating						C
Common Instance Reference	U	U	U	U	U	U	U	U
Acquisition Context	U	U	U	U	M			M	M
ICC Profile	U	U	C	C		U			U
SOP Common	M	M	M	M	M	M	M	M	M
Frame Extraction	C	C	C	C	C		C

Table A.1-1e. Composite Information Object Modules Overview - More Images

IODs Modules	IVOCT	Seg	Hgt Map Seg	Leg Conv Enh CT	Leg Conv Enh MR	Leg Conv Enh PET
Patient	M	M	M	M	M	M
Clinical Trial Subject	U	U	U	U	U	U
General Study	M	M	M	M	M	M
Patient Study	U	U	U	U	U	U
Clinical Trial Study	U	U	U	U	U	U
General Series	M	M	M	M	M	M
Clinical Trial Series	U	U	U	U	U	U
CT Series				M
MR Series					M
Enhanced PET Series						M
Segmentation Series		M	M
Intravascular OCT Series	M
Frame of Reference	M	C	M	M	M	M
Synchronization	M			U	U	U
Cardiac Synchronization	C			U	U	U
Respiratory Synchronization				U	U	U
Bulk Motion Synchronization					U
General Equipment	M	M	M	M	M	M
Enhanced General Equipment	M	M	M	U	U	U
Acquisition		U	M
Multi-Resolution Pyramid		U
General Image		M	M
General Reference		U	U
Microscope Slide Layer Tile Organization		C
Image Pixel	M	M		M	M	M
Floating Point Image Pixel			M
Palette Color Lookup Table		C
Supplemental Palette Color Lookup Table	C
Contrast/Bolus				U	U
Enhanced Contrast/Bolus	M			U	U
Multi-frame Functional Groups	M	M	M	M	M	M
Multi-frame Dimension	M	M	M	U	U	U
Device	U			U	U
Specimen		U		U	U	U
Intervention						U
Intravascular OCT Image	M
Intravascular OCT Acquisition Parameters	M
Intravascular OCT Processing Parameters	C
Intravascular Image Acquisition Parameters	M
Enhanced CT Image				M
Enhanced MR Image					M
Enhanced PET Image						M
Segmentation Image		M
Height Map Segmentation Image			M
Common Instance Reference	M	C	M	M	M	M
ICC Profile		C	M
Acquisition Context	M			M	M	M
SOP Common	M	M	M	M	M	M
Frame Extraction	C	C	C	C	C	C

Table A.1-2. Composite Information Object Modules Overview - Non-Images

IODs Modules	MR Spectroscopy	Raw Data	Surface Scan Point Cloud	Surface Scan Mesh	Content Assessment Result	WS Bulk Smpl Ann
Patient	M	M	M	M	M	M
Clinical Trial Subject	U	U	U	U	U	U
General Study	M	M	M	M	M	M
Patient Study	U	U	U	U	U	U
Clinical Trial Study	U	U	U	U	U	U
General Series	M	M	M	M	M	M
Clinical Trial Series	U	U	U	U	U	U
Optical Surface Scanner Series			M	M
Microscopy Bulk Simple Annotations Series						M
Frame of Reference	M	U	M	M		C
Sync.	C	C
Cardiac Sync.	C
Respiratory Sync.	C
Bulk Motion Sync.	C
General Equip.	M	M	M	M	M	M
Enhanced General Equip.	M		M	M	M	M
Enhanced Patient Orientation	U
Multi-frame Functional Groups	M
Multi-frame Dim.	M
Specimen	U	U	U	U
Raw Data		M
MR Spect.	M
MR Spect. Pulse Sequence	C
MR Spect. Data	M
Point Cloud			M
Surface Mesh				M
UV Mapping			U	U
Scan Procedure			M	M
Content Assessment Results					M
Microscopy Bulk Simple Annotations						M
Acquisition Context	M	M
Common Instance Reference					M	M
ICC Profile						U
SOP Common	M	M	M	M	M	M
Frame Extraction	C

Table A.1-3. Composite Information Object Modules Overview - More Non-Images

IODs Modules	Ln Mx	Aut Ref Mx	Ker Mx	Sub Ref Mx	Vis Acy Mx	Op Ax Mx	IO Ln Cl	OPV	Reg	Def Reg	Fid	RWV	Str Rl	Sfc Seg	Bs St Dsp	Trc Res
Patient	M	M	M	M	M	M	M	M	M	M	M	M	M	M	M	M
Clinical Trial Subject	U	U	U	U	U	U	U	U	U	U	U	U	U	U	U	U
General Study	M	M	M	M	M	M	M	M	M	M	M	M	M	M	M	M
Patient Study	U	U	U	U	U	U	U	U	U	U	U	U	U	U	U	U
Clinical Trial Study	U	U	U	U	U	U	U	U	U	U	U	U	U	U	U	U
General Series	M	M	M	M	M	M	M	M	M	M	M		M	M	M	M
Clinical Trial Series	U	U	U	U	U	U	U	U			U		U	U	U	U
Presentation Series															M
Spatial Registration Series									M	M
Spatial Fiducials Series											M
Real World Value Mapping Series												M
Stereometric Series													M
Segmentation Series														M
Lensometry Msrmnts. Series	M
Autorefraction Msrmnts. Series		M
Keratometry Msrmnts. Series			M
Subjective Refraction Msrmnts. Series				M
Visual Acuity Msrmnts. Series					M
Ophthalmic Axial Msrmnts. Series						M
Intraocular Lens Calculations Series							M
Visual Field Static Perimetry Msrmnts. Series								M
Tractography Results Series																M
Frame of Reference									M	M				M		M
General Equipment	M	M	M	M	M	M	M	M	M	M	M	M	M	M	M	M
Enhanced General Equipment	M	M	M	M	M	M	M	M		M				M	M	M
Specimen																U
Stereometric Relationship													M
Spatial Registration									M
Deformable Spatial Registration										M
Spatial Fiducials											M
Real World Value Mapping												M
Surface Segmentation														M
Surface Mesh														M
Structured Display															M
Structured Display Image Box															M
Structured Display Annotation															U
General Ophthalmic Refractive Msrmnts.	M	M	M	M	M	M	M
Lensometry Msrmnts.	M
Autorefraction Msrmnts.		M
Keratometry Msrmnts.			M
Subjective Refraction Msrmnts.				M
Visual Acuity Msrmnts.					M
Ophthalmic Axial Msrmnts.						M
Intraocular Lens Calculations							M
Visual Field Static Perimetry Test Parameters								M
Visual Field Static Perimetry Test Reliability								M
Visual Field Static Perimetry Test Msrmnts.								M
Visual Field Static Perimetry Test Results								M
Ophthalmic Patient Clinical Information and Test Lens Parameters								U
Common Instance Reference									M	M	M	M	M	C	M	M
General Reference									U	U	U			U
Tractography Results																M
SOP Common	M	M	M	M	M	M	M	M	M	M	M	M	M	M	M	M

Table A.1-4. Composite Information Object Modules Overview - Radiotherapy

IODs Modules	RT Dose	RT Struc Set	RT Plan	RT Beam Rec	RT Brachy Rec	RT Sum	RT Ion Plan	RT Ion Beams Treat Rec	RT Beams Delivery Inst	RT Brachy App Setup Delivery Inst
Patient	M	M	M	M	M	M	M	M	M	M
Clinical Trial Subject	U	U	U	U	U	U	U	U	U	U
General Study	M	M	M	M	M	M	M	M	M	M
Patient Study	U	U	U	U	U	U	U	U	U	U
Clinical Trial Study	U	U	U	U	U	U	U	U	U	U
General Series									M	M
Clinical Trial Series	U	U	U	U	U	U	U	U	U	U
RT Series	M	M	M	M	M	M	M	M
Frame of Reference	M	U	U				M
General Equipment	M	M	M	M	M	M	M	M	M	M
Enhanced General Equipment										M
General Image	C
Image Plane	C
Image Pixel	C
Multi-frame	C
RT Dose	M
RT DVH	U
Structure Set		M
ROI Contour		M
RT ROI Observations		M
RT General Treatment Record				M	M	M		M
RT Treatment Machine Record				M	M			M
Measured Dose Reference Record				U	U			U
Calculated Dose Reference Record				U	U			U
RT Beams Session Record				M
RT Ion Beams Session Record								M
RT Brachy Session Record					M
RT Treatment Summary Record				U	U	M		U
RT General Plan			M				M
RT Prescription			U				U
RT Tolerance Tables			U
RT Ion Tolerance Tables							U
RT Patient Setup			U	U	U		U	U
RT Fraction Scheme			U				U
RT Beams			C
RT Ion Beams							M
RT Brachy Application Setups			C
RT Beams Delivery Instruction									M
RT Brachy Application Setup Delivery Instruction										M
Approval		U	U				U
Common Instance Reference	U	U	U	U	U	U	U	U	C	M
General Reference		U	U	U	U	U	U	U	U	U
SOP Common	M	M	M	M	M	M	M	M	M	M
Frame Extraction	C

Table A.1-4b. Composite Information Object Modules Overview - Second Generation Radiotherapy

IODs Modules	RT Physn Intent	RT Seg Annot	RT Rad Set	C-Arm P-E Rad	Tomo Rad	Rob Arm Rad	RT Rad Rec Set	RT Rad Slvg Rec	C-Arm P-E Rec	Tomo Rec	Rob Arm Rec	RT Rad Set Del Inst	RT Treat Prep
Patient	M	M	M	M	M	M	M	M	M	M	M	M	M
Clinical Trial Subject	U	U	U	U	U	U	U	U	U	U	U	U	U
General Study	M	M	M	M	M	M	M	M	M	M	M	M	M
Patient Study	U	U	U	U	U	U	U	U	U	U	U	U	U
Clinical Trial Study	U	U	U	U	U	U	U	U	U	U	U	U	U
General Series			M	M	M	M	M	M	M	M	M	M	M
Clinical Trial Series	U	U	U	U	U	U	U	U	U	U	U	U	U
Enhanced RT Series	M	M	M	M	M	M	M	M	M	M	M	M	M
General Equipment	M	M	M	M	M	M	M	M	M	M	M	M	M
Enhanced General Equipment	M	M	M	M	M	M	M	M	M	M	M	M	M
Frame of Reference			M	M	M	M		U	M	M	M
Synchronization									C	C	C
Radiotherapy Common Instance	M	M	M	M	M	M	M	M	M	M	M	M	M
RT Physician Intent	M
RT Prescription	U
RT Treatment Phase Intent	C
RT Segment Annotation		M
RT Radiation Set			M
RT Radiation Set Delivery Instruction												M
RT Treatment Preparation													M
RT Dose Contribution			C
RT Radiation Record Set							M
RT Dose Contribution Record							C
RT Delivery Device Common				M	M	M		M	M	M	M
RT Radiation Common				M	M	M
RT Radiation Record Common								M	M	M	M
RT Radiation Salvage Record								M
C-Arm Photon-Electron Delivery Device				M					M
C-Arm Photon-Electron Beam				M					M
Tomotherapeutic Delivery Device					M					M
Tomotherapeutic Beam					M					M
Robotic-Arm Delivery Device						M					M
Robotic-Arm Path						M					M
Segment Reference		M
General Reference	M	M	M	M	M	M	M	M	M	M	M	M	M
Common Instance Reference	M	M	M	M	M	M	M	M	M	M	M	M	M
SOP Common	M	M	M	M	M	M	M	M	M	M	M	M	M

Table A.1-4c. Composite Information Object Modules Overview - More Second Generation Radiotherapy

IODs Modules	Enh RT Img	Enh Cont RT Img	RT Pat Pos Acq Inst
Patient	M	M	M
Clinical Trial Subject	U	U	U
General Study	M	M	M
Patient Study	U	U	U
Clinical Trial Study	U	U	U
General Series	M	M	M
Clinical Trial Series	U	U	U
Enhanced RT Series	M	M	M
Frame Of Reference	M	M
Synchronization	C	C
Cardiac Synchronization	C	C
Respiratory Synchronization	C	C
General Equipment	M	M	M
Enhanced General Equipment	M	M	M
Image Pixel	M	M
Enhanced RT Image Device	M	M
Enhanced RT Image	M	M
RT Patient Position Acquisition Device			M
RT Patient Position Acquisition Instruction			M
Multi-frame Functional Groups	M
Sparse Multi-frame Functional Groups		M
Multi-frame Dimension	M
Enhanced Contrast/Bolus	C	C
Device	U	U
General Reference	M	M	M
Common Instance Reference	M	M	M
SOP Common	M	M	M
Radiotherapy Common Instance	M	M	M
Frame Extraction	C

Table A.1-5. Composite Information Object Modules Overview - Implants

IODs Modules	Generic Implant Template	Implant Assembly Template	Implant Template Group
Generic Implant Template Description	M
Generic Implant Template 2D Drawings	C
Generic Implant Template 3D Models	C
Generic Implant Template Mating Features	U
Generic Implant Template Planning Landmarks	U
Implant Assembly Template		M
Implant Template Group			M
SOP Common	M	M	M
Surface Mesh	U

Table A.1-6. Composite Information Object Modules Overview - Presentation States

IODs Modules	Gray Pres State	Col Pres State	Pseudo Col Pres State	Blend Pres State	XA RF Pres State	Planar MPR Vol Pres State	Vol Rend Vol Pres State	Adv Blend Pres State	Var Mod LUT Pres State
Patient	M	M	M	M	M	M	M	M	M
Clinical Trial Subject	U	U	U	U	U	U	U	U	U
General Study	M	M	M	M	M	M	M	M	M
Patient Study	U	U	U	U	U	U	U	U	U
Clinical Trial Study	U	U	U	U	U	U	U	U	U
General Series	M	M	M	M	M	M	M	M	M
Clinical Trial Series	U	U	U	U	U	U	U	U	U
Presn. Series	M	M	M	M	M	M	M	M	M
Frame of Reference						M	M	M
General Equip.	M	M	M	M	M	M	M	M	M
Enhanced General Equip.					M	M	M	M	M
Mask	C		C						C
Display Shutter	C	C	C						C
Bitmap Display Shutter	C	C	C		C				C
Palette Color LUT			M	M					C
Overlay Plane	C	C	C		C				C
Disp. Area	M	M	M	M	M			U	M
Overlay Actvn.	C	C	C		C				C
Graphic Annot.	C	C	C	C	C	U	U	U	C
Spatial Trans.	C	C	C	C	C			C	C
Graphic Layer	C	C	C	C	C	C	C	C	C
Graphic Group	U	U	U	U		U	U	U	U
Modality LUT	C		C
Variable Modality LUT									C
Softcopy VOI LUT	C		C		C				C
Softcopy Presn. LUT	M				M				C
Presn. State Ident.	M	M	M	M	M			M	M
Presn. State Reln.	M	M	M		M				M
Presn. State Shutter	M	M	M		M				M
Presn. State Mask	M		M						M
Presn. State Blending				M
Adv. Presn. State Blending								M
Adv. Presn. State Display								M
XA/XRF Presn. State Mask					C
XA/XRF Presn. State Shutter					C
XA/XRF Presn. State Presn.					C
Volumetric Presentation State Identification						M	M
Volumetric Presentation State Relationship						M	M
Volume Cropping						C	C
Presentation View Description						M	M
Multi-Planar Reconstruction Geometry						M
Volume Render Geometry							M
Render Shading							U
MPR Volumetric Presentation State Display						M
Render Display							M
Volumetric Graphic Annotation						U	U
Presentation Animation						U	U
ICC Profile		M	M	M				M	C
Common Instance Reference						M	M	M
SOP Common	M	M	M	M	M	M	M	M	M

Table A.1-7. Composite Information Object Modules Overview - Structured Reports

IODs Modules	Basic Text SR	Enhd SR	Comp SR	Comp 3D SR	Extns SR	Key Obj Sel	Rend Obj Sel	Mam CAD	Ch CAD	Col CAD	Impl Plan SR	Prc Log
Patient	M	M	M	M	M	M	M	M	M	M	M	M
Clinical Trial Subject	U	U	U	U	U	U	U	U	U	U	U	U
General Study	M	M	M	M	M	M	M	M	M	M	M	M
Patient Study	U	U	U	U	U	U	U	U	U	U	U	U
Clinical Trial Study	U	U	U	U	U	U	U	U	U	U	U	U
Clinical Trial Series	U	U	U	U	U	U	U	U	U	U	U	U
SR Document Series	M	M	M	M	M			M	M	M	M	M
Key Object Document Series						M	M				M
Sync.		U	U	U	U		M		U			M
General Equip.	M	M	M	M	M	M	M	M	M	M	M	M
Enhanced General Equip.					M		M			M	M
SR Document General	M	M	M	M	M			M	M	M	M	M
SR Document Content	M	M	M	M	M	M	M	M	M	M	M	M
Key Object Document						M	M				M
Timezone											M
SOP Common	M	M	M	M	M	M	M	M	M	M	M	M

Table A.1-7b. Composite Information Object Modules Overview - More Structured Reports

IODs Modules	RD SR	R-RD SR	Pat RD SR	Enh RD SR	Sp Rx Rp	Mac Grd Rp	Acq Ctx SR	Simp Card Echo SR	Plan IA Admin SR	Perf IA Admin SR	WF Ann SR
Patient	M	M	M	M	M	M	M	M	M	M	M
Clinical Trial Subject	U	U	U	U	U	U	U	U	U	U	U
General Study	M	M	M	M	M	M	M	M	M	M	M
Patient Study	U	U	U	U	U	U	U	U	U	U	U
Clinical Trial Study	U	U	U	U	U	U	U	U	U	U	U
Clinical Trial Series	U	U	U	U	U	U	U	U	U	U	U
SR Document Series	M	M	M	M	M	M	M	M	M	M	M
Key Object Document Series
Sync.	C	C	C	C			C	C		M	C
General Equip.	M	M	M	M	M	M	M	M	M	M	M
Enhanced General Equip.	M	M	M	M	M	M	M	M	M	M	M
SR Document General	M	M	M	M	M	M	M	M	M	M	M
SR Document Content	M	M	M	M	M	M	M	M	M	M	M
Key Object Document
Timezone								M
SOP Common	M	M	M	M	M	M	M	M	M	M	M

Table A.1-8. Composite Information Object Modules Overview - Waveforms

IODs Modules	Basic Voice Audio	12 Lead ECG	General ECG WF	General 32-bit ECG WF	Ambul ECG WF	Hemo WF	Basic Cardiac EP WF	Arterial Pulse WF	Resp WF	General Audio WF	Scalp EEG WF	EMG WF	EOG WF	Sleep EEG WF	Multi Resp WF	Body Posn WF
Patient	M	M	M	M	M	M	M	M	M	M	M	M	M	M	M	M
Clinical Trial Subject	U	U	U	U	U	U	U	U	U	U	U	U	U	U	U	U
General Study	M	M	M	M	M	M	M	M	M	M	M	M	M	M	M	M
Patient Study	U	U	U	U	U	U	U	U	U	U	U	U	U	U	U	U
Clinical Trial Study	U	U	U	U	U	U	U	U	U	U	U	U	U	U	U	U
General Series	M	M	M	M	M	M	M	M	M	M	M	M	M	M	M	M
Clinical Trial Series	U	U	U	U	U	U	U	U	U	U	U	U	U	U	U	U
Synchronization	U	U	U	U	U	C	C	M	M	M	U	U	U	U	U	U
General Equipment	M	M	M	M	M	M	M	M	M	M	M	M	M	M	M	M
Enhanced General Equipment				M				M	M	M	M	M	M	M	M	M
Waveform Identification	M	M	M	M	M	M	M	M	M	M	M	M	M	M	M	M
Waveform	M	M	M	M	M	M	M	M	M	M	M	M	M	M	M	M
Waveform Annotation	U	C	C	C	C	C	C	C	C	C	C	C	C	C	C	C
Acquisition Context	M	M	M	M	U	M	M	M	M	M	M	U	U	U	U	U
SOP Common	M	M	M	M	M	M	M	M	M	M	M	M	M	M	M	M

Table A.1-9. Composite Information Object Modules Overview - Protocols

IODs Modules	CT Performed Procedure Protocol	XA Performed Procedure Protocol	CT Defined Procedure Protocol	XA Defined Procedure Protocol	Protocol Approval
Patient	M	M
Clinical Trial Subject	U	U
General Study	M	M
Patient Study	U	U
Clinical Trial Study	U	U
General Series	M	M
Clinical Trial Series	U	U
Enhanced Series	M	M
CT Protocol Series	M
XA Protocol Series		M
Frame of Reference	M	M
General Equipment	M	M	M	M	M
Enhanced General Equipment	M	M	M	M	M
Protocol Context	M	M	M	M
Patient Protocol Context	U	U
Clinical Trial Context			U	U
Patient Specification			U	U
Equipment Specification			M	M
Instructions	U	U	U	U
Patient Positioning	U	U	U	U
General Defined Acquisition			U	U
Performed CT Acquisition	U
Performed XA Acquisition		U
General Defined Reconstruction			U	U
Performed CT Reconstruction	U
Performed XA Reconstruction		U
Defined Storage			U	U
Performed Storage	U	U
Protocol Approval					M
SOP Common	M	M	M	M	M

Table A.1-10. Composite Information Object Modules Overview - Encapsulated Documents

IODs Modules	Enc PDF	Enc CDA	Enc STL	Enc OBJ	Enc MTL
Patient	M	M	M	M	M
Clinical Trial Subject	U	U	U	U	U
General Study	M	M	M	M	M
Patient Study	U	U	U	U	U
Clinical Trial Study	U	U	U	U	U
Clinical Trial Series	U	U	U	U	U
Encapsulated Document Series	M	M	M	M	M
Frame of Reference			M	M
General Equipment	M	M	M	M	M
Enhanced General Equipment			M	M	M
SC Equipment	M	M
Encapsulated Document	M	M	M	M	M
Manufacturing 3D Model			M	M	M
ICC Profile			U	U	U
SOP Common	M	M		M	M
Common Instance Reference			C	C	C

Table A.1-11. Real-Time Object Modules Overview - Images

IODs Modules	RTV EN	RTV PH
Patient	M	M
Clinical Trial Subject	U	U
General Study	M	M
Patient Study	U	U
Clinical Trial Study	U	U
General Series	M	M
Clinical Trial Series	U	U
General Equipment	M	M
Enhanced General Equipment	M	M
Frame of Reference	C	C
Synchronization	M	M
General Image	M	M
General Reference	U	U
Real-Time Bulk Data Flow	M	M
Acquisition Context	M	M
Device	U	U
Specimen	C	C
VL Image	M	M
ICC Profile	M	U
SOP Common	M	M
Common Instance Reference	M	M
Real-Time Acquisition	M	M
Current Frame Functional Groups	M	M

Table A.1-12. Real-Time Object Modules Overview - Waveforms

IODs Modules	RTV Basic Voice Audio
Patient	M
Clinical Trial Subject	U
General Study	M
Patient Study	U
Clinical Trial Study	U
General Series	M
Clinical Trial Series	U
General Equipment	M
Enhanced General Equipment	M
Synchronization	M
Waveform Identification	M
Real-Time Bulk Data Flow	M
Acquisition Context	M
SOP Common	M
Current Frame Functional Groups	M

Table A.1-13. Composite Information Object Modules Overview – Non-Patient Related Information

IODs Modules	Hanging Protocol	Color Palette	Inventory
Equipment			M
Hanging Protocol Definition	M
Hanging Protocol Environment	M
Hanging Protocol Display	M
Palette Color LUT		M
ICC Profile		M
Color Palette Definition		M
Inventory			M
SOP Common	M	M	M

Table A.1-14. Composite Information Object Modules Overview - Waveform Presentation States

IODs Modules	Waveform Presentation State	Waveform Acquisition Presentation State
Patient	M	M
Clinical Trial Subject	U	U
General Study	M	M
Patient Study	U	U
Clinical Trial Study	U	U
General Series	M	M
Clinical Trial Series	U	U
Presentation Series	M	M
Synchronization	C	C
General Equipment	M	M
Enhanced General Equipment	M	M
Presentation State Identification	M	M
Waveform Presentation State Relationship	M	M
Structured Waveform Annotation	U	U
Textual Waveform Annotation	U	U
Displayed Waveform Segment	U	U
Montage Activation	U	U
Waveform Presentation Montage	C	C
SOP Common	M	M

A.2 Computed Radiography Image IOD

A.2.1 Computed Radiography Image IOD Description

The Computed Radiography Image IOD specifies an image that has been created by a computed radiography imaging device.

Note

Digital Luminescence Radiography is an equivalent term for computed Radiography.

A.2.2 Computed Radiography Image IOD Entity-Relationship Model

This IOD uses the E-R Model in Section A.1.2, with only the Image IE below the Series IE. The Frame of Reference IE is not a component of this IOD.

A.2.3 Computed Radiography Image IOD Module Table

Table A.2-1 specifies the Modules of the Computed Radiography Image IOD.

Table A.2-1. Computed Radiography Image IOD Modules

IE	Module	Reference	Usage
Patient	Patient	C.7.1.1	M
Patient	Clinical Trial Subject	C.7.1.3	U
Study	General Study	C.7.2.1	M
	Patient Study	C.7.2.2	U
	Clinical Trial Study	C.7.2.3	U
Series	General Series	C.7.3.1	M
	CR Series	C.8.1.1	M
	Clinical Trial Series	C.7.3.2	U
Equipment	General Equipment	C.7.5.1	M
Acquisition	General Acquisition	C.7.10.1	M
Image	General Image	C.7.6.1	M
	General Reference	C.12.4	U
	Image Pixel	C.7.6.3	M
	Contrast/Bolus	C.7.6.4	C - Required if contrast media was used in this image
	Display Shutter	C.7.6.11	U
	Device	C.7.6.12	U
	Specimen	C.7.6.22	U
	CR Image	C.8.1.2	M
	Overlay Plane	C.9.2	U
	Modality LUT	C.11.1	U
	VOI LUT	C.11.2	U
	SOP Common	C.12.1	M
	Common Instance Reference	C.12.2	U

Note

The Curve Module (Retired) was previously included in the Image IE for this IOD but has been retired. See PS3.3-2004.

A.3 CT Image IOD

A.3.1 CT Image IOD Description

The CT Image IOD specifies an image that has been created by a Computed Tomography imaging device.

A.3.2 CT Image IOD Entity-Relationship Model

This IOD uses the E-R Model in Section A.1.2, with only the Image IE below the Series IE.

A.3.3 CT Image IOD Module Table

Table A.3-1 specifies the Modules of the CT Image IOD.

Table A.3-1. CT Image IOD Modules

IE	Module	Reference	Usage
Patient	Patient	C.7.1.1	M
Patient	Clinical Trial Subject	C.7.1.3	U
Study	General Study	C.7.2.1	M
	Patient Study	C.7.2.2	U
	Clinical Trial Study	C.7.2.3	U
Series	General Series	C.7.3.1	M
Series	Clinical Trial Series	C.7.3.2	U
Frame of Reference	Frame of Reference	C.7.4.1	M
Frame of Reference	Synchronization	C.7.4.2	C - Required if time synchronization was applied.
Equipment	General Equipment	C.7.5.1	M
Acquisition	General Acquisition	C.7.10.1	M
Image	General Image	C.7.6.1	M
	General Reference	C.12.4	U
	Enhanced Patient Orientation	C.7.6.30	U
	Image Plane	C.7.6.2	M
	Image Pixel	C.7.6.3	M
	Contrast/Bolus	C.7.6.4	C - Required if contrast media was used in this image
	Device	C.7.6.12	U
	Specimen	C.7.6.22	U
	CT Image	C.8.2.1	M
	Multi-energy CT Image	C.8.2.2	C - Required if Multi-energy CT Acquisition (0018,9361) is YES.
	Overlay Plane	C.9.2	U
	VOI LUT	C.11.2	U
	SOP Common	C.12.1	M
	Common Instance Reference	C.12.2	U

A.3.3.1 CT Image IOD Content Constraints

If Multi-energy CT Acquisition (0018,9361) is YES the following constraints will apply:

The Contrast/Bolus Module shall be present if contrast was administered even if images are processed to remove contrast information from the pixels, e.g. Virtual Non-Contrast images.
The Real World Value Mapping Sequence (0040,9096) shall be present in the General Image Module.
For Measurement Units Code Sequence (0040,08EA) in the Real World Value Mapping Sequence (0040,9096) DCID 301 “Multi-energy Material Unit” shall be used.

A.4 MR Image IOD

A.4.1 MR Image IOD Description

The MR Image IOD specifies an image that has been created by a Magnetic Resonance imaging device.

A.4.2 MR Image IOD Entity-Relationship Model

This IOD uses the E-R Model in Section A.1.2, with only the Image IE below the Series IE.

A.4.3 MR Image IOD Module Table

Table A.4-1 specifies the Modules of the MR Image IOD.

Table A.4-1. MR Image IOD Modules

IE	Module	Reference	Usage
Patient	Patient	C.7.1.1	M
Patient	Clinical Trial Subject	C.7.1.3	U
Study	General Study	C.7.2.1	M
	Patient Study	C.7.2.2	U
	Clinical Trial Study	C.7.2.3	U
Series	General Series	C.7.3.1	M
Series	Clinical Trial Series	C.7.3.2	U
Frame of Reference	Frame of Reference	C.7.4.1	M
Equipment	General Equipment	C.7.5.1	M
Acquisition	General Acquisition	C.7.10.1	M
Image	General Image	C.7.6.1	M
	General Reference	C.12.4	U
	Enhanced Patient Orientation	C.7.6.30	U
	Image Plane	C.7.6.2	M
	Image Pixel	C.7.6.3	M
	Contrast/Bolus	C.7.6.4	C - Required if contrast media was used in this image
	Device	C.7.6.12	U
	Specimen	C.7.6.22	U
	MR Image	C.8.3.1	M
	Overlay Plane	C.9.2	U
	VOI LUT	C.11.2	U
	SOP Common	C.12.1	M
	Common Instance Reference	C.12.2	U

A.5 Nuclear Medicine Image IOD

A.5.1 Nuclear Medicine Image IOD Description

The Nuclear Medicine Image IOD specifies an image that has been created by a Nuclear Medicine (NM) imaging device. This includes data created by external detection devices that create images of the distribution of administered radioactive materials in the body. Depending on the specific radio pharmaceutical administered and the particular imaging procedure performed, problems involving changes in metabolism, function, or physiology can be investigated and various regional pathologies can be studied.

A.5.2 Nuclear Medicine Image IOD Entity-Relationship Model

This IOD uses the E-R Model in Section A.1.2, with only the Image IE below the Series IE.

A.5.3 Nuclear Medicine Image IOD Module Table (Retired)

This Section was defined in a previous release of the DICOM Standard. The Section is now retired.

A.5.4 Nuclear Medicine Image IOD Module Table

Table A.5-1 specifies the Modules of the Nuclear Medicine Image IOD.

Table A.5-1. Nuclear Medicine Image IOD Modules

IE	Module	Reference	Usage
Patient	Patient	C.7.1.1	M
Patient	Clinical Trial Subject	C.7.1.3	U
Study	General Study	C.7.2.1	M
	Patient Study	C.7.2.2	U
	Clinical Trial Study	C.7.2.3	U
Series	General Series	C.7.3.1	M
	Clinical Trial Series	C.7.3.2	U
	NM/PET Patient Orientation	C.8.4.6	M
Frame of Reference	Frame of Reference	C.7.4.1	U
Frame of Reference	Synchronization	C.7.4.2	C - Required if time synchronization was applied
Equipment	General Equipment	C.7.5.1	M
Acquisition	General Acquisition	C.7.10.1	M
Image	General Image	C.7.6.1	M
	General Reference	C.12.4	U
	Image Pixel	C.7.6.3	M
	Acquisition Context	C.7.6.14	U - See Section A.5.4.1
	Device	C.7.6.12	U
	Specimen	C.7.6.22	U
	NM Image Pixel	C.8.4.7	M
	Multi-frame	C.7.6.6	M
	NM Multi-frame	C.8.4.8	M
	NM Image	C.8.4.9	M
	NM Isotope	C.8.4.10	M
	NM Detector	C.8.4.11	M
	NM Tomo Acquisition	C.8.4.12	C - Required if Image Type (0008,0008) Value 3 is TOMO, GATED TOMO, RECON TOMO or RECON GATED TOMO
	NM Multi-gated Acquisition	C.8.4.13	C - Required if Image Type (0008,0008) Value 3 is GATED, GATED TOMO, or RECON GATED TOMO
	NM Phase	C.8.4.14	C - Required if Image Type (0008,0008) Value 3 is DYNAMIC
	NM Reconstruction	C.8.4.15	C - Required if Image Type (0008,0008) Value 3 is RECON TOMO or RECON GATED TOMO
	Overlay Plane	C.9.2	U
	Multi-frame Overlay	C.9.3	U
	VOI LUT	C.11.2	U
	ICC Profile	C.11.15	U
	SOP Common	C.12.1	M
	Common Instance Reference	C.12.2	U
	Frame Extraction	C.12.3	C - Required if the SOP Instance was created in response to a Frame-Level retrieve request

Note

The Curve Module (Retired) was previously included in the Image IE for this IOD but has been retired. See PS3.3-2004.

A.5.4.1 Acquisition Context Module

For Acquisition Context Sequence (0040,0555) DTID 3470 “NM/PET Acquisition Context” shall be used, which includes description of the cardiovascular rest or stress state.

The Acquisition Context Sequence (0040,0555) shall always apply to all Frames in the Image. Patient State shall always apply to all Frames in the Image, therefore, neither Referenced Frame Numbers (0040,A136) nor Referenced Frame Number (0008,1160) shall be present.

The Acquisition Context information may be entered during acquisition, or obtained from the Modality Worklist using information supplied in the Protocol Context, using TID 15101 “NM/PET Protocol Context”.

A.6 Ultrasound Image IOD

A.6.1 Ultrasound Image IOD Description

The Ultrasound Image IOD specifies an image that has been created by an Ultrasound (US) imaging device.

A.6.2 Ultrasound Image IOD Entity-Relationship Model

This IOD uses the E-R Model in Section A.1.2, with only the Image IE below the Series IE.

A.6.3 Ultrasound Image IOD Module Table (Retired)

This Section was defined in a previous release of the DICOM Standard. The Section is now retired.

A.6.4 Ultrasound Image IOD Module Table

Table A.6-1 specifies the Modules of the Ultrasound Image IOD.

Table A.6-1. Ultrasound Image IOD Modules

IE	Module	Reference	Usage
Patient	Patient	C.7.1.1	M
Patient	Clinical Trial Subject	C.7.1.3	U
Study	General Study	C.7.2.1	M
	Patient Study	C.7.2.2	U
	Clinical Trial Study	C.7.2.3	U
Series	General Series	C.7.3.1	M
Series	Clinical Trial Series	C.7.3.2	U
Frame of Reference	Frame of Reference	C.7.4.1	U
Frame of Reference	Synchronization	C.7.4.2	U
Equipment	General Equipment	C.7.5.1	M
Acquisition	General Acquisition	C.7.10.1	M
Image	General Image	C.7.6.1	M
	General Reference	C.12.4	U
	Image Pixel	C.7.6.3	M
	Contrast/Bolus	C.7.6.4	C - Required if contrast media was used in this image
	Palette Color Lookup Table	C.7.9	C - Required if Photometric Interpretation (0028,0004) has a Value of PALETTE COLOR
	Device	C.7.6.12	U
	Specimen	C.7.6.22	U
	US Region Calibration	C.8.5.5	U
	US Image	C.8.5.6	M
	Overlay Plane	C.9.2	U
	VOI LUT	C.11.2	U
	ICC Profile	C.11.15	U
	SOP Common	C.12.1	M
	Common Instance Reference	C.12.2	U

Note

The US Frame of Reference Module was previously included in this IOD, but has been retired. See PS3.3-2003.

A.6.4.1 Mutually Exclusive IEs

Note

A Curve IE was previously included in this IOD that was mutually exclusive with the Image IE, but has been retired. See PS3.3-2004.

A.6.4.2 Ultrasound Image IOD Content Constraints

A.6.4.2.1 Series Performed Protocol

For the purpose of conveying ultrasound protocol data management information it is recommended that the Performed Protocol Code Sequence (0040,0260) be assigned the code value(s) of the performed ultrasound protocol, if any. For Performed Protocol Code Sequence (0040,0260) BCID 12001 “Ultrasound Protocol Type” may be used.

A.6.4.2.2 Active Image Area Overlays

The Overlay Plane Module may be used to describe the active image area by use of an overlay. In this case, an Overlay Type (60xx,0040) Value of R and an appropriate Overlay Subtype (60xx,0045) Value is used.

A.7 Ultrasound Multi-frame Image IOD

A.7.1 Ultrasound Multi-frame Image IOD Description

The Ultrasound Multi-frame Image IOD specifies a Multi-frame Image that has been created by an ultrasound imaging device.

A.7.2 Ultrasound Multi-frame Image IOD Entity-Relationship Model

This IOD uses the E-R Model in Section A.1.2, with only the Image IE below the Series IE.

A.7.3 Ultrasound Multi-frame Image IOD Module Table (Retired)

This Section was defined in a previous release of the DICOM Standard. The Section is now retired.

A.7.4 Ultrasound Multi-frame Image IOD Module Table

Table A.7-1 specifies the Modules of the Ultrasound Multi-frame Image IOD.

Table A.7-1. Ultrasound Multi-frame Image IOD Modules

IE	Module	Reference	Usage
Patient	Patient	C.7.1.1	M
Patient	Clinical Trial Subject	C.7.1.3	U
Study	General Study	C.7.2.1	M
	Patient Study	C.7.2.2	U
	Clinical Trial Study	C.7.2.3	U
Series	General Series	C.7.3.1	M
Series	Clinical Trial Series	C.7.3.2	U
Frame of Reference	Frame of Reference	C.7.4.1	U
Frame of Reference	Synchronization	C.7.4.2	C - Required if Modality (0008,0060) = IVUS. May be present otherwise.
Equipment	General Equipment	C.7.5.1	M
Acquisition	General Acquisition	C.7.10.1	M
Image	General Image	C.7.6.1	M
	General Reference	C.12.4	U
	Image Pixel	C.7.6.3	M
	Contrast/Bolus	C.7.6.4	C - Required if contrast media was used in this image.
	Cine	C.7.6.5	M
	Multi-frame	C.7.6.6	M
	Frame Pointers	C.7.6.9	U
	Palette Color Lookup Table	C.7.9	C - Required if Photometric Interpretation (0028,0004) has a Value of PALETTE COLOR
	Device	C.7.6.12	U
	Specimen	C.7.6.22	U
	US Region Calibration	C.8.5.5	U
	US Image	C.8.5.6	M
	Overlay Plane	C.9.2	U
	Multi-frame Overlay	C.9.3	U
	VOI LUT	C.11.2	U
	ICC Profile	C.11.15	U
	SOP Common	C.12.1	M
	Common Instance Reference	C.12.2	U
	Frame Extraction	C.12.3	C - Required if the SOP Instance was created in response to a Frame-Level retrieve request

Note

The US Frame of Reference Module was previously included in this IOD, but has been retired. See PS3.3-2003.

A.7.4.1 Mutually Exclusive IEs

Note

A Curve IE was previously included in this IOD that was mutually exclusive with the Image IE, but has been retired. See PS3.3-2004.

A.7.4.2 Ultrasound Image IOD Content Constraints

A.7.4.2.1 Series Performed Protocol

A.7.4.2.2 Active Image Area Overlays

The Overlay Plane Module and Multi-Frame Overlay Module may be used to describe the active image area by use of a either a single frame overlay that applies to all image Frames, or per-frame overlays. In either case, an Overlay Type (60xx,0040) Value of R and an appropriate Overlay Subtype (60xx,0045) Value is used. In the case of a single frame overlay that applies to all image Frames, the active area specified by such an active image area overlay will be at the same location in every Frame of the image as specified in Section C.9.2 Overlay Plane Module.

A.8 Secondary Capture Image IODs

The Secondary Capture Image IODs specify images that are converted from a non-DICOM format to a modality independent DICOM format.

Examples of types of equipment that create Secondary Capture (SC) Images include:

Video interfaces that convert an analog video signal into a digital image
Digital interfaces that are commonly used to transfer non-DICOM digital images from an imaging device to a laser printer
Film digitizers that convert an analog film image to digital data
Workstations that construct images that are encoded as a screen dump
Scanned documents and other bitmap images including hand-drawings
Synthesized images that are not modality-specific, such as cine-loops of 3D reconstructions

Originally, one relatively unconstrained, single-frame, Secondary Capture Image IOD was defined in the DICOM Standard. Though this IOD is retained and not retired since it is in common use, more specific IODs for particular categories of application are also defined.

The following IODs are all multi-frame. A Single-frame Image is encoded as a Multi-frame Image with only one Frame. The multi-frame Secondary Capture Image IODs consist of:

Multi-frame Single Bit Secondary Capture Image IOD
Multi-frame Grayscale Byte Secondary Capture Image IOD
Multi-frame Grayscale Word Secondary Capture Image IOD
Multi-frame True Color Secondary Capture Image IOD

A.8.1 Secondary Capture Image IOD

A.8.1.1 Secondary Capture Image IOD Description

The Secondary Capture Image IOD specifies Single-frame Images that are converted from a non-DICOM format to a modality independent DICOM format, without any constraints on pixel data format.

A.8.1.2 Secondary Capture Image IOD Entity-Relationship Model

This IOD uses the E-R Model in Section A.1.2, with only the Image IE below the Series IE. The Frame of Reference IE is not a component of this IOD.

A.8.1.3 Secondary Capture Image IOD Module Table

Table A.8-1 specifies the Modules of the Secondary Capture Image IOD.

Table A.8-1. Secondary Capture Image IOD Modules

IE	Module	Reference	Usage
Patient	Patient	C.7.1.1	M
Patient	Clinical Trial Subject	C.7.1.3	U
Study	General Study	C.7.2.1	M
	Patient Study	C.7.2.2	U
	Clinical Trial Study	C.7.2.3	U
Series	General Series	C.7.3.1	M
Series	Clinical Trial Series	C.7.3.2	U
Frame of Reference	Frame of Reference	C.7.4.1	C - Required if Image Position (Patient) (0020,0032) or Image Orientation (Patient) (0020,0037) are present. May be present otherwise.
Frame of Reference	Synchronization	C.7.4.2	U
Equipment	General Equipment	C.7.5.1	U
Equipment	SC Equipment	C.8.6.1	M
Acquisition	General Acquisition	C.7.10.1	M
Image	General Image	C.7.6.1	M
	General Reference	C.12.4	U
	Enhanced Patient Orientation	C.7.6.30	U
	Image Plane	C.7.6.2	U
	Image Pixel	C.7.6.3	M
	Device	C.7.6.12	U
	Specimen	C.7.6.22	U
	SC Image	C.8.6.2	M
	Overlay Plane	C.9.2	U
	Modality LUT	C.11.1	U
	VOI LUT	C.11.2	U
	ICC Profile	C.11.15	U
	SOP Common	C.12.1	M
	Common Instance Reference	C.12.2	U

Note

If Image Position (Patient) (0020,0032) and Image Orientation (Patient) (0020,0037) (from the Image Plane Module) are present, then the Values of Pixel Spacing (0028,0030) (from the Image Plane Module and the Basic Pixel Spacing Calibration Macro included from the SC Image Module) are intended to be used for 3D spatial computations, rather than any Values of Nominal Scanned Pixel Spacing (0018,2010) (from the SC Image Module), which may also be present.

A.8.2 Multi-frame Single Bit Secondary Capture Image IOD

A.8.2.1 Multi-frame Single Bit Secondary Capture Image IOD Description

The Multi-frame Single Bit Secondary Capture Image IOD specifies images that are converted from a non-DICOM format to a modality independent DICOM format.

This IOD is typically used for scanned documents and bitmap images of hand drawings.

A.8.2.2 Multi-frame Single Bit Secondary Capture Image IOD Entity-Relationship Model

This IOD uses the E-R Model in Section A.1.2, with only the Image IE below the Series IE.

A.8.2.3 Multi-frame Single Bit Secondary Capture Image IOD Module Table

Table A.8-2 specifies the Modules of the Multi-frame Single Bit Secondary Capture Image IOD.

Table A.8-2. Multi-frame Single Bit Secondary Capture Image IOD Modules

IE	Module	Reference	Usage
Patient	Patient	C.7.1.1	M
Patient	Clinical Trial Subject	C.7.1.3	U
Study	General Study	C.7.2.1	M
	Patient Study	C.7.2.2	U
	Clinical Trial Study	C.7.2.3	U
Series	General Series	C.7.3.1	M
Series	Clinical Trial Series	C.7.3.2	U
Equipment	General Equipment	C.7.5.1	U
Equipment	SC Equipment	C.8.6.1	M
Acquisition	General Acquisition	C.7.10.1	M
Image	General Image	C.7.6.1	M
	General Reference	C.12.4	U
	Enhanced Patient Orientation	C.7.6.30	U
	Image Pixel	C.7.6.3	M
	Cine	C.7.6.5	C - Required if Frame Increment Pointer (0028,0009) is Frame Time (0018,1063) or Frame Time Vector (0018,1065)
	Multi-frame	C.7.6.6	M
	Frame Pointers	C.7.6.9	U
	Device	C.7.6.12	U
	Specimen	C.7.6.22	U
	SC Image	C.8.6.2	U
	SC Multi-frame Image	C.8.6.3	M
	SC Multi-frame Vector	C.8.6.4	C - Required if Number of Frames is greater than 1
	SOP Common	C.12.1	M
	Common Instance Reference	C.12.2	U
	Frame Extraction	C.12.3	C - Required if the SOP Instance was created in response to a Frame-Level retrieve request

A.8.2.4 Multi-frame Single Bit Secondary Capture Image IOD Content Constraints

In the Image Pixel Module, the following constraints apply:

Samples per Pixel (0028,0002) shall be 1
Photometric Interpretation (0028,0004) shall be MONOCHROME2
Bits Allocated (0028,0100) shall be 1
Bits Stored (0028,0101) shall be 1
High Bit (0028,0102) shall be 0
Pixel Representation (0028,0103) shall be 0
Planar Configuration (0028,0006) shall not be present

Note

As a consequence of these Attribute Values, single bit pixels are packed eight to a byte as defined by the encoding rules in PS3.5.

The VOI LUT Module shall not be present.

The Overlay Plane Module shall not be present.

A.8.3 Multi-frame Grayscale Byte Secondary Capture Image IOD

A.8.3.1 Multi-frame Grayscale Byte Image IOD Description

The Multi-frame Grayscale Byte Secondary Capture Image IOD specifies Grayscale Byte images that are converted from a non-DICOM format to a modality independent DICOM format.

This IOD is typically used for screen captured images for modalities that have pixel values of 8 bits, but may also be appropriate for scanned grayscale documents.

A.8.3.2 Multi-frame Grayscale Byte Secondary Capture Image IOD Entity-Relationship Model

This IOD uses the E-R Model in Section A.1.2, with only the Image IE below the Series IE.

A.8.3.3 Multi-frame Grayscale Byte Secondary Capture Image IOD Module Table

Table A.8-3 specifies the Modules of the Multi-frame Grayscale Byte Secondary Capture Image IOD.

Table A.8-3. Multi-frame Grayscale Byte Secondary Capture Image IOD Modules

IE	Module	Reference	Usage
Patient	Patient	C.7.1.1	M
Patient	Clinical Trial Subject	C.7.1.3	U
Study	General Study	C.7.2.1	M
	Patient Study	C.7.2.2	U
	Clinical Trial Study	C.7.2.3	U
Series	General Series	C.7.3.1	M
Series	Clinical Trial Series	C.7.3.2	U
Equipment	General Equipment	C.7.5.1	U
Equipment	SC Equipment	C.8.6.1	M
Frame of Reference	Frame of Reference	C.7.4.1	C - Required if Pixel Measures or Plane Position (Patient) or Plane Orientation (Patient) Functional Group Macros Present
Frame of Reference	Synchronization	C.7.4.2	U
Acquisition	General Acquisition	C.7.10.1	M
Image	General Image	C.7.6.1	M
	General Reference	C.12.4	U
	Enhanced Patient Orientation	C.7.6.30	U
	Image Pixel	C.7.6.3	M
	Cine	C.7.6.5	C - Required if Frame Increment Pointer (0028,0009) is Frame Time (0018,1063) or Frame Time Vector (0018,1065)
	Multi-frame	C.7.6.6	M
	Frame Pointers	C.7.6.9	U
	Device	C.7.6.12	U
	Multi-frame Functional Groups	C.7.6.16	U
	Multi-frame Dimension	C.7.6.17	U
	Specimen	C.7.6.22	U
	SC Image	C.8.6.2	U
	SC Multi-frame Image	C.8.6.3	M
	SC Multi-frame Vector	C.8.6.4	C - Required if Number of Frames is greater than 1
	VOI LUT	C.11.2	C - Required if the VOI LUT stage is not an identity transformation
	SOP Common	C.12.1	M
	Common Instance Reference	C.12.2	U
	Frame Extraction	C.12.3	C - Required if the SOP Instance was created in response to a Frame-Level retrieve request

A.8.3.4 Multi-frame Grayscale Byte Secondary Capture Image IOD Content Constraints

The VOI LUT Module is required if the VOI LUT stage is not an identity transformation. Support for both window and LUT is mandatory. The output grayscale space is defined to be in P-Values.

Note

If the VOI LUT Module is absent, then the stored pixel values are in P-Values.

In the Image Pixel Module, the following constraints apply:

Samples per Pixel (0028,0002) shall be 1
Photometric Interpretation (0028,0004) shall be MONOCHROME2
Bits Allocated (0028,0100) shall be 8
Bits Stored (0028,0101) shall be 8
High Bit (0028,0102) shall be 7
Pixel Representation (0028,0103) shall be 0
Planar Configuration (0028,0006) shall not be present

In the SC Multi-frame Image Module, the following constraints apply:

Rescale Intercept (0028,1052) shall be 0
Rescale Slope (0028,1053) shall be 1
Rescale Type (0028,1054) shall be US

The Overlay Plane Module shall not be present.

A.8.3.5 Multi-frame Grayscale Byte Secondary Capture Image Functional Group Macros

Table A.8-3b specifies the use of the Functional Group Macros used in the Multi-frame Functional Groups Module for the Multi-frame Grayscale Byte Secondary Capture Image IOD.

Table A.8-3b. Multi-frame Grayscale Byte Secondary Capture Image Functional Group Macros

Functional Group Macro	Section	Usage
Pixel Measures	C.7.6.16.2.1	C - Required if Plane Position (Patient) or Plane Orientation (Patient) Macros Present
Plane Position (Patient)	C.7.6.16.2.3	C - Required if Pixel Measures or Plane Orientation (Patient) Macros Present
Plane Orientation (Patient)	C.7.6.16.2.4	C - Required if Pixel Measures or Plane Position (Patient) Macros Present

Note

If the Pixel Measures Macro is present, then the Values of Pixel Spacing (0028,0030) therein are intended to be used for 3D spatial computations, rather than any Values of Nominal Scanned Pixel Spacing (0018,2010) (from the SC Multi-frame Image Module), which may also be present.

A.8.4 Multi-frame Grayscale Word Secondary Capture Image IOD

A.8.4.1 Multi-frame Grayscale Word Secondary Capture Image IOD Description

The Multi-frame Grayscale Word Secondary Capture Image IOD specifies Grayscale Word images that are converted from a non-DICOM format to a modality independent DICOM format.

This IOD is typically used for screen captured images for modalities that have pixel values greater than 8 bits.

A.8.4.2 Multi-frame Grayscale Word Secondary Capture Image IOD Entity-Relationship Model

This IOD uses the E-R Model in Section A.1.2, with only the Image IE below the Series IE.

A.8.4.3 Multi-frame Grayscale Word Secondary Capture Image IOD Module Table

Table A.8-4 specifies the Modules of the Multi-frame Grayscale Word Secondary Capture Image IOD.

Table A.8-4. Multi-frame Grayscale Word Secondary Capture Image IOD Modules

IE	Module	Reference	Usage
Patient	Patient	C.7.1.1	M
Patient	Clinical Trial Subject	C.7.1.3	U
Study	General Study	C.7.2.1	M
	Patient Study	C.7.2.2	U
	Clinical Trial Study	C.7.2.3	U
Series	General Series	C.7.3.1	M
Series	Clinical Trial Series	C.7.3.2	U
Equipment	General Equipment	C.7.5.1	U
Equipment	SC Equipment	C.8.6.1	M
Frame of Reference	Frame of Reference	C.7.4.1	C - Required if Pixel Measures or Plane Position (Patient) or Plane Orientation (Patient) Functional Group Macros Present
Frame of Reference	Synchronization	C.7.4.2	U
Acquisition	General Acquisition	C.7.10.1	M
Image	General Image	C.7.6.1	M
	General Reference	C.12.4	U
	Enhanced Patient Orientation	C.7.6.30	U
	Image Pixel	C.7.6.3	M
	Cine	C.7.6.5	C - Required if Frame Increment Pointer (0028,0009) is Frame Time (0018,1063) or Frame Time Vector (0018,1065)
	Multi-frame	C.7.6.6	M
	Frame Pointers	C.7.6.9	U
	Device	C.7.6.12	U
	Multi-frame Functional Groups	C.7.6.16	U
	Multi-frame Dimension	C.7.6.17	U
	Specimen	C.7.6.22	U
	SC Image	C.8.6.2	U
	SC Multi-frame Image	C.8.6.3	M
	SC Multi-frame Vector	C.8.6.4	C - Required if Number of Frames is greater than 1
	VOI LUT	C.11.2	C - Required if the VOI LUT stage is not an identity transformation
	SOP Common	C.12.1	M
	Common Instance Reference	C.12.2	U
	Frame Extraction	C.12.3	C - Required if the SOP Instance was created in response to a Frame-Level retrieve request

A.8.4.4 Multi-frame Grayscale Word Secondary Capture Image IOD Content Constraints

The VOI LUT Module is required if the VOI LUT stage is not an identity transformation. Support for both window and LUT is mandatory. The output grayscale space is defined to be in P-Values.

Note

If the VOI LUT Module is absent, then the stored pixel values are in P-Values.

In the Image Pixel Module, the following constraints apply:

Samples per Pixel (0028,0002) shall be 1
Photometric Interpretation (0028,0004) shall be MONOCHROME2
Bits Allocated (0028,0100) shall be 16
Bits Stored (0028,0101) shall be greater than or equal to 9 and less than or equal to 16
High Bit (0028,0102) shall be one less than Bits Stored (0028,0101)
Pixel Representation (0028,0103) shall be 0
Planar Configuration (0028,0006) shall not be present

Note

Rescale Slope (0028,1053) and Rescale Intercept (0028,1052) are not constrained in this IOD to any particular values. E.g., they may be used to recover floating point values scaled to the integer range of the stored pixel values, Rescale Slope (0028,1053) may be less than one, e.g., a Rescale Slope (0028,1053) of 1.0/65535 would allow represent floating point values from 0 to 1.0.

The Overlay Plane Module shall not be present. Unused high bits shall be filled with zeroes.

A.8.4.5 Multi-frame Grayscale Word Secondary Capture Image Functional Group Macros

Table A.8-4b specifies the use of the Functional Group Macros used in the Multi-frame Functional Groups Module for the Multi-frame Grayscale Word Secondary Capture Image IOD.

Table A.8-4b. Multi-frame Grayscale Word Secondary Capture Image Functional Group Macros

Functional Group Macro	Section	Usage
Pixel Measures	C.7.6.16.2.1	C - Required if Plane Position (Patient) or Plane Orientation (Patient) Macros Present
Plane Position (Patient)	C.7.6.16.2.3	C - Required if Pixel Measures or Plane Orientation (Patient) Macros Present
Plane Orientation (Patient)	C.7.6.16.2.4	C - Required if Pixel Measures or Plane Position (Patient) Macros Present

Note

A.8.5 Multi-frame True Color Secondary Capture Image IOD

A.8.5.1 Multi-frame True Color Image IOD Description

The Multi-frame True Color Secondary Capture Image IOD specifies True Color images that are converted from a non-DICOM format to a modality independent DICOM format.

This IOD is typically used for screen captured or synthetic images where true color is used, but may also be appropriate for scanned color documents.

A.8.5.2 Multi-frame True Color Secondary Capture Image IOD Entity-Relationship Model

This IOD uses the E-R Model in Section A.1.2, with only the Image IE below the Series IE.

A.8.5.3 Multi-frame True Color Secondary Capture Image IOD Module Table

Table A.8-5 specifies the Modules of the Multi-frame True Color Secondary Capture Image IOD.

Table A.8-5. Multi-frame True Color Secondary Capture Image IOD Modules

IE	Module	Reference	Usage
Patient	Patient	C.7.1.1	M
Patient	Clinical Trial Subject	C.7.1.3	U
Study	General Study	C.7.2.1	M
	Patient Study	C.7.2.2	U
	Clinical Trial Study	C.7.2.3	U
Series	General Series	C.7.3.1	M
Series	Clinical Trial Series	C.7.3.2	U
Frame of Reference	Frame of Reference	C.7.4.1	C - Required if Pixel Measures or Plane Position (Patient) or Plane Orientation (Patient) Functional Group Macros Present
Frame of Reference	Synchronization	C.7.4.2	U
Equipment	General Equipment	C.7.5.1	U
Equipment	SC Equipment	C.8.6.1	M
Acquisition	General Acquisition	C.7.10.1	M
Image	General Image	C.7.6.1	M
	General Reference	C.12.4	U
	Enhanced Patient Orientation	C.7.6.30	U
	Image Pixel	C.7.6.3	M
	Cine	C.7.6.5	C - Required if Frame Increment Pointer (0028,0009) is Frame Time (0018,1063) or Frame Time Vector (0018,1065)
	Multi-frame	C.7.6.6	M
	Frame Pointers	C.7.6.9	U
	Device	C.7.6.12	U
	Multi-frame Functional Groups	C.7.6.16	U
	Multi-frame Dimension	C.7.6.17	U
	Specimen	C.7.6.22	U
	SC Image	C.8.6.2	U
	SC Multi-frame Image	C.8.6.3	M
	SC Multi-frame Vector	C.8.6.4	C - Required if Number of Frames is greater than 1
	ICC Profile	C.11.15	U
	SOP Common	C.12.1	M
	Common Instance Reference	C.12.2	U
	Frame Extraction	C.12.3	C - Required if the SOP Instance was created in response to a Frame-Level retrieve request

A.8.5.4 Multi-frame True Color Secondary Capture Image IOD Content Constraints

The VOI LUT Module shall not be present.

In the Image Pixel Module, the following constraints apply:

Samples per Pixel (0028,0002) shall be 3
Photometric Interpretation (0028,0004) shall be RGB for uncompressed or lossless compressed Transfer Syntaxes that do not have defined color space transformations, YBR_ICT for irreversible JPEG 2000 Transfer Syntaxes, YBR_RCT for reversible JPEG 2000 Transfer Syntaxes, YBR_PARTIAL_420 for MPEG2, MPEG-4 AVC/H.264, HEVC/H.265 Transfer Syntaxes and YBR_FULL_422 for JPEG lossy compressed Transfer Syntaxes and YBR_FULL or RGB for RLE Transfer Syntaxes

Note

Future lossless and lossy Transfer Syntaxes may lead to the need for new definitions and choices for Photometric Interpretation.
Bits Allocated (0028,0100) shall be 8
Bits Stored (0028,0101) shall be 8
High Bit (0028,0102) shall be 7
Pixel Representation (0028,0103) shall be 0
Planar Configuration (0028,0006) shall be 0 (color-by-pixel) if Photometric Interpretation (0028,0004) is RGB

The Overlay Plane Module shall not be present.

For images being referenced as texture maps that are not clinical images, a modality Value of TEXTUREMAP may be used as the Value of Modality (0008,0060).

A.8.5.5 Multi-frame True Color Secondary Capture Image Functional Group Macros

Table A.8-5b specifies the use of the Functional Group Macros used in the Multi-frame Functional Groups Module for the Multi-frame True Color Secondary Capture Image IOD.

Table A.8-5b. Multi-frame True Color Secondary Capture Image Functional Group Macros

Functional Group Macro	Section	Usage
Pixel Measures	C.7.6.16.2.1	C - Required if Plane Position (Patient) or Plane Orientation (Patient) Macros Present
Plane Position (Patient)	C.7.6.16.2.3	C - Required if Pixel Measures or Plane Orientation (Patient) Macros Present
Plane Orientation (Patient)	C.7.6.16.2.4	C - Required if Pixel Measures or Plane Position (Patient) Macros Present

Note

A.9 Standalone Overlay IOD (Retired)

Retired. See PS3.3-2004.

A.10 Standalone Curve IOD (Retired)

Retired. See PS3.3-2004.

A.11 Basic Study Descriptor IOD (Retired)

Retired. See PS3.3-2004.

A.12 Standalone Modality LUT IOD (Retired)

Retired. See PS3.3-2004.

A.13 Standalone VOI LUT IOD (Retired)

Retired. See PS3.3-2004.

A.14 X-Ray Angiographic Image IOD

A.14.1 XA Image IOD Description

This Section defines the Information Object for single plane X-Ray Angiographic (XA) Imaging that includes those Attributes and Information Objects necessary for the interchange of digital X-Ray Angiographic data. This includes images of the heart and all blood vessels.

The X-Ray Angiographic Image IOD share a significant amount of common information with the XRF IOD. The differences between the two IODs are that the XRF Image IOD includes a tomography Module; and the two IODs utilize different methods to specify positioner angles. The XRF Image IOD contains a single column angulation Data Element that uses an Equipment-Based Coordinate System, while X-Ray Angiographic Image IOD c-arm positioner angles are specified in a Patient-Based Coordinate System. RF applications that support a Patient-Based Coordinate System with cranial/caudal, LAO/RAO angles may utilize the X-Ray Angiographic Image IOD.

The X-Ray Angiographic Image IOD is also applicable to clinical areas other than angiography (e.g., Interventional Procedures, Myelography, Biopsy/Localization, and Neurology).

Note

For the purpose of X-Ray Angiography (XA), this IOD can be used to encode a Single-frame Image, or a Cine Run encoded in a single Multi-frame Image.
A typical Study might include all the images generated between the time a Patient gets on and gets off the procedure table. As several separable diagnostic or therapeutic processes may occur during a single Study (e.g., pre-intervention CA, left ventriculography, and post-intervention CA), a Series may be defined as comprising a set of images (single or multi-frame) associated with one such process within a Study.
This IOD can be used to encode a single plane acquisition, or one plane of a biplane acquisition.

A.14.2 XA Image IOD Entity-Relationship Model

This IOD uses the E-R Model in Section A.1.2, with only the Image IE below the Series IE.

A.14.3 XA Image IOD Module Table

Table A.14-1 specifies the Modules of the X-Ray Angiographic Image IOD.

Table A.14-1. X-Ray Angiographic Image IOD Modules

IE	Module	Reference	Usage
Patient	Patient	C.7.1.1	M
Patient	Clinical Trial Subject	C.7.1.3	U
Study	General Study	C.7.2.1	M
	Patient Study	C.7.2.2	U
	Clinical Trial Study	C.7.2.3	U
Series	General Series	C.7.3.1	M
Series	Clinical Trial Series	C.7.3.2	U
Frame of Reference	Synchronization	C.7.4.2	U
Equipment	General Equipment	C.7.5.1	M
Acquisition	General Acquisition	C.7.10.1	M
Image	General Image	C.7.6.1	M
	General Reference	C.12.4	U
	Image Pixel	C.7.6.3	M
	Contrast/Bolus	C.7.6.4	C - Required if contrast media was used in this Image
	Cine	C.7.6.5	C - Required if pixel data is Multi-frame Cine data
	Multi-frame	C.7.6.6	C - Required if pixel data is Multi-frame Cine data
	Frame Pointers	C.7.6.9	U
	Mask	C.7.6.10	C - Required if the Image may be subtracted
	Display Shutter	C.7.6.11	U
	Device	C.7.6.12	U
	Intervention	C.7.6.13	U
	Specimen	C.7.6.22	U
	X-Ray Image	C.8.7.1	M
	X-Ray Acquisition	C.8.7.2	M
	X-Ray Collimator	C.8.7.3	U
	X-Ray Table	C.8.7.4	C - Required if Image is created with table motion, may be present otherwise
	XA Positioner	C.8.7.5	M
	DX Detector	C.8.11.4	U
	Overlay Plane	C.9.2	U
	Multi-frame Overlay	C.9.3	C - Required if Overlay data contains multiple Frames.
	Modality LUT	C.11.1	C - Required if Pixel Intensity Relationship (0028,1040) is LOG U - Optional if Pixel Intensity Relationship (0028,1040) is DISP
	VOI LUT	C.11.2	U
	SOP Common	C.12.1	M
	Common Instance Reference	C.12.2	U
	Frame Extraction	C.12.3	C - Required if the SOP Instance was created in response to a Frame-Level retrieve request

Note

The Curve Module (Retired) was previously included in the Image IE for this IOD but has been retired. See PS3.3-2004.

A.15 X-Ray Angiographic Bi-plane Image IOD (Retired)

A.16 X-Ray Radiofluoroscopic Image IOD

A.16.1 XRF Image IOD Description

The focus for this X-Ray Radiofluoroscopic Image IOD is to address the requirements for image transfer found in general Radiofluoroscopic applications performed on a table with a column. For applications performed on X-Ray RF acquisition systems that support a Patient-Based Coordinate System with cranial/caudal, LAO/RAO angles, etc. the X-Ray Angiographic Image IOD may be used.

Note

An example of a case where the X-Ray Angiographic Image IOD may be preferred to the RF IOD are RF acquisition system equipped with an X-Ray source and an image Receptor positioned by what is generally called a c-arm (e.g., Interventional Procedures, Myelography, Biopsy, and Neurology).

This Section defines the Information Object for X-Ray Radiofluoroscopic (XRF) Imaging that includes those Attributes and Information Objects necessary for the interchange of digital X-Ray RF Image data. The XRF IOD is applicable to X-Ray acquisition systems equipped with an image receptor whose plane is parallel to the table plane where the Patient is. This Table has in general the ability to be tilted. Furthermore the X-Ray source may be supported by a column that can be angulated to adjust the incidence of the X-Ray beam on the image receptor plan. An equipment based coordinated system is used to track these angles.

Note

For the purpose of X-Ray Radiofluoroscopy, this IOD can be used to encode a Single-frame Image, or a Cine Run encoded in a single Multi-frame Image.
A typical Study might include all the images generated between the time a Patient gets on and gets off the procedure table. As several separable diagnostic or therapeutic processes may occur during a single Study, a Series may be defined as comprising a set of images (single or multi-frame) associated with one such process within a Study.

A.16.2 X-Ray Radiofluoroscopic Image IOD Entity-Relationship Model

This IOD uses the E-R Model in Section A.1.2, with only the Image IE below the Series IE.

Note

When a Study (or Study Component) contains a number of Multi-frame Images that do not need to be grouped under different Series, a single Series may be used with a Series number containing an arbitrary value (e.g., 1).

A.16.3 X-Ray Radiofluoroscopic Image IOD Module Table

Table A.16-1 specifies the Modules of the X-Ray Radiofluoroscopic Image IOD.

Table A.16-1. X-Ray Radiofluoroscopic Image IOD Modules

IE	Module	Reference	Usage
Patient	Patient	C.7.1.1	M
Patient	Clinical Trial Subject	C.7.1.3	U
Study	General Study	C.7.2.1	M
	Patient Study	C.7.2.2	U
	Clinical Trial Study	C.7.2.3	U
Series	General Series	C.7.3.1	M
Series	Clinical Trial Series	C.7.3.2	U
Frame of Reference	Synchronization	C.7.4.2	U
Equipment	General Equipment	C.7.5.1	M
Acquisition	General Acquisition	C.7.10.1	M
Image	General Image	C.7.6.1	M
	General Reference	C.12.4	U
	Image Pixel	C.7.6.3	M
	Contrast/Bolus	C.7.6.4	C - Required if contrast media was used in this Image
	Cine	C.7.6.5	C - Required if pixel data is Multi-frame Cine Data
	Multi-frame	C.7.6.6	C - Required if pixel data is Multi-frame Cine Data
	Frame Pointers	C.7.6.9	U
	Mask	C.7.6.10	C - Required if the Image may be subtracted
	Display Shutter	C.7.6.11	U
	Device	C.7.6.12	U
	Intervention	C.7.6.13	U
	Specimen	C.7.6.22	U
	X-Ray Image	C.8.7.1	M
	X-Ray Acquisition	C.8.7.2	M
	X-Ray Collimator	C.8.7.3	U
	X-Ray Table	C.8.7.4	U
	XRF Positioner	C.8.7.6	U
	X-Ray Tomography Acquisition	C.8.7.7	C - Required if Scan Option (0018,0022) is TOMO
	DX Detector	C.8.11.4	U
	Overlay Plane	C.9.2	U
	Multi-frame Overlay	C.9.3	C - Required if Overlay Data contains multiple Frames
	Modality LUT	C.11.1	C - Required if Pixel Intensity Relationship (0028,1040) is LOG U - Optional if Pixel Intensity Relationship (0028,1040) is DISP
	VOI LUT	C.11.2	U
	SOP Common	C.12.1	M
	Common Instance Reference	C.12.2	U
	Frame Extraction	C.12.3	C - Required if the SOP Instance was created in response to a Frame-Level retrieve request

Note

The Curve Module (Retired) was previously included in the Image IE for this IOD but has been retired. See PS3.3-2004.

A.17 RT Image IOD

A.17.1 RT Image IOD Description

The focus for this RT Image IOD is to address the requirements for image transfer found in general Radiotherapy (RT) applications performed on conventional simulators, virtual simulators, and portal imaging devices. Such images have a conical imaging geometry and may either be acquired directly from the device, or digitized using a film digitizer. Numeric beam data parameters may also be recorded with the image, indicating the parameter values at the time the image was taken or created.

A.17.2 RT Image IOD Entity-Relationship Model

This IOD uses the E-R Model in Section A.1.2, with only the Image IE below the Series IE.

A.17.3 RT Image IOD Module Table

Table A.17.3-1 specifies the Modules of the RT Image IOD.

Table A.17.3-1. RT Image IOD Modules

IE	Module	Reference	Usage
Patient	Patient	C.7.1.1	M
Patient	Clinical Trial Subject	C.7.1.3	U
Study	General Study	C.7.2.1	M
	Patient Study	C.7.2.2	U
	Clinical Trial Study	C.7.2.3	U
Series	RT Series	C.8.8.1	M
Series	Clinical Trial Series	C.7.3.2	U
Frame of Reference	Frame of Reference	C.7.4.1	U
Equipment	General Equipment	C.7.5.1	M
Acquisition	General Acquisition	C.7.10.1	M
Image	General Image	C.7.6.1	M
	General Reference