Identification of the Subtraction Item used to associate a certain Mask Sub-Pixel Shift (0028,6114) in the Frame Pixel Shift Functional Group. See C.7.6.16.2.14.1. Required if SOP Class UID (0008,0016) equals "1.2.840.10008.5.1.4.1.1.12.1.1" or "1.2.840.10008.5.1.4.1.1.12.2.1". May be present otherwise.

Subtraction Item ID (0028,9416) specifies the ID of a subtraction operation to which the Mask Sub-pixel Shift (0028,6114) is associated. The Subtraction Item ID is also present in the Mask Subtraction Sequence (0028,6100) to allow this association. When used as per-frame macro, the Subtraction Item ID (0028,9416) allows to specify different values of Mask Sub-pixel Shift (0028,6114) individually frame by frame, and relate them to a single item of the Mask Subtraction Sequence (0028,6100). Note: There is no restriction in the number of Subtraction Item ID’s associated to each contrast frame. The same contrast frame may be present in several items of the Mask Subtraction Sequence, each item having a different value of Subtraction Item ID. When used as shared macro, the Subtraction Item ID (0028,9416) allows to specify one or more values of Mask Sub-pixel Shift that will be applied to all the frames of the Multi-frame image. Note: Example of usage of Subtraction Item ID in a per-frame macro, see Figure C.7.6.16-8: In this example of Multi-Frame Image with 3 frames, one Mask Frame (i.e., Frame 1) is applied to the next two frames of the Multi-Frame image (i.e., Frames 2 and 3). Therefore, there is only one item in the Mask Subtraction Sequence, containing its own Subtraction Item ID value (i.e., 100). The Frame Pixel Shift Macro allows to define a Mask Sub-Pixel Shift different for each contrast frame. First Frame Subtracted: Subtraction of Frame 1 (Mask) to Frame 2, with Sub-Pixel Shift 1.3\2.4 Second Frame Subtracted: Subtraction of Frame 1 (Mask) to Frame 3, with Sub-Pixel Shift 1.9\3.0 Figure C.7.6.16-8 Example of usage of Subtraction Item ID in a per-frame Macro

Each pair of numbers in this multi-valued attribute specify a beginning and ending frame number inclusive of a range where this particular mask operation is valid. Discontinuous ranges are represented by multiple pairs of numbers. Frames in a Multi-frame Image are specified by sequentially increasing number values beginning with 1. If this Attribute is missing in this particular sequence item, then the mask operation is applicable throughout the entire Multi-frame Image, subject to certain limits as described in C.7.6.10.1.1. Required if Mask Operation (0028,6101) equals REV_TID. May be present otherwise. Specifies the frame numbers of the pixel data used to generate this mask. Frames in a Multi-frame Image are specified by sequentially increasing number values beginning with 1. Required if the Mask Operation (0028,6101) is AVG_SUB. Specifies the number of contrast frames to average together before performing the mask operation. If the Attribute is missing, no averaging is performed. A pair of floating point numbers specifying the fractional vertical [adjacent row spacing] and horizontal [adjacent column spacing] pixel shift applied to the mask before subtracting it from the contrast frame. See Section C.7.6.10.1.2. Note: When the Frame Pixel Shift Functional Group is present the values of the Mask Pixel Shift attribute of that Functional Group prevails over the values specified in this module.

A pair of floating point numbers specifying the fractional vertical [adjacent row spacing] and horizontal [adjacent column spacing] pixel shift applied to the mask before subtracting it from the contrast frame. The row offset results in a shift of the pixels along the column axis. The column offset results in a shift of the pixels along the row axis. A positive row offset is a shift toward the pixels of the lower row of the pixel plane. A positive column offset is a shift toward the pixels of the left hand side column of the pixel plane.

If Mask Operation is TID, specifies the offset to be subtracted from the current frame number in order to locate the mask frame in TID mode. If Mask Operation is REV_TID, specifies the initial offset to be subtracted from the first contrast frame number. See section C.7.6.10.1.1. If zero length, TID Offset defaults to 1. Required if Mask Operation (0028,6101) is TID or REV_TID. Free form explanation of this particular mask operation. Specifies the method of selection of the mask operations of this item. Defined Terms: SYSTEM USER Specifies the recommended viewing protocol(s). Defined terms: SUB = for subtraction with mask images; NAT = native viewing of image as sent. Note: If an implementation does not recognize the defined term for Recommended Viewing Mode (0028,1090) , reverting to native display mode is recommended. Shape(s) of the shutter defined for display. Enumerated Values: RECTANGULAR CIRCULAR POLYGONAL This multi-valued Attribute shall contain at most one of each Enumerated Value. Required if Shutter Shape (0018,1600) is RECTANGULAR. Location of the left edge of the rectangular shutter with respect to pixels in the image given as column. Required if Shutter Shape (0018,1600) is RECTANGULAR. Location of the right edge of the rectangular shutter with respect to pixels in the image given as column. Required if Shutter Shape (0018,1600) is RECTANGULAR. Location of the upper edge of the rectangular shutter with respect to pixels in the image given as row. Required if Shutter Shape (0018,1600) is RECTANGULAR. Location of the lower edge of the rectangular shutter with respect to pixels in the image given as row. Required if Shutter Shape (0018,1600) is CIRCULAR. Location of the center of the circular shutter with respect to pixels in the image given as row and column. Required if Shutter Shape (0018,1600) is CIRCULAR. Radius of the circular shutter with respect to pixels in the image given as a number of pixels along the row direction. Required if Shutter Shape (0018,1600) is POLYGONAL. Multiple Values where the first set of two values are: row of the origin vertex column of the origin vertex Two or more pairs of values follow and are the row and column coordinates of the other vertices of the polygon shutter. Polygon shutters are implicitly closed from the last vertex to the origin vertex and all edges shall be non-intersecting except at the vertices. A single gray unsigned value used to replace those parts of the image occluded by the shutter, when rendered on a monochrome display. The units are specified in P-Values, from a minimum of 0000H (black) up to a maximum of FFFFH (white). Note: The maximum P-Value for this Attribute may be different from the maximum P-Value from the output of the Presentation LUT, which may be less than 16 bits in depth. A color triplet value used to replace those parts of the image occluded by the shutter, when rendered on a color display. The units are specified in PCS-Values, and the value is encoded as CIELab. See C.10.7.1.1.

Attributes such as Graphic Layer Recommended Display CIELab Value (0070,0401) consist of three unsigned short values:

Introduces sequence of items describing devices used that may be visible in the image. One or more Items may be included in this Sequence. Manufacturer of the device Manufacturer's model name of the device Manufacturer's serial number of the device User-supplied identifier for the device Length in mm of device. See C.7.6.12.1.1.

Depending on the type of device specified by the Code Value (0008,0100) in an item of the Device Sequence (0050,0010), various device size attributes (e.g., Device Length (0050,0014), Device Diameter (0050,0016), Device Volume (0050,0018), Inter Marker Distance (0050,0019)) may be required to fully characterize the device.

Unit diameter of device. See C.7.6.12.1.1.

Required if Device Diameter (0050,0016) is present. Defined terms: FR = French GA = Gauge IN = Inch MM = Millimeter Volume of device in ml. See C.7.6.12.1.1.

Distance in mm between markers on calibrated device. See C.7.6.12.1.1.

Further description in free form text describing the device. Introduces sequence of items describing interventional therapies or procedures. One or more Items may be included in this Sequence. Temporal relation of SOP Instance to intervention Enumerated Values: PRE INTERMEDIATE POST NONE Sequence that identifies the interventional drug. Only one item shall be included in this Sequence. Time of administration of the interventional drug. Time of completion of administration of the intervention drug. Sequence that identifies the Administration Route. This sequence shall contain exactly one item. Further description in free form text describing the therapy or other intervention. A sequence of Items that describes the conditions present during the acquisition of the data of the SOP Instance. Zero or more items may be included in this sequence. The type of the value encoded in this Item. Defined Terms: TEXT NUMERIC CODE DATE TIME PNAME See Section 10.2. A concept that constrains the meaning of (i.e. defines the role of) the Observation Value. The "Name" component of a Name/Value pair. This sequence shall contain exactly one item. References one or more frames in a Multi-frame SOP Instance. The first frame shall be denoted as frame number one. Required if this SOP Instance is a Multi-frame SOP Instance and the values in this sequence item do not apply to all frames. This is the Value component of a Name/Value pair when the Concept implied by Concept Name Code Sequence (0040,A043) is a set of one or more numeric values. Required if the value that Concept Name Code Sequence (0040,A043) requires (implies) is a set of one or more integers or real numbers. Shall not be present otherwise. Units of measurement. Only a single Item shall be permitted in this Sequence. Required if Numeric Value (0040,A30A) is sent. Shall not be present otherwise. This is the Value component of a Name/Value pair when the Concept implied by Concept Name Code Sequence (0040,A043) is a date. Note: The purpose or role of the date value could be specified in Concept Name Code Sequence (0040,A043). Required if the value that Concept Name Code Sequence (0040,A043) requires (implies) is a date. Shall not be present otherwise. This is the Value component of a Name/Value pair when the Concept implied by Concept Name Code Sequence (0040,A043) is a time. Note: The purpose or role of the time value could be specified in Concept Name Code Sequence (0040,A043). Required if the value that Concept Name Code Sequence (0040,A043) requires (implies) is a time. Shall not be present otherwise. This is the Value component of a Name/Value pair when the Concept implied by Concept Name Code Sequence (0040,A043) is a Person Name. Note: The role of the person could be specified in Concept Name Code Sequence (0040,A043). Required if the value that Concept Name Code Sequence (0040,A043) irequires (implies) is a person name. Shall not be present otherwise. This is the Value component of a Name/Value pair when the Concept implied by Concept Name Code Sequence (0040,A043) is a Text Observation Value. Required if Date (0040,A121), Time (0040,A122), and Person Name (0040,A123) do not fully describe the concept specified by Concept Name Code Sequence (0040,A043). Shall not be present otherwise. This is the Value component of a Name/Value pair when the Concept implied by Concept Name Code Sequence (0040,A043) is a Coded Value. This sequence shall contain exactly one item. Required if Date (0040,A121), Time (0040,A122), Person Name (0040,A123), Text Value (0040,A160), and the pair of Numeric Value (0040,A30A) and Measurement Units Code Sequence (0040,08EA) are not present. Free-text description of the image-acquisition context. Shape of the shutter defined for display. Enumerated Values are: BITMAP This Attribute shall contain one Value. Specifies the Group (60xx) of an Overlay stored within the Presentation State IOD that contains the bitmap data, as defined in the Overlay Plane Module C.9.2. A single gray unsigned value used to replace those parts of the image occluded by the shutter, when rendered on a monochrome display. The units are specified in P-Values, from a minimum of 0000H (black) up to a maximum of FFFFH (white). Note: The maximum P-Value for this Attribute may be different from the maximum P-Value from the output of the Presentation LUT, which may be less than 16 bits in depth. A color triplet value used to replace those parts of the image occluded by the shutter, when rendered on a color display. The units are specified in PCS-Values, and the value is encoded as CIELab. See C.10.7.1.1.

Attributes such as Graphic Layer Recommended Display CIELab Value (0070,0401) consist of three unsigned short values:

Sequence that contains the Functional Group Macros that are shared for all frames in this SOP Instance and Concatenation. Note: The contents of this sequence are the same in all SOP Instances that comprise a Concatenation. Zero or one Item may be included in this sequence. See section C.7.6.16.1.1 for further explanation. Sequence that contains the Functional Group Macros corresponding to each frame of the Multi-frame Image. The first Item corresponds with the first frame, and so on. Each Item shall contain the same set of Functional Group Macros. This Sequence shall contain the same number of Items as the number of frames in the Multi-frame image. See Section C.7.6.16.1.2 for further explanation.

The Per-frame Functional Groups Sequence Attribute (5200,9230) consists of a Sequence of Items. Each Item describes the frame of the same rank in the multi-frame pixel data. The first Item describes frame 1, the second Item describes frame 2, etc. Frames are implicitly numbered starting from 1. See Figure C.7.6.16-1.

A number that identifies this instance. The value shall be the same for all SOP Instances of a Concatenation, and different for each separate Concatenation and for each SOP Instance not within a Concatenation in a series. The date the data creation was started. Note: For instance, this is the date the pixel data is created, not the date the data is acquired. The time the data creation was started. Note: For instance, this is the time the pixel data is created, not the time the data is acquired. Number of frames in a multi-frame image. See C.7.6.6.1.1 for further explanation.

A Multi-frame Image is defined as a Image whose pixel data consists of a sequential set of individual Image Pixel frames. A Multi-frame Image is transmitted as a single contiguous stream of pixels. Frame headers do not exist within the data stream. Each individual frame shall be defined (and thus can be identified) by the Attributes in the Image Pixel Module (see C.7.6.3). All Image IE Attributes shall be related to the first frame in the Multi-frame image. The total number of frames contained within a Multi-frame Image is conveyed in the Number of Frames (0028,0008). The frames within a Multi-frame Image shall be conveyed as a logical sequence. The information that determines the sequential order of the frames shall be identified by the Data Element Tag or tags conveyed by the Frame Increment Pointer (0028,0009). Each specific Image IOD that supports the Multi-frame Module specializes the Frame Increment Pointer (0028,0009) to identify the Attributes that may be used as sequences. Even if only a single frame is present, Frame Increment Pointer (0028,0009) is still required to be present and have at least one value, each of which shall point to an attribute that is also present in the dataset and has a value. Note: For example, in single-frame instance of an IOD that is required to or may contain the Cine Module, it may be appropriate for Frame Time (0018,1063) to be present with a value of 0, and be the only target of Frame Increment Pointer (0028,0009).

Offset of the first frame in a multi-frame image of a concatenation. Logical frame numbers in a concatenation can be used across all its SOP instances. This offset can be applied to the implicit frame number to find the logical frame number in a concatenation. The offset is numbered from zero; i.e., the instance of a concatenation that begins with the first frame of the concatenation has a Concatenation Frame Offset Number (0020,9228) of zero. Required if Concatenation UID (0020,9161) is present. The frame number selected for use as a pictorial representation (e.g. icon) of the multi-frame Image. Identifier of all SOP Instances that belong to the same concatenation. Required if a group of multi-frame image SOP Instances within a Series are part of a Concatenation. Identifier for one SOP Instance belonging to a concatenation. See C.7.6.16.2.2.4 for further specification. The first instance in a concatenation (that with the lowest Concatenation Frame Offset Number (0020,9228) value) shall have an In-concatenation Number (0020,9162) value of 1, and subsequent instances shall have values monotonically increasing by 1. Required if Concatenation UID (0020,9161) is present.

Due to implementation specific reasons (such as maximum object size) the information of a multi-frame image may be split into more than one SOP Instance. These SOP Instances form together a Concatenation. This is a group of SOP Instances within a Series that is uniquely identified by the Concatenation UID (0020,9161). The Dimension Index Sequence (0020,9222) for each SOP Instance with the same Concatenation UID (0020,9161) shall contain exactly the same tags and values. In a Concatenation the Dimension Index Sequence (0020,9222) items of the Shared Functional Groups (5200,9229) shall be identical and have the same values for all individual SOP Instances. The items of the Per-frame Functional Groups (5200,9230) shall be identical for all individual SOP Instances but the values may change per frame. For all other Attributes of all the Modules of the IOD, the same Attributes shall be present and the values shall be identical, with the exception of the following Attributes:

The number of SOP Instances sharing the same Concatenation UID. Identifies the physical characteristics of the pixels of this frame. Only a single Item shall be permitted in this sequence. Physical distance in the patient between the centers of each pixel, specified by a numeric pair - adjacent row spacing (delimiter) adjacent column spacing in mm. See 10.7.1.3 for further explanation of the value order. Note: In the case of CT images with an Acquisition Type (0018,9302) of CONSTANT_ANGLE, the pixel spacing is that in a plane normal to the central ray of the diverging X-Ray beam as it passes through the data collection center. Required if Volumetric Properties (0008,9206) is other than DISTORTED or SAMPLED. May be present otherwise. Nominal reconstructed slice thickness, in mm. See C.7.6.2.1.1 and C.7.6.16.2.3.1 for further explanation. Required if Volumetric Properties (0008,9206) is VOLUME or SAMPLED. May be present otherwise.

The Image Position (0020,0032) specifies the x, y, and z coordinates of the upper left hand corner of the image; it is the center of the first voxel transmitted. Image Orientation (0020,0037) specifies the direction cosines of the first row and the first column with respect to the patient. These Attributes shall be provide as a pair. Row value for the x, y, and z axes respectively followed by the Column value for the x, y, and z axes respectively. The direction of the axes is defined fully by the patient’s orientation. The x-axis is increasing to the left hand side of the patient. The y-axis is increasing to the posterior side of the patient. The z-axis is increasing toward the head of the patient. The patient based coordinate system is a right handed 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. Note If a patient lies parallel to the ground, face-up on the table, with his feet-to-head direction same as the front-to-back direction of the imaging equipment, the direction of the axes of this patient based coordinate system and the equipment based coordinate system in previous versions of this Standard will coincide. The Image Plane Attributes, in conjunction with the Pixel Spacing Attribute, describe the position and orientation of the image slices relative to the patient-based coordinate system. In each image frame the Image Position (Patient) (0020,0032) specifies the origin of the image with respect to the patient-based coordinate system. RCS and the Image Orientation (Patient) (0020,0037) attribute values specify the orientation of the image frame rows and columns. The mapping of pixel location to the RCS is calculated as follows: size 12{ left [ matrix { P rSub { size 8{x} } {} ## P rSub { size 8{y} } {} ## P rSub { size 8{z} } {} ## 1 } right ]= left [ matrix { X rSub { size 8{x} } Δi {} # Y rSub { size 8{x} } Δj {} # 0 {} # S rSub { size 8{x} } {} ## X rSub { size 8{y} } Δi {} # Y rSub { size 8{y} } Δj {} # 0 {} # S rSub { size 8{y} } {} ## X rSub { size 8{z} } Δi {} # Y rSub { size 8{z} } Δj {} # 0 {} # S rSub { size 8{z} } {} ## 0 {} # 0 {} # 0 {} # 1{} } right ] left [ matrix { i {} ## j {} ## 0 {} ## 1 } right ]} {} = M Where: Pxyz The coordinates of the voxel (i,j) in the frame’s image plane in units of mm. Sxyz The three values of the Image Position (Patient) (0020,0032) attributes. It is the location in mm from the origin of the RCS. Xxyz The values from the row (X) direction cosine of the Image Orientation (Patient) (0020,0037) attribute. Yxyz The values from the column (Y) direction cosine of the Image Orientation (Patient) (0020,0037) attribute. i Column index to the image plane. The first column is index zero. i Column pixel resolution of the Pixel Spacing (0028,0030) attribute in units of mm. j Row index to the image plane. The first row index is zero. j Row pixel resolution of the Pixel Spacing (0028,0030) attribute in units of mm. Additional constraints apply: 1) The row and column direction cosine vectors shall be orthogonal, i.e. their dot product shall be zero. 2) The row and column direction cosine vectors shall be normal, i.e. the dot product of each direction cosine vector with itself shall be unity.

Identifies general characteristics of this frame. Only a single Item shall be permitted in this sequence. A number identifying the single continuous gathering of data over a period of time that resulted in this frame. The point in time that is most representative of when data was acquired for this frame. See C.7.6.16.2.2.1 and C.7.6.16.2.2.2 for further explanation. Note: The synchronization of this time with an external clock is specified in the synchronization Module in Acquisition Time synchronized (0018,1800). Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise.

Figure C.7.6.16-2 shows the relationships among the various timing parameters used.

The date and time that the acquisition of data that resulted in this frame started. See C.7.6.16.2.2.1 for further explanation. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise.

Figure C.7.6.16-2 shows the relationships among the various timing parameters used.

The actual amount of time [in milliseconds] that was used to acquire data for this frame. See C.7.6.16.2.2.1 and C.7.6.16.2.2.3 for further explanation. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise.

Figure C.7.6.16-2 shows the relationships among the various timing parameters used.

Description of the position in the cardiac cycle that is most representative of this frame. Defined Terms: END_SYSTOLE END_DIASTOLE UNDETERMINED Description of the position in the respiratory cycle that is most representative of this frame. Defined Terms: START _RESPIR END_RESPIR UNDETERMINED Contains the values of the indices defined in the Dimension Index Sequence (0020,9222) for this multi-frame header frame. The number of values is equal to the number of Items of the Dimension Index Sequence and shall be applied in the same order. See section C.7.6.17.1 for a description. Required if the value of the Dimension Index Sequence (0020,9222) contains Items. Ordinal number (starting from 1) of the frame in the set of frames with different temporal positions. Identification of a group of frames, with different positions and/or orientations that belong together, within a dimension organization. See C.7.6.16.2.2.4 for further explanation

The ordinal number of a frame in a group of frames, with the same Stack ID Required if Stack ID (0020,9056) is present. See section C.7.6.16.2.2.4 for further explanation. User-defined comments about the frame. Label corresponding to a specific dimension index value. Selected from a set of dimension values defined by the application. This attribute may be referenced by the Dimension Index Pointer (0020,9165) attribute in the Multi-frame Dimension Module. See C.7.6.16.2.2.5 for further explanation.

The Frame Label attribute (0020,9453) can be used to label frames that need to be handled as a group in application. The Dimension Index Pointer (0020,9165) from the Dimension Module may point to this attribute if it is the base of a dimension.

Identifies the position of the plane of this frame. Only a single Item shall be permitted in this sequence. The x, y, and z coordinates of the upper left hand corner (center of the first voxel transmitted) of the frame, in mm. See C.7.6.2.1.1 and C.7.6.16.2.3.1 for further explanation. Note: In the case of CT images with an Acquisition Type (0018,9302) of CONSTANT_ANGLE the image plane is defined to pass through the data collection center and be normal to the central ray of the diverging X-Ray beam. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL and Volumetric Properties (0008,9206) of this frame is other than DISTORTED, may be present otherwise.

Identifies orientation of the plane of this frame. Only a single Item shall be permitted in this sequence. The direction cosines of the first row and the first column with respect to the patient. See C.7.6.2.1.1 and C.7.6.16.2.3.1 for further explanation. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL and Volumetric Properties (0008,9206) of this frame is other than DISTORTED. May be present otherwise.

A sequence that provides reference to a set of SOP Class/Instance pairs identifying images or other composite SOP Instances used to plan the acquisition or significant related images. See Section C.7.6.16.2.5.1 for further explanation. Zero or more Items may be included in this Sequence.

Referenced Image Sequence (0008,1140) shall be used to provide a reference to a set of SOP Class/Instance pairs identifying other data objects used to plan the acquisition of this image where the images shall share the same Frame of Reference UID (0020,0052). For each Item that contains such a reference, the value of the Purpose of Reference Code Sequence (0040,A170) shall be (”121311”, DCM, ”Localizer"). Applications can use the Referenced Image Sequence (0008,1140) in combination with data in Plane Position and Plane Orientation Macros to provide projections of the position of an image with respect to the referenced image. The Referenced Image Sequence (0008,1140) may also be present when references to other images (or frames within other images) are required for other reasons, as specified by Purpose of Reference Code Sequence (0040,A170). Note: An Image may contain references to itself (e.g. to other frames within itself).

Describes the purpose for which the reference is made. Only a single Item shall be permitted in this sequence. See C.7.6.16.2.5.1 for further explanation.

A sequence that that provides reference to the set of SOP Class/Instance pairs of the Images or other composite SOP Instances which were used to derive this frame. Zero or more Items may be included in this Sequence. A text description of how this frame data was derived. See C.7.6.1.1.3 for further explanation.

If an Image is identified to be a derived image (see C.7.6.1.1.2 Image Type), Derivation Description (0008,2111) and Derivation Code Sequence (0008,9215) describe the way in which the image was derived. They may be used whether or not the Source Image Sequence (0008,2112) is provided. They may also be used in cases when the Derived Image pixel data is not significantly changed from one of the source images and the SOP Instance UID of the Derived Image is the same as the one used for the source image. Notes: 1. Examples of Derived Images that would normally be expected to affect professional interpretation and would thus have a new UID include: a. images resulting from image processing of another image (e.g. unsharp masking), b. a multiplanar reformatted CT image, c. a DSA image derived by subtracting pixel values of one image from another. d. an image that has been decompressed after having been compressed with a lossy compression algorithm. To ensure that the user has the necessary information about the lossy compression, the approximate compression ratio may be included in Derivation Description (0008,2111). An example of a Derived Image that would normally not be expected to affect professional interpretation and thus would not require a new UID is an image that has been padded with additional rows and columns for more display purposes. 2. An image may be lossy compressed, e.g., for long term archive purposes, and its SOP Instance UID changed. PS3.4 provides a mechanism by which a query for the original image Instance may return a reference to the UID of the lossy compressed version of the image using the Alternate Representation Sequence (0008,3001). This allows an application processing a SOP Instance that references the original image UID, e.g., a Structured Report, to obtain a reference to an accessible version of the image even if the original SOP Instance is no longer available.

A coded description of how this frame was derived. See C.7.6.1.1.3 for further explanation. One or more Items may be included in this Sequence. More than one Item indicates that successive derivation steps have been applied.

A Sequence which identifies the set of Image or other SOP Class/Instance pairs of the Instances which were used to derive this frame. Zero or more Items may be included in this Sequence. See C.7.6.1.1.4 for further explanation.

If an Image is identified to be a Derived image (see C.7.6.1.1.2 Image Type), Source Image Sequence (0008,2112) is an optional list of Referenced SOP Class UID (0008,1150)/ Referenced SOP Instance UID (0008,1150) pairs that identify the source images used to create the Derived image. It may be used whether or not there is a description of the way the image was derived in Derivation Description (0008,2111) or Derivation Code Sequence (0008,9215). Note: Multiple Items may be present within Source Image Sequence (0008,2112), in which case either: a) those images were combined to make the derived image (e.g. multiple source images to make an MPR or MIP), or b) each of the items represents a step in the successive derivation of an image (e.g. when an image has had successive lossy compression steps applied to it), c) some combination of the above. The Purpose of Reference Code Sequence (0040,A170) and the Attributes within the referenced images themselves may be used to determine the history of the derivation, which is not otherwise explicitly specified.

Describes the purpose for which the reference is made, that is what role the source image or frame played in the derivation of this image or frame. Only a single Item shall be permitted in this sequence. Sequence that describes the frame specific cardiac synchronization parameters. Only a single Item shall be permitted in this sequence. The nominal time relative to the preceding R peak divided by the nominal R-R interval multiplied by 100. Required if used as a dimension index, may be present otherwise. The nominal time in ms from the time of the previous R-peak to the value of the Frame Reference DateTime (0018,9151). See C.7.6.16.2.7.1 for further explanation.

The Nominal Cardiac Trigger Delay Time (0020,9153) is the nominal trigger delay time in ms from the previous R-peak to the value of the Frame Reference DateTime (0018,9151). When frames are acquired with prospective gating, that is, the data acquisition actually begins in response to a timed delay from the R-peak, it may be that Actual Cardiac Trigger Delay Time (0020,9252) and the Nominal Cardiac Trigger Delay Time (0020,9153) have the same value. However, when frames are the result of retrospective gating, that is, the data is continuously acquired and then later compared with a simultaneously acquired ECG waveform and fitted into time slots corresponding to nominal phases of the cardiac cycle, then Nominal Cardiac Trigger Delay Time (0020,9153) and the Actual Cardiac Trigger Delay Time (0020,9252) may have different values. When multiple cardiac cycles are averaged together, then the Low R-R Value (0018,1081), and High R-R Value (0018,1082) are an average of the cardiac cycles that were accepted in the frame. Note: For cardiac gated acquisitions the choice of the Frame Reference DateTime (0018,9151) is influenced by the Nominal Cardiac Trigger Delay Time (0020,9153). For respiratory gated acquisitions the choice of the Frame Reference DateTime (0018,9151) is influenced by the Nominal Respiratory Trigger Delay Time (0020,9255). Figure C.7.6.16-5 depicts the usage.

The actual time in ms from the time of the previous R-peak to the value of the Frame Reference DateTime (0018,9151). See C.7.6.16.2.7.1 for further explanation. Required if Intervals Acquired (0018,1083) is present and has a value of 1. May be present otherwise.

Number of R-R intervals acquired. Number of R-R intervals rejected. Average number of heart beats per minute for the collection period for this frame. This shall include all accepted beats as well as rejected beats. Note: During prolonged acquisitions the average heart rate may differ from the reciprocal of the nominal R-R interval. Nominal R-peak - R-peak interval time in ms for the cardiac cycle used for the acquisition of this frame. See C.7.6.16.2.7.1 for further explanation. Required if Cardiac Synchronization Technique (0018,9037) equals other than NONE or REALTIME. May be present otherwise.

R-R interval low limit for beat rejection, in ms. R-R interval high limit for beat rejection, in ms. Identifies anatomic characteristics of this frame. Only a single Item shall be permitted in this sequence. Laterality of (possibly paired) body parts (as described in Anatomic Region Sequence (0008,2218)) examined. Enumerated Values: R = right L = left U = unpaired B = both left and right Note: This Attribute is mandatory, in order to ensure that frames may be positioned correctly relative to one another for display. Shall be consistent with any laterality information contained in Primary Anatomic Structure Modifier Sequence (0008,2230), if present. Contains the attributes involved in the transformation of stored pixel values. Only a single Item shall be permitted in this sequence. The value b in relationship between stored values (SV) and the output units. Output units = m*SV + b. m in the equation specified by Rescale Intercept (0028,1052). Specifies the output units of Rescale Slope (0028,1053) and Rescale Intercept (0028,1052). See C.11.1.1.2 for further explanation. Enumerated Value: US = Unspecified if Modality (0008,0060) equals MR.

Specifies the units of the output of the Modality LUT or rescale operation. Defined Terms: OD = The number in the LUT represents thousands of optical density. That is, a value of 2140 represents an optical density of 2.140. HU = Hounsfield Units (CT) US = Unspecified Other values are permitted, but are not defined by the DICOM Standard.

Window Center and Width values applied to the frame. Only one item is permitted in this sequence. Window Center for display. See C.11.2.1.2 for further explanation.

Window Center (0028,1050) and Window Width (0028,1051) specify a linear conversion from stored pixel values (after any Modality LUT or Rescale Slope and Intercept specified in the IOD have been applied) to values to be displayed. Window Center contains the input value that is the center of the window. Window Width contains the width of the window. Note: The terms “window center” and “window width” are not consistently used in practice, nor were they defined in previous versions of the standard. The definitions here are presented for the purpose of defining consistent meanings for identity and threshold transformations while preserving the common practice of using integral values for center and width. Window Width (0028,1051) shall always be greater than or equal to 1. When Window Width (0028,1051) is greater than 1, these Attributes select the range of input values that are to be mapped to the full range of the displayed output. When Window Width (0028,1051) is equal to 1, they specify a threshold below which input values will be displayed as the minimum output value. Note: Whether the minimum output value is rendered as black or white may depend on the value of Photometric Interpretation (0028,0004) or the presence of a Presentation LUT Module. These Attributes are applied according to the following pseudo-code, where x is the input value, y is an output value with a range from ymin to ymax, c is Window Center (0028,1050) and w is Window Width (0028,1051): if (x <= c - 0.5 - (w-1)/2), then y = ymin else if (x > c - 0.5 + (w-1)/2), then y = ymax, else y = ((x - (c - 0.5)) / (w-1) + 0.5) * (ymax - ymin)+ ymin Notes: 1. For the purpose of this definition, a floating point calculation without integer truncation is assumed, though the manner of implementation may vary as long as the result is the same. 2. The pseudo-code function computes a continuous value over the output range without any discontinuity at the boundaries. The value of 0 for w is expressly forbidden, and the value of 1 for w does not cause division by zero, since the continuous segment of the function will never be reached for that case. 3. For example, for an output range 0 to 255: c=2048, w=4096 becomes: if (x <= 0) then y = 0 else if (x > 4095) then y = 255 else y = ((x - 2047.5) / 4095 + 0.5) * (255-0) + 0 c=2048, w=1 becomes: if (x <= 2047.5) then y = 0 else if (x > 2047.5) then y = 255 else /* not reached */ c=0, w=100 becomes: if (x <= -50) then y = 0 else if (x > 49) then y = 255 else y = ((x + 0.5) / 99 + 0.5) * (255-0) + 0 c=0, w=1 becomes: if (x <= -0.5) then y = 0 else if (x > -0.5) then y = 255 else /* not reached */ 4. A Window Center of 2n-1 and a Window Width of 2n selects the range of input values from 0 to 2n-1. This represents an identity VOI LUT transformation in the case where no Modality LUT is specified and the stored pixel data are n bit unsigned integers. 5. A Window Width of 1 is typically used to represent a "threshold" operation in which those integer input values less than the Window Center are represented as the minimum displayed value and those greater than or equal to the Window Center are represented as the maximum displayed value. A Window Width of 2 will have the same result for integral input values. 6. The application of Window Center (0028,1050) and Window Width (0028,1051) may select a signed input range. There is no implication that this signed input range is clipped to zero. 7. The selected input range may exceed the actual range of the input values, thus effectively “compressing” the contrast range of the displayed data into a narrower band of the available contrast range, and “flattening” the appearance. There are no limits to the maximum value of the window width, or to the minimum or maximum value of window level, both of which may exceed the actual or possible range of input values. 8. Input values "below" the window are displayed as the minimum output value and input values "above" the window are displayed as the maximum output value. This is the common usage of the window operation in medical imaging. There is no provision for an alternative approach in which all values "outside" the window are displayed as the minimum output value. 9. The output of the Window Center/Width or VOI LUT transformation is either implicitly scaled to the full range of the display device if there is no succeeding transformation defined, or implicitly scaled to the full input range of the succeeding transformation step (such as the Presentation LUT), if present. See C.11.6.1. 10. Fractional values of Window Center and Window Width are permitted (since the VR of these Attributes is Decimal String), and though they are not often encountered, applications should be prepared to accept them. These Attributes shall be used only for Images with Photometric Interpretation (0028,0004) values of MONOCHROME1 and MONOCHROME2. They have no meaning for other Images. If multiple values are present, both Attributes shall have the same number of values and shall be considered as pairs. Multiple values indicate that multiple alternative views may be presented. If any VOI LUT Table is included by an Image, a Window Width and Window Center or the VOI LUT Table, but not both, may be applied to the Image for display. Inclusion of both indicates that multiple alternative views may be presented. If multiple items are present in VOI LUT Sequence (0028,3010), only one may be applied to the Image for display. Multiple items indicate that multiple alternative views may be presented. If the VOI LUT Module is defined in an IOD and if neither a VOI LUT Sequence nor a Window Width and Window Center are present, then the VOI LUT stage of the grayscale pipeline is defined to be an identity transformation. Notes: 1. This requirement is specified so that IODs that define a particular output space for the grayscale pipeline, such as P-Values, are not in an undefined state when no VOI LUT Sequence or Window Width and Window Center are present. 2. Despite the Type 3 requirement for VOI LUT Sequence and Window Center, implementations that render images are expected to implement and apply these transformations when they are present in the image, unless overridden by the user, a presentation state, or a hanging protocol, and to allow the user to select which transformation to apply when multiple transformations are present.

Window Width for display. See C.11.2.1.2 for further explanation.

Explanation of the Window Center and Width. Defined Terms for CT: BRAIN SOFT_TISSUE LUNG BONE Describes a VOI LUT function to apply to the values of Window Center (0028,1050) and Window Width (0028,1051). See C.11.2.1.3 for further explanation. Defined terms: LINEAR SIGMOID When this attribute is not present, the interpretation of the values of Window Center (0028,1050) and Window Width (0028,1051) is linear as in C.11.2.1.2.

The VOI LUT Function (0028,1056) specifies a potentially non-linear conversion for the output of the (conceptual) Modality LUT values to the input of the (conceptual) Presentation LUT. The behavior for the value LINEAR is defined in C.11.2.1.2. For all other values, the VOI LUT Function (0028,1056) shall include a unique descriptor of the LUT function to be used. Each descriptor is associated with a bivariate function of Window Center (0028,1050) and Window Width (0028,1051). If the VOI LUT Function (0028,1056) is present with a value other than LINEAR, the values provided in Window Center (0028,1050) and Window Width (0028,1051) shall not be interpreted as a linear conversion of the (conceptual) Modality LUT values to the input to the (conceptual) Presentation LUT – but as parameters for the function defined by the VOI LUT Function descriptor in (0028,1056). When defined, each descriptor must provide the functional relationship between the output of the (conceptual) Modality LUT values to the input of the (conceptual) Presentation LUT.

The mapping of stored values to associated real world values. One or more Items may be included in this sequence. Specifies the first stored value mapped for the Real Word Value Intercept (0040,9224) and Real World Value Slope (0040,9225) or Real World Value LUT (0040,9212) of this Item. See C.7.6.16.2.11.1 for further explanation.

Specifies the last stored value mapped for the Real Word Value Intercept (0040,9224) and Real World Value Slope (0040,9225) or Real World Value LUT (0040,9212) of this Item. See C.7.6.16.2.11.1 for further explanation.

The Intercept value in relationship between stored values (SV) and the real world values. See section C.7.6.16.2.11.2 for further explanation. Required if Real World Value LUT Data (0040,9212) is not present. The Slope value in relationship between stored values (SV) and the real world values. See section C.7.6.16.2.11.2 for further explanation. Required if Real World Value LUT Data (0040,9212) is not present. LUT Data in this Sequence. Required if Real World Value Intercept (0040,9224) is not present. Free form text explanation of the meaning of the LUT. Label that is used to identify this transformation. Units of measurement. Only a single value shall be present. See C.7.6.16.2.11.1 for further explanation.

Contains the attributes describing the use of contrast for this frame. One or more Items shall be present in this sequence. Identifying number corresponding to the agent described in the Enhanced Contrast/Bolus Module. The number shall be 1 for the first Item and increase by 1 for each subsequent Item. The administration of the selected agent had begun by the time this frame was acquired. Enumerated Values: YES NO The selected agent was detected in the frame. Enumerated Values: YES NO May only be zero length if the acquisition device is not capable of detecting the presence of this contrast agent in the frame. Nominal phase of intravenous contrast administration. Defined terms: PRE_CONTRAST POST_CONTRAST IMMEDIATE DYNAMIC STEADY_STATE DELAYED ARTERIAL CAPILLARY VENOUS PORTAL_VENOUS Required if Contrast/Bolus Administration Route Sequence (0018,0014) for the Contrast/Bolus Agent Number (0018,9337) defined in the Contrast/Bolus Agent Sequence (0018,0012) is (G-D101, SRT, "Intravenous route") or (G-D101, SNM3, "Intravenous route"); may be present otherwise. Note: SRT is the preferred designator for SNOMED, but SNM3 is allowed for backward compatibility. See PS3.16. Defines a sequence of Pixel Intensity Relationship LUTs. One or more items shall be present in this sequence. At least one item with LUT Function (0028,9474) equals TO_LINEAR LUT shall be present if Pixel Intensity Relationship (0028,1040) equals LOG. Only a single item with LUT Function (0028,9474) equals TO_LINEAR LUT shall be present. Specifies the format of the LUT Data in this Sequence. See C.11.1.1 and C.7.6.16.2.13.1 for further explanation.

LUT Data in this Sequence. The transformation function this LUT applies to the stored pixel values. Defined Terms: TO_LOG TO_LINEAR Sequence containing the pixel shift for a number of masks for this frame. One or more items shall be present in this sequence. Identifier of the Subtraction Item in the Mask Subtraction Sequence (0028,6100) to which this pixel shift is associated. See C.7.6.16.2.14.1.

A pair of floating point numbers specifying the fractional vertical [adjacent row spacing] and horizontal [adjacent column spacing] pixel shift applied to the mask before subtracting it from this contrast frame. Note: If no pixel shift has to be applied a pair of zero values should be specified. See Section C.7.6.10.1.2.

Sequence containing the row and column directions for this frame in the patient. Only a single Item shall be permitted in this sequence. Patient direction of the rows and columns of this frame. See C.7.6.1.1.1 for further explanation.

The Patient Orientation (0020,0020) relative to the image plane shall be specified by two values that designate the anatomical direction of the positive row axis (left to right) and the positive column axis (top to bottom). The first entry is the direction of the rows, given by the direction of the last pixel in the first row from the first pixel in that row. The second entry is the direction of the columns, given by the direction of the last pixel in the first column from the first pixel in that column. Anatomical direction shall be designated by the capital letters: A (anterior), P (posterior), R (right), L (left), H (head), F (foot). Each value of the orientation attribute shall contain at least one of these characters. If refinements in the orientation descriptions are to be specified, then they shall be designated by one or two additional letters in each value. Within each value, the letters shall be ordered with the principal orientation designated in the first character.

Sequence containing the display shutter parameters for this frame. Only a single Item shall be permitted in this sequence. Sequence that describes the frame specific respiratory synchronization parameters. Only a single Item shall be permitted in this sequence. Measured interval time in ms from maximum respiration peak to the next peak for the respiratory cycle in which this frame occurs. See C.7.6.16.2.17.1 for further explanation. Required if Respiratory Motion Compensation Technique (0018,9170) equals other than NONE or REALTIME and Respiratory Trigger Type (0020,9250) is absent or has a value of TIME or BOTH.

For time based respiratory gating, the Nominal Respiratory Trigger Delay Time (0020,9255) is the prescribed trigger delay time in ms from the previous Respiratory-peak to the value of the Frame Reference DateTime (0018,9151). When frames are acquired with prospective gating, that is, the data acquisition actually begins in response to a timed delay from the Respiratory trigger, it may be that Actual Respiratory Trigger Delay Time (0020,9257) and the Nominal Respiratory Trigger Delay Time (0020,9255) have the same value. However, when frames are the result of retrospective gating, that is, the data is continuously acquired and then later compared with a simultaneously acquired respiratory waveform and fitted into bins corresponding to nominal phases of the respiratory cycle, then Nominal Respiratory Trigger Delay Time (0020,9255) and the Actual Respiratory Trigger Delay Time (0020,9257) may have different values. Figure C.7.6.16-9a and C.7.6.16-9b depict the usage. Figure C.7.6.16-9a Respiratory Timing Tags Figure C.7.6.16-9b Relationship of Respiratory Amplitude Attributes

The nominal time relative to the preceding respiratory inspiration maximum divided by the nominal respiratory interval multiplied by 100. Required if used as a dimension index, may be present otherwise. The nominal time in ms from the beginning of the respiratory interval to the value of the Frame Reference DateTime (0018,9151). See C.7.6.16.2.17.1 for further explanation.

The actual time in ms from the beginning of the respiratory interval to the value of the Frame Reference DateTime (0018,9151). See C.7.6.16.2.17.1 for further explanation. Required if Respiratory Trigger Type (0020,9250) is TIME or BOTH.

Nominal amplitude of the respiratory signal at which the acquisition of data for this frame begins, in percent of the nominal maximum value (which represents maximum inspiration). Required if Respiratory Trigger Type (0020,9250) is AMPLITUDE or BOTH. The phase of respiration at which the Starting Respiratory Amplitude (0020,9246) was measured. Enumerated Value: INSPIRATION MAXIMUM EXPIRATION MINIMUM Required if Starting Respiratory Amplitude (0020,9246) is present. Nominal amplitude of the respiratory signal at which the acquisition of data for this frame ends, in percent of the nominal maximum value (which represents maximum inspiration). Required if Respiratory Trigger Type (0020,9250) is AMPLITUDE or BOTH. The phase of respiration at which the Ending Respiratory Amplitude (0020,9248) was measured. Enumerated Value: INSPIRATION MAXIMUM EXPIRATION MINIMUM Required if Ending Respiratory Amplitude (0020,9248) is present. Sequence containing the Irradiation Event Identification for this frame. Only a single Item shall be permitted in this sequence. Unique identification of the irradiation event(s) associated with the acquisition of this image. Sequence that lists the Dimension Organization UIDs referenced by the containing SOP Instance. See section C.7.6.17.2 for further explanation. Zero or more Items may be included in this Sequence. Uniquely identifies a set of dimensions referenced within the containing SOP Instance. See section C.7.6.17.2 for further explanation. Identifies the sequence containing the indices used to specify the dimension of the multi-frame object. Zero or more Items may be included in this sequence. Contains the Data Element Tag that is used to identify the Attribute connected with the index. See section C.7.6.17.1 for further explanation. Identification of the creator of a group of private data elements. Required if the Dimension Index Pointer (0020,9165) value is the Data Element Tag of a Private Attribute. Contains the Data Element Tag of the Functional Group Sequence that contains the Attribute that is referenced by the Dimension Index Pointer (0020,9165). See section C.7.6.17.1 for further explanation. Required if the value of the Dimension Index Pointer (0020,9165) is the Data Element Tag of an Attribute that is contained within a Functional Group Sequence. Identification of the creator of a group of private data elements. Required if the Functional Group Pointer 0020,9167) value is the Data Element Tag of a Private Attribute. Uniquely identifies a set of dimensions referenced within the containing SOP Instance. In particular the dimension described by this sequence item is associated with this Dimension Organization UID. See section C.7.6.17.2 for further explanation. Required if the value of the Dimension Organization Sequence (0020,9221) contains Items Free text description that explains the meaning of the dimension. Defines if a cardiac synchronization technique was applied during or after the acquisition. Enumerated Values: NONE REALTIME = total time for the acquisition is shorter than cardiac cycle, no gating is applied PROSPECTIVE = certain thresholds have been set for a gating window that defines the acceptance of measurement data during the acquisition RETROSPECTIVE = certain thresholds have been set for a gating window that defines the acceptance of measurement data after the acquisition PACED = there is a constant RR interval (e.g., Pacemaker), which makes thresholding not required Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise. Cardiac Signal Source. Defined Terms: ECG = electrocardiogram VCG = vector cardiogram PP = peripheral pulse MR = magnetic resonance, i.e. M-mode or cardiac navigator Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED and Cardiac Synchronization Technique (0018,9037) equals other than NONE. Otherwise may be present if Image Type (0008,0008) Value 1 is DERIVED and Cardiac Synchronization Technique (0018,9037) equals other than NONE. R-R interval in ms measured prior to or during the scan. Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED and Cardiac Synchronization Technique (0018,9037) equals other than NONE. Otherwise may be present if Image Type (0008,0008) Value 1 is DERIVED and Cardiac Synchronization Technique (0018,9037) equals other than NONE. Note: The Heart Rate (0018,1088) attribute is not used in this Module, since its value can be derived as 1/ Cardiac RR Interval Specified (0018,9070). Cardiac arrhythmia rejection technique. Defined Terms: NONE RR_INTERVAL = rejection based on deviation from average RR interval QRS_LOOP = rejection based on deviation from regular QRS loop PVC = rejection based on PVC criteria Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED and Cardiac Synchronization Technique (0018,9037) equals PROSPECTIVE or RETROSPECTIVE. Otherwise may be present if Image Type (0008,0008) Value 1 is DERIVED and Cardiac Synchronization Technique (0018,9037) equals PROSPECTIVE or RETROSPECTIVE. R-R interval low limit for beat rejection, in ms. Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED and Cardiac Synchronization Technique (0018,9037) equals PROSPECTIVE or RETROSPECTIVE. Otherwise may be present if Image Type (0008,0008) Value 1 is DERIVED and Cardiac Synchronization Technique (0018,9037) equals PROSPECTIVE or RETROSPECTIVE. R-R interval high limit for beat rejection, in ms. Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED and Cardiac Synchronization Technique (0018,9037) equals PROSPECTIVE or RETROSPECTIVE. Otherwise may be present if Image Type (0008,0008) Value 1 is DERIVED and Cardiac Synchronization Technique (0018,9037) equals PROSPECTIVE or RETROSPECTIVE. Number of R-R intervals acquired and used to create the image (not including the intervals rejected). Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED and Cardiac Synchronization Technique (0018,9037) equals other than NONE. Otherwise may be present if Image Type (0008,0008) Value 1 is DERIVED and Cardiac Synchronization Technique (0018,9037) equals other than NONE. Number of R-R intervals rejected. Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED and Cardiac Synchronization Technique (0018,9037) equals other than NONE. Otherwise may be present if Image Type (0008,0008) Value 1 is DERIVED and Cardiac Synchronization Technique (0018,9037) equals other than NONE. Number of beats prescribed to be skipped after each detected arrhythmia. Description of type of framing performed. Defined Terms: FORW = time forward from trigger BACK = time back before trigger PCNT = percentage of R-R forward from trigger See C.7.6.18.1.1.1. Required if type of framing is not time forward from trigger, may be present otherwise.

Cardiac Framing Type (0018,1064) is the mechanism used to select the data acquired to construct the frames within a specified cardiac timing interval.C.7.6.18.2 Respiratory Synchronization Module Table C7.6.18-2 specifies the attributes of the Respiratory Synchronization Module. Table C.7.6.18-2 RESPIRATORY SYNCHRONIZATION MODULE ATTRIBUTES

Applied technique to reduce respiratory motion artifacts. Defined Terms: NONE BREATH_HOLD REALTIME = image acquisition shorter than respiratory cycle GATING = Prospective gating TRACKING = prospective through-plane or in-plane motion tracking PHASE_ORDERING = prospective phase ordering PHASE_RESCANNING = prospective techniques, such as real-time averaging, diminishing variance and motion adaptive gating RETROSPECTIVE = retrospective gating CORRECTION = retrospective image correction Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise. Signal source from which respiratory motion is derived. Defined Terms: NONE BELT = includes various devices that detect or track expansion of the chest NASAL_PROBE CO2_SENSOR NAVIGATOR = MR navigator and organ edge detection MR_PHASE = phase (of center k-space line) ECG = baseline demodulation of the ECG Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED and Respiratory Motion Compensation Technique (0018,9170) equals other than NONE. Otherwise may be present if Image Type (0008,0008) Value 1 is DERIVED and Respiratory Motion Compensation Technique (0018,9170 equals other than NONE. Respiratory trigger threshold in percent of the chest expansion for the frame relative to the last Respiratory-Peak. See C.7.6.16.2.17.1 for further explanation. Required if Respiratory Motion Compensation Technique (0018,9170) equals other than NONE, REALTIME or BREATH_HOLD and if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise.

Characteristic of the respiratory signal used to the define the respiratory triggering. Defined Terms: TIME AMPLITUDE BOTH Required if the value is not TIME, may be present otherwise. Applied technique to reduce bulk or other physiology motion artifacts. Defined Terms: NONE REALTIME = image acquisition shorter than motion cycle GATING = prospective gating TRACKING = prospective through and/or in‑plane motion tracking RETROSPECTIVE = retrospective gating CORRECTION = retrospective image correction Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise. Signal source to measure motion. Defined Terms: JOINT = joint motion detection NAVIGATOR = MR navigator and organ edge detection MR_PHASE = phase (of center k‑space line) Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED and Bulk Motion Compensation Technique (0018,9172) equals other than NONE. Otherwise may be present if Image Type (0008,0008) Value 1 is DERIVED and Bulk Motion Compensation Technique (0018,9172) equals other than NONE. Specifies the format of the Red Palette Color Lookup Table Data (0028,1201). See C.7.6.3.1.5 for further explanation.

The three values of Palette Color Lookup Table Descriptor (0028,1101-1103) describe the format of the Lookup Table Data in the corresponding Data Element (0028,1201-1203) or (0028,1221-1223). The first value is the number of entries in the lookup table. When the number of table entries is equal to 216 then this value shall be 0. The first value shall be identical for each of the Red, Green and Blue Palette Color Lookup Table Descriptors. The second value is the first stored pixel value mapped. This pixel value is mapped to the first entry in the Lookup Table Data. All image pixel values less than the first value mapped are also mapped to the first entry in the Lookup Table Data if the Photometric Interpretation is PALETTE COLOR. Note: In the case of the Supplemental Palette Color LUT, the stored pixel values less than the second descriptor value are grayscale values. An image pixel value one greater than the first value mapped is mapped to the second entry in the Lookup Table Data. Subsequent image pixel values are mapped to the subsequent entries in the Lookup Table Data up to an image pixel value equal to number of entries + first value mapped – 1, which is mapped to the last entry in the Lookup Table Data. Image pixel values greater than or equal to number of entries + first value mapped are also mapped to the last entry in the Lookup Table Data. The second value shall be identical for each of the Red, Green and Blue Palette Color Lookup Table Descriptors. The third value specifies the number of bits for each entry in the Lookup Table Data. It shall take the value of 8 or 16. The LUT Data shall be stored in a format equivalent to 8 bits allocated when the number of bits for each entry is 8, and 16 bits allocated when the number of bits for each entry is 16, where in both cases the high bit is equal to bits allocated-1. The third value shall be identical for each of the Red, Green and Blue Palette Color Lookup Table Descriptors. Note: Some implementations have encoded 8 bit entries with 16 bits allocated, padding the high bits; this can be detected by comparing the number of entries specified in the LUT Descriptor with the actual value length of the LUT Data entry. The value length in bytes should equal the number of entries if bits allocated is 8, and be twice as long if bits allocated is 16. When the Palette Color Lookup Table Descriptor (0028,1101-1103) are used as part of the Palette Color Lookup Table Module or the Supplemental Palette Color Lookup Table Module, the third value shall be equal to 16. Notes: 1. A value of 16 indicates the Lookup Table Data will range from (0,0,0) minimum intensity to (65535,65535,65535) maximum intensity. 2. Since the Palette Color Lookup Table Descriptor (0028,1101-1103) Attributes are multi-valued, in an Explicit VR Transfer Syntax, only one value representation (US or SS) may be specified, even though the first and third values are always by definition interpreted as unsigned. The explicit VR actually used is dictated by the VR needed to represent the second value, which will be consistent with Pixel Representation (0028,0103).

Specifies the format of the Green Palette Color Lookup Table Data (0028,1202). See C.7.6.3.1.5 for further explanation.

Specifies the format of the Blue Palette Color Lookup table Data (0028,1203). See C.7.6.3.1.5 for further explanation.

Red Palette Color Lookup Table Data. See C.7.6.3.1.6 for further explanation.

Palette Color Lookup Table Data (0028,1201-1203) contain the lookup table data corresponding to the Lookup Table Descriptor (0028,1101-1103). Palette color values must always be scaled across the full range of available intensities. This is indicated by the fact that there are no bits stored and high bit values for palette color data. Note: For example, if there are 16 bits per entry specified and only 8 bits of value are truly used then the 8 bit intensities from 0 to 255 must be scaled to the corresponding 16 bit intensities from 0 to 65535. To do this for 8 bit values, simply replicate the value in both the most and least significant bytes. These lookup tables shall be used only when there is a single sample per pixel (single image plane) in the image. These lookup tables are required when the value of Photometric Interpretation (0028,0004) is Palette Color. The semantics of these lookup tables is not defined otherwise.

Green Palette Color Lookup Table Data. See C.7.6.3.1.6 for further explanation.

Blue Palette Color Lookup Table Data. See C.7.6.3.1.6 for further explanation.

A 4x4 homogeneous transformation matrix that maps patient coordinate space of the reconstructed image to the equipment defined original coordinate space. Matrix elements shall be listed in row-major order. See C.7.6.21.1.

The Image to Equipment Mapping Matrix (0028,9520) is used to describe the relationship between the Patient oriented coordinate system and a modality specific equipment coordinate system. This mapping can only be used with systems that have a well-defined equipment coordinate system (such as XA, etc.). The Image to Equipment Mapping Matrix AMB describes how to transform a point (Bx,By,Bz) with respect to the Patient coordinate system into (Ax,Ay,Az) with respect to the equipment coordinate system according to the equation below. size 12{ left [ matrix { "" lSup { size 8{A} } x {} ## "" lSup { size 8{A} } y {} ## "" lSup { size 8{A} } z {} ## 1 } right ]= left [ matrix { M rSub { size 8{"11"} } {} # M rSub { size 8{"12"} } {} # M rSub { size 8{"13"} } {} # T rSub { size 8{x} } {} ## M rSub { size 8{"21"} } {} # M rSub { size 8{"22"} } {} # M rSub { size 8{"23"} } {} # T rSub { size 8{y} } {} ## M rSub { size 8{"31"} } {} # M rSub { size 8{"32"} } {} # M rSub { size 8{"33"} } {} # T rSub { size 8{z} } {} ## 0 {} # 0 {} # 0 {} # 1{} } right ] left [ matrix { "" lSup { size 8{B} } x {} ## "" lSup { size 8{B} } y {} ## "" lSup { size 8{B} } z {} ## 1 } right ]} {} The Image to Equipment Mapping Matrix is a rigid transformation that involves only translations and rotations. Mathematically, the matrix shall be orthonormal and can describe six degrees of freedom: three translations, and three rotations. Note: Both the Patient Coordinate System and the Equipment Coordinate System are expressed in millimeters.

Identification of the type of equipment coordinate system in which the projection images were acquired. See C.7.6.21.2. Defined Terms: ISOCENTER

The Equipment Coordinate System Identification (0028,9537) identifies the Reference Coordinate System to which the Image to Equipment Mapping Matrix (0028,9520) is related. The Defined Term ISOCENTER refers to a coordinate reference system where the origin corresponds with the center of rotation of the projections. Note: For X-Ray 3D Angiographic Images created from SOP Instances of the Enhanced XA SOP Class (1.2.840.10008.5.1.4.1.1.12.1.1) the isocenter coordinate system is used to describe the positioning of the table and positioner (see C.8.19.6.13), and will use only the Defined Term ISOCENTER.

Specifies the format of the Red Palette Color Lookup Table Data (0028,1201). See C.7.6.3.1.5 for further explanation.

Specifies the format of the Green Palette Color Lookup Table Data (0028,1202). See C.7.6.3.1.5 for further explanation.

Specifies the format of the Blue Palette Color Lookup table Data (0028,1203). See C.7.6.3.1.5 for further explanation.

Palette Color Lookup Table UID. See C.7.9.1 for further explanation.

This data element uniquely identifies a palette color lookup table set (red, green, blue). Note: This can be used to avoid reloading a palette if a system already has that palette loaded without examining all the data entries in the palette.

Red Palette Color Lookup Table Data. Required if segmented data is NOT used in an Image IOD, or if the IOD is a Presentation State IOD. See C.7.6.3.1.6 for further explanation.

Green Palette Color Lookup Table Data. Required if segmented data is NOT used in an Image IOD, or if the IOD is a Presentation State IOD. See C.7.6.3.1.6 for further explanation.

Blue Palette Color Lookup Table Data. Required if segmented data is NOT used in an Image IOD, or if the IOD is a Presentation State IOD. See C.7.6.3.1.6 for further explanation.

Segmented Red Palette Color Lookup Table Data. Required segmented data is used in an Image IOD; shall not be present in a Presentation State IOD. See C.7.9.2 for further explanation.

The Segmented Palette Color Lookup Table Data (0028,1221-1223) is stored as a series of segments, see Table C.7-23. When the segments are expanded into the actual lookup table data, it shall have the number of table entries specified by the first value of the Palette Color Lookup Table Descriptors (0028,1101-1103), Number of Table Entries. These lookup tables shall be used only when segmented lookup table data use is desriable and there is a single sample per pixel (single image plane) in the image. Table C.7-23 COMPRESSED PALETTE COLOR LOOKUP TABLE DATA There are currently three types of segments: discrete, linear, and indirect. The segments type is identified by the opcodes in Table C.7-24: Table C.7-24 SEGMENT TYPES

Segmented Green Palette Color Lookup Table Data. Required if segmented data is used in an Image IOD; shall not be present in a Presentation State IOD. See C.7.9.2 for further explanation.

Segmented Blue Palette Color Lookup Table Data. Required if segmented data is used in an Image IOD; shall not be present in a Presentation State IOD. See C.7.9.2 for further explanation.

Text description of the part of the body examined. See PS 3.16 Annex on Correspondence of Anatomic Region Codes and Body Part Examined for Defined Terms Radiographic view associated with Patient Position (0018,5100). Defined Terms: AP = Anterior/Posterior PA = Posterior/Anterior LL = Left Lateral RL = Right Lateral RLD = Right Lateral Decubitus LLD = Left Lateral Decubitus RLO = Right Lateral Oblique LLO = Left Lateral Oblique Label for the type of filter inserted into the x-ray beam Label describing any grid inserted. Size of the focal spot in mm. For devices with variable focal spot or multiple focal spots, small dimension followed by large dimension. Label of the type of storage phosphor plates used in this series Label of type of phosphor on the plates Specifies the intended interpretation of the pixel data. Shall have one of the following Enumerated Values: MONOCHROME1 MONOCHROME2 Peak kilo voltage output of the x-ray generator used The ID or serial number of the sensing plate upon which the image was acquired Distance in mm from source to detector center. Note: This value is traditionally referred to as Source Image Receptor Distance (SID). Distance in mm from source to isocenter (center of field of view) . Note: This value is traditionally referred to as Source Object Distance (SOD). Time of x-ray exposure in msec X-Ray Tube Current in mA. The exposure expressed in mAs, for example calculated from Exposure Time and X-Ray Tube Current. The exposure expressed in µAs, for example calculated from Exposure Time and X-Ray Tube Current. Physical distance measured at the front plane of the Image Receptor housing between the center of each pixel. Specified by a numeric pair - row spacing value (delimiter) column spacing value - in mm. In the case of CR, the front plane is defined to be the external surface of the CR plate closest to the patient and radiation source. Power in kW to the x-ray generator. Describes device-specific processing associated with the image (e.g. Organ Description) Code representing the device-specific processing associated with the image (e.g. CR Organ Filtering code) Orientation of cassette, used to properly position the image for display. Enumerated Values: LANDSCAPE PORTRAIT Size of cassette. Defined Terms: 18CMX24CM 8INX10IN 24CMX30CM 10INX12IN 30CMX35CM 30CMX40CM 11INX14IN 35CMX35CM 14INX14IN 35CMX43CM 14INX17IN Total number of x-ray exposures that have been made on the plate identified in Plate ID (0018,1004) Relative x-ray exposure on the plate. Meaning of values is implementation specific. May be used to adjust the dynamic range of the plate digitizer (scanner). Read out sensitivity. Image identification characteristics. See C.8.2.1.1.1 for specialization.

For CT Images, Image Type (0008,0008) is specified to be Type 1 and uses one of the following Defined Terms for Value 3: AXIAL identifies a CT Axial Image LOCALIZER identifies a CT Localizer Image Note: Axial in this context means any cross-sectional image, and includes transverse, coronal, sagittal and oblique images.

Number of samples (planes) in this image. See C.8.2.1.1.2 for specialization.

For CT Images, Samples per Pixel (0028,0002) shall have an Enumerated Value of 1.

Specifies the intended interpretation of the pixel data. See C.8.2.1.1.3 for specialization.

For CT Images, Photometric Interpretation (0028,0004) shall have one of the following Enumerated Values: MONOCHROME1 MONOCHROME2 See C.7.6.3.1.1.2 for definition of these terms.

Number of bits allocated for each pixel sample. Each sample shall have the same number of bits allocated. See C.8.2.1.1.4 for specialization.

For CT Images, Bits Allocated (0028,0100) shall have the Enumerated Value of 16.

Number of bits stored for each pixel sample. Each sample shall have the same number of bits stored. See C.8.2.1.1.5 for specialization.

For CT Images, Bits Stored (0028,0101) shall have the Enumerated Values of 12 to 16.

Most significant bit for pixel sample data. Each sample shall have the same high bit. See C.8.2.1.1.6 for specialization.

For CT Images, High Bit (0028,0102) shall have only the Enumerated Value of one less than the value sent in Bits Stored.

The value b in relationship between stored values (SV) and Hounsfield (HU). HU = m*SV+b m in the equation specified in Rescale Intercept (0028,1052). Peak kilo voltage output of the x-ray generator used A number identifying the single continuous gathering of data over a period of time which resulted in this image Parameters of scanning sequence. The diameter in mm of the region over which data were collected The x, y, and z coordinates (in the patient coordinate system) in mm of the center of the region in which data were collected. See C.8.15.3.6.1.

In Figure C.8-19 the relationship of the Geometric Attributes within the CT Geometry and CT Reconstruction functional groups is shown. The figure, viewed from the front of the gantry (where the table enters the gantry), is informative only and is not meant to represent a standardization of an equipment-based frame of reference. Figure C.8-19: Geometry of CT Acquisition System

Diameter in mm of the region from within which data were used in creating the reconstruction of the image. Data may exist outside this region and portions of the patient may exist outside this region. The x, y, and z coordinates (in the patient coordinate system) of the reconstruction center target point as used for reconstruction in mm. See C.8.15.3.6.1. Note: If the reconstructed image is not magnified or panned the value corresponds with the Data Collection Center (Patient) (0018,9313) attribute.

The calibration factors for the Calcium Scoring Mass Factor Patient (0018,9351) and Calcium Scoring Mass Factor Device (0018,9352) attributes are defined by the International Consortium for Multi-Detector CT Evaluation of Coronary Calcium, see McCollough, C.H. “A multi-institutional, multi-manufacturer, international standard for the quantification of coronary artery calcium using cardiac CT”.

The calibration factors for the calcium mass score of the device. These factors incorporate the effects of This a multi-value attribute, the first value specifies the mass factor for a small patient size, the second value for a medium patient size and the third value for a large patient size. See C.8.2.1.1.7.

Contains the attributes defining the data acquisition in a multiple X-Ray source system beyond the primary source. The primary X-Ray source is specified in other attributes of this module. One or more items may be present. Peak kilo voltage output of the X-Ray generator used. Nominal X-Ray tube current in milliamperes. The diameter in mm of the region over which data were collected. Used nominal size of the focal spot in mm. Type of filter(s) inserted into the X-Ray beam. The X-Ray absorbing material used in the filter. Image identification characteristics. See C.8.3.1.1.1 for specialization.

For MR Images, Image Type (0008,0008) is specified to be Type 1 and use one of the following Defined Terms for Value 3:

Number of samples (planes) in this image. See C.8.3.1.1.2 for specialization.

For MR Images, Samples per Pixel (0028,0002) shall have an Enumerated Value of 1.

Specifies the intended interpretation of the pixel data. See C.8.3.1.1.3 for specialization.

For MR Images, Photometric Interpretation (0028,0004) shall have one of the following Enumerated Values: MONOCHROME1 MONOCHROME2 See C.7.6.3.1.2 for definition of these terms.

Number of bits allocated for each pixel sample. Each sample shall have the same number of bits allocated. See C.8.3.1.1.4 for specialization.

For MR Images, Bits Allocated (0028,0100) shall have the Enumerated Value of 16.

Description of the type of data taken. Enumerated Values: SE = Spin Echo IR = Inversion Recovery GR = Gradient Recalled EP = Echo Planar RM = Research Mode Note: Multi-valued, but not all combinations are valid (e.g. SE/GR, etc.). Variant of the Scanning Sequence. Defined Terms: SK = segmented k-space MTC = magnetization transfer contrast SS = steady state TRSS = time reversed steady state SP = spoiled MP = MAG prepared OSP = oversampling phase NONE = no sequence variant Parameters of scanning sequence. Defined Terms: PER = Phase Encode Reordering RG = Respiratory Gating CG = Cardiac Gating PPG = Peripheral Pulse Gating FC = Flow Compensation PFF = Partial Fourier - Frequency PFP = Partial Fourier - Phase SP = Spatial Presaturation FS = Fat Saturation Identification of data encoding scheme. Enumerated Values: 2D = frequency x phase 3D = frequency x phase x phase The period of time in msec between the beginning of a pulse sequence and the beginning of the succeeding (essentially identical) pulse sequence. Required except when Scanning Sequence (0018,0020) is EP and Sequence Variant (0018,0021) is not SK. Time in ms between the middle of the excitation pulse and the peak of the echo produced (kx=0). In the case of segmented k-space, the TE(eff) is the time between the middle of the excitation pulse to the peak of the echo that is used to cover the center of k-space (i.e.-kx=0, ky=0). Number of lines in k-space acquired per excitation per image. Time in msec after the middle of inverting RF pulse to middle of excitation pulse to detect the amount of longitudinal magnetization. Required if Scanning Sequence (0018,0020) has values of IR. Time, in msec, between peak of the R wave and the peak of the echo produced. In the case of segmented k-space, the TE(eff) is the time between the peak of the echo that is used to cover the center of k-space. Required for Scan Options (0018,0022) which include heart gating (e.g. CG, PPG, etc.) User defined name for the Scanning Sequence (0018,0020) and Sequence Variant (0018,0021) combination. Angio Image Indicator. Primary image for Angio processing. Enumerated Values: Y = Image is Angio N = Image is not Angio Number of times a given pulse sequence is repeated before any parameter is changed Precession frequency in MHz of the nucleus being addressed Nucleus that is resonant at the imaging frequency. Examples: 31P, 1H The echo number used in generating this image. In the case of segmented k-space, it is the effective Echo Number. Nominal field strength of MR magnet, in Tesla Spacing between slices, in mm. The spacing is measured from the center-to-center of each slice. Total number of lines in k-space in the 'y' direction collected during acquisition. Fraction of acquisition matrix lines acquired, expressed as a percent. Ratio of field of view dimension in phase direction to field of view dimension in frequency direction, expressed as a percent. Reciprocal of the total sampling period, in hertz per pixel. Average R-R interval used for the scans, in msec Beat length sorting has been applied. Enumerated Values: Y = yes N = No R-R interval low limit for beat rejection, in msec R-R interval high limit for beat rejection, in msec Number of R-R intervals acquired. Number of R-R intervals rejected. Description of type of PVC rejection criteria used. Number of beats skipped after a detected arrhythmia. Beats per minute. Number of images per cardiac cycle. Percent of R-R interval, based on Heart Rate (0018,1088), prescribed as a window for a valid/usable trigger. Diameter in mm. of the region from within which data were used in creating the reconstruction of the image. Data may exist outside this region and portions of the patient may exist outside this region. Receive coil used. Transmit coil used. Dimensions of the acquired frequency /phase data before reconstruction. Multi-valued: frequency rows\frequency columns\phase rows\phase columns. The axis of phase encoding with respect to the image. Enumerated Values: ROW = phase encoded in rows. COL = phase encoded in columns. Steady state angle in degrees to which the magnetic vector is flipped from the magnetic vector of the primary field. Calculated whole body Specific Absorption Rate in watts/kilogram. Flip angle variation applied during image acquisition. Enumerated Values: Y = yes N = no The rate of change of the gradient coil magnetic flux density with time (T/s). Temporal order of a dynamic or functional set of Images. Total number of temporal positions prescribed. Time delta between Images in a dynamic or functional set of Images. Sequence that describes the orientation of the patient with respect to gravity. See C.8.4.6.1.1 for further explanation. Zero or one item shall be present in the sequence.

The Patient Orientation Code Sequence (0054,0410) is used to describe the orientation of the patient with respect to gravity, and is independent of the position in the gantry.

Patient Orientation Modifier. Required if needed to fully specify the orientation of the patient with respect to gravity. See C.8.4.6.1.2 for further explanation. Zero or one item shall be present in the sequence.

The Patient Orientation Modifier Code Sequence (0054,0412) is used to modify or enhance the orientation specified by Patient Orientation Code Sequence (0054,0410).

Sequence which describes the orientation of the patient with respect to the gantry. See Section C.8.4.6.1.3 for further explanation. Zero or one item shall be present in the sequence.

Patient Gantry Relationship Code Sequence (0054,0414) is used to describe the patient direction within the gantry, such as head-first or feet-first. When imaging the extremities, these directions are related to normal anatomic position. Example: In normal anatomic position, the fingers point towards the feet.

Number of samples (color planes) in this image. The value shall be 1. Specifies the intended interpretation of the pixel data. See C.8.4.7.1.1 for further explanation.

For NM Images, Photometric Interpretation (0028,0004) shall have one of the following Enumerated Values: MONOCHROME2 PALETTE COLOR See C.7.6.3.1.2 for definition of these terms.

Number of bits allocated for each pixel sample. Each sample shall have the same number of bits allocated. Enumerated Values: 8, 16. Number of bits stored for each pixel sample. Each sample shall have the same number of bits stored. The value shall be the same as the value in Bits Allocated (0028,0100). Most significant bit for pixel sample data. Each sample shall have the same high bit. Shall be one less than the value in Bits Stored (0028,0101). 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 10.7.1.3 for further explanation of the value order. Contains the Data Element Tags of one or more frame index vectors. See C.8.4.8.1.1 for further specialization.

By definition, NM Images are multi-dimensional Multi-frame Images. The value of the Frame Increment Pointer (0028,0009) contains the Tag for one or more frame indexing vectors. This determines the number of dimensions of frame indices in the image, and the order in which these indices vary from one frame to the next, with the last Tag indicating the most rapidly changing index. The Enumerated Values for the Frame Increment Pointer (0028,0009) are determined by the Image Type (0008,0008), Value 3, as shown in Table C.8-8. Table C.8-8 ENUMERATED VALUES FOR FRAME INCREMENT POINTER

An array which contains the energy window number for each frame. Required if the value of the Frame Increment Pointer (0028,0009) includes the Tag for Energy Window Vector (0054,0010). See C.8.4.8.1.2 for specialization.

Number of Energy Windows (0054,0011) is the number of distinct energy window groupings acquired in this image. See C.8.4.10.1. When Image Type (0008,0008), Value 3, is RECON TOMO or RECON GATED TOMO, then the Number of Energy Windows (0054,0011) shall be 1. Energy Window Vector (0054,0010) is an indexing vector. The value of the nth element of this vector is the energy window number for the nth frame in this image, and shall have a value from 1 to Number of Energy Windows (0054,0011).

Number of energy window groupings. See C.8.4.8.1.2 for specialization.

An array which contains the detector number for each frame. Required if the value of the Frame Increment Pointer (0028,0009) includes the Tag for Detector Vector (0054,0020). See C.8.4.8.1.3 for specialization.

Number of Detectors (0054,0021) is the number of separate detectors which differentiate the frames in this image. When Image Type (0008,0008), Value 3, is RECON TOMO or RECON GATED TOMO, then the Number of Detectors (0054,0021) shall be 1. Note: Number of Detectors (0054,0021) does not necessarily represent the actual number of detectors used during data acquisition. Example 1: In a TOMO acquisition in which frames from 2 or more detectors are interleaved to form one continuous set of frames, then no distinction is made between frames on the basis of which detector created them. In this case, the Number of Detectors (0054,0021) would be 1. Example 2: In a WHOLE BODY acquisition in which a single detector acquires anterior and posterior views in two separate passes, the Number of Detectors (0054,0021) would be 2. Detector Vector (0054,0020) is an indexing vector. The value of the nth element of this vector is the detector number of the nth frame in this image, and shall have a value from 1 to Number of Detectors (0054,0021).

Number of detectors. See C.8.4.8.1.3 for specialization.

An array which contains the phase number for each frame. Required if the value of the Frame Increment Pointer (0028,0009) includes the Tag for Phase Vector (0054,0030). See C.8.4.8.1.4 for specialization.

Number of Phases (0054,0031) is the number of dynamic phases, independent of the number of Detectors and Isotopes. See Section C.8.4.14 for definition of a phase. Phase Vector (0054,0030) is an indexing vector. The value of the nth element of this vector is the phase number of the nth frame in this image, and shall have a value from 1 to Number of Phases (0054,0031).

Number of phases. Required if the value of the Frame Increment Pointer (0028,0009) includes the Tag for Phase Vector (0054,0030). See C.8.4.8.1.4 for specialization.

An array which contains the rotation number for each frame. Required if the value of the Frame Increment Pointer (0028,0009) includes the Tag for Rotation Vector (0054,0050). See C.8.4.8.1.5 for specialization.

Number of Rotations (0054,0051) is the number of separate rotations. See Section C.8.4.12 for definition of a rotation. When Image Type (0008,0008), Value 3, is RECON TOMO, GATED TOMO or RECON GATED TOMO, then the Number of Rotations (0054,0051) shall be 1. Rotation Vector (0054,0050) is an indexing vector. The value of the nth element of this vector is the rotation number of the nth frame in this image, and shall have a value from 1 to Number of Rotations (0054,0051).

Number of rotations. Required if Image Type (0008,0008), Value 3 is TOMO, GATED TOMO, RECON TOMO, or RECON GATED TOMO. See C.8.4.8.1.5 for specialization.

An array which contains the R-R interval number for each frame. Required if the value of the Frame Increment Pointer (0028,0009) includes the Tag for R-R Interval Vector (0054,0060). See C.8.4.8.1.6 for specialization.

Number of R-R Intervals (0054,0061) is the number of ranges of heartbeat durations collected. A gated acquisition may employ one R-R Interval to collect data from normal beats, a second R-R Interval to collect data from ectopic beats, and possibly others. Each R-R Interval accepts beats whose duration is greater than its Low R-R Value (0018,1081) and shorter than its High R-R Value (0018,1082). Beats which do not fall within these ranges may be accepted by another R-R Interval, or may be rejected. The Number of R-R Intervals (0054,0061) is the total number of such ranges. R-R Interval Vector (0054,0060) is an indexing vector. The value of the nth element of this vector is the interval number of the nth frame in this image, and shall have a value from 1 to Number of R-R Intervals (0054,0061).

Number of R-R intervals. Required if the value of the Frame Increment Pointer (0028,0009) includes the Tag for R-R Interval Vector (0054,0060). See C.8.4.8.1.6 for specialization.

An array which contains the time slot number for each frame. Required if the value of the Frame Increment Pointer (0028,0009) includes the Tag for Time Slot Vector (0054,0070). See C.8.4.8.1.7 for specialization.

Number of Time Slots (0054,0071) is the number of frames into which each gating event is divided in a gated acquisition. For example, in a cardiac gated acquisition, data from a number of heartbeats are then combined by summing together the first frames from all beats into a summed first frame, all the second frames into a summed second frame, and so on. The result has the same number of frames as the Number of Time Slots in each beat. Time Slot Vector (0054,0070) is an indexing vector. The value of the nth element of this vector is the time slot number of the nth frame in this image, and shall have a value from 1 to Number of Time Slots (0054,0071).

Number of time slots. Required if the value of the Frame Increment Pointer (0028,0009) includes the Tag for Time Slot Vector (0054,0070). See C.8.4.8.1.7 for specialization.

An array which contains the spatial slice number for each frame. Required if the value of the Frame Increment Pointer (0028,0009) includes the Tag for Slice Vector (0054,0080). See C.8.4.8.1.8 for specialization.

Number of Slices (0054,0081) is the number of slices in each separate volume. Note: For images with Image Type (0008,0008), Value 3, equal to RECON GATED TOMO this implies that Number of Slices (0054,0081) is the same for all R-R Intervals and Time Slots. Slice Vector (0054,0080) is an indexing vector. The value of the nth element of this vector is the slice number of the nth frame in this image, and shall have a value from 1 to Number of Slices (0054,0081).

Number of slices. Required if the value of the Frame Increment Pointer (0028,0009) includes the Tag for Slice Vector (0054,0080). See C.8.4.8.1.8 for specialization.

An array which contains the angular view number for each frame. Required if the value of the Frame Increment Pointer (0028,0009) includes the Tag for Angular View Vector (0054,0090). See C.8.4.8.1.9 for specialization.

Angular View Vector (0054,0090) is an indexing vector. The value of the nth element of this vector is the angular view number of the nth frame in this image. If Image Type (0008,0008), Value 3, is TOMO or GATED TOMO, then the value shall be from 1 to Number of Frames in Rotation (0054,0053).

An array which contains the time slice number for each frame. Required if the value of the Frame Increment Pointer (0028,0009) includes the Tag for Time Slice Vector (0054,0100). See C.8.4.8.1.10 for specialization.

Time Slice Vector (0054,0100) is an indexing vector. The value of the nth element of this vector is the time slice number of the nth frame in this image, and shall have a value from 1 to Number of Frames in Phase (0054,0033).

Image identification characteristics. See C.8.4.9.1.1 for specialization.

For NM images, Image Type (0008,0008) Value 3 is specified to be Type 1 and use one of the following Enumerated Values: STATIC DYNAMIC GATED WHOLE BODY TOMO GATED TOMO RECON TOMO RECON GATED TOMO For NM images, Image Type (0008,0008) Value 4 is specified to use one of the following Enumerated Values: EMISSION TRANSMISSION Note: For NM images, Image Type (0008,0008) Value 1 will be ORIGINAL for all raw data and reconstructed images. DERIVED may be appropriate for some other results images. For NM images, Image Type (0008,0008) Value 2 will be PRIMARY.

User or equipment generated Image identifier. Specifies whether an Image has undergone lossy compression. Enumerated Values: 00 = Image has NOT been subjected to lossy compression. 01 = Image has been subjected to lossy compression. See C.7.6.1.1.5 Required if Lossy Compression has been performed on the Image.

The Attribute Lossy Image Compression (0028,2110) conveys that the Image has undergone lossy compression. It provides a means to record that the Image has been compressed (at a point in its lifetime) with a lossy algorithm and changes have been introduced into the pixel data. Once the value has been set to “01”, it shall not be reset. Note: If an image is compressed with a lossy algorithm, the attribute Lossy Image Compression (0028,2110) is set to “01”. Subsequently, if the image is decompressed and transferred in uncompressed format, this attribute value remains “01”. The value of the Lossy Image Compression (0028,2110) Attribute in SOP Instances containing multiple frames in which one or more of the frames have undergone lossy compression shall be “01”. Note: It is recommended that the applicable frames be noted in the Attribute Derivation Description (0008,2111). If an image is originally obtained as a lossy compressed image from the sensor, then Lossy Image Compression (0028,2110) is set to “01” and Value 1 of the Attribute Image Type (0008,0008) shall be set to ORIGINAL. If an image is a compressed version of another image, Lossy Image Compression (0028,2110) is set to “01”, Value 1 of the Attribute Image Type (0008,0008) shall be set to DERIVED, and if the predecessor was a DICOM image, then the Image shall receive a new SOP Instance UID. Note: 1. It is recommended that the approximate compression ratio be provided in the Attribute Derivation Description (0008,2111). Furthermore, it is recommended that Derivation Description (0008,2111) be used to indicate when pixel data changes might affect professional interpretation. (see C.7.6.1.1.3). 2. The attribute Lossy Image Compression (0028,2110) is defined as Type 3 for backward compatibility with existing IODs. It is expected to be required (i.e., defined as Type 1C) for new Image IODs and for existing IODs that undergo a major revision (e.g. a new IOD is specified). The Defined Terms for Lossy Image Compression Method (0028,2114) are: ISO_10918_1 = JPEG Lossy Compression ISO_14495_1 = JPEG-LS Near-lossless Compression ISO_15444_1 = JPEG 2000 Irreversible Compression ISO_13818_2 = MPEG2 Compression

Sum of all gamma events for all frames in the image. See C.8.4.9.1.2 for specialization.

Counts Accumulated (0018,0070) is the total of all gamma events accumulated in all frames of this Image. This attribute applies to acquisition data, and often does not apply to processed images (DERIVED, SECONDARY).

Description of how the data collection was stopped. Defined Terms: CNTS = counts DENS = density MANU = manual OVFL = data overflow TIME = time TRIG = physiological trigger See C.8.4.9.1.3 for specialization.

Acquisition Termination Condition (0018,0071) is the method of acquisition termination which was actually applied to the data collection. The Defined Terms and definitions are: CNTS = preset count limit was reached DENS = preset count density was reached MANU = acquisition was terminated manually OVFL = acquisition was terminated automatically by pixel data overflow condition TIME = preset time limit was reached TRIG = preset number of physiological triggers was reached

The height of the patient table in mm. The range and values of this element are determined by the manufacturer. Should not be included if Image Type (0008,0008), Value 3, is TOMO, GATED TOMO, RECON TOMO or RECON GATED TOMO. Location of the patient table (or gantry relative to the table) in mm. The range and values of this element are determined by the manufacturer. Should not be included if Image Type (0008,0008), Value 3, is TOMO, GATED TOMO, RECON TOMO or RECON GATED TOMO. Elapsed time for data acquisition in msec. Required if Image Type (0008,0008) Value 3 is: WHOLE BODY or STATIC. See C.8.4.9.1.4 for specialization.

Actual Frame Duration (0018,1242) is defined as the elapsed time in msec for a single frame of an acquisition. For some types of multi-frame images, Actual Frame Duration (0018,1242) may have a more specialized meaning as defined in the appropriate IOD Module.

Maximum count rate achieved during the acquisition in counts/sec. Code or description of processing functions applied to the data. A value that indicates which, if any, corrections have been applied to the image. Corrections are applied to all frames in the image. Defined Terms: UNIF = flood corrected COR = center of rotation corrected NCO = non-circular orbit corrected DECY = decay corrected ATTN = attenuation corrected SCAT = scatter corrected DTIM = dead time corrected NRGY = energy corrected LIN = linearity corrected MOTN = motion corrected CLN = count loss normalization; Any type of normalization applied to correct for count loss in Time Slots. The type of scan performed. Used only if Image Type (0008,0008), Value 3, contains the value WHOLE BODY. Enumerated Values: 1PS = one pass 2PS = two pass PCN = patient contour following employed MSP = multiple static frames collected into a whole body frame. The speed of the camera motion over the body in mm/sec. Required if Image Type (0008,0008) Value 3 contains the value WHOLE BODY. Size of the imaged area in the direction of scanning motion, in mm. Required if Image Type (0008,0008) Value 3 contains the value WHOLE BODY. Text indicating trigger source. Defined Term: EKG Sequence of Items that describe the energy window groups used. Zero or more Items may be included in this sequence. The number of items shall be equal to Number of Energy Windows (0054,0011). The first item corresponds to frames with value of 1 in the Energy Window Vector (0054,0010), the second item with value 2, etc. A user defined name which describes this Energy Window. Sequence of Items that describes this energy window group. One or more Items may be included in this Sequence. The lower limit of the energy window in KeV. See C.8.4.10.1.1 for further explanation.

Energy Window Lower Limit (0054,0014) is the acquisition energy window lower limit in KeV for acceptance of scintillation events into this Isotope.

The upper limit of the energy window in KeV. See C.8.4.10.1.2 for further explanation.

Energy Window Upper Limit (0054,0015) is the acquisition energy window upper limit in KeV for acceptance of scintillation events into this Isotope.

Sequence of Items that describe isotope information. Zero or more Items may be included in this sequence. Sequence that identifies the radionuclide. Zero or one item shall be present in the sequence. Route of injection. Sequence that identifies the administration route for the radiopharmaceutical. This sequence shall contain exactly one item. Volume of injection in cubic cm. Time of start of injection. See C.8.4.10.1.5 for further explanation.

Radiopharmaceutical Start Time (0018,1072) is the actual time of radiopharmaceutical administration to the patient for imaging purposes, using the same time base as for the Acquisition Start Time (0008,0032).

Time of end of injection. See C.8.4.10.1.6 for further explanation.

Radiopharmaceutical Stop Time (0018,1073) is the actual ending time of radiopharmaceutical administration to the patient for imaging purposes, using the same time base as for the Acquisition Start Time (0008,0032).

Total amount of radionuclide injected. See C.8.4.10.1.7 for further explanation.

Radionuclide Total Dose (0018,1074) is the radiopharmaceutical dose administered to the patient measured in MegaBecquerels (Mbq) at the Radiopharmaceutical Start Time.

Sequence that contains calibration data. One or more Items may be included in this Sequence. The Item number in the Energy Window Information Sequence to which the following calibration data relates. The Items are numbered starting from 1. Pre-injection syringe count rate in counts/sec. See C.8.4.10.1.8 for further explanation.

Syringe Counts (0018,1045) is the pre-injection syringe acquisition count rate measured in counts/sec, corrected to the Acquisition Start Time (0008,0032) if necessary.

Post-injection residue syringe count rate in counts/sec. See C.8.4.10.1.9 for further explanation.

Residual Syringe Counts (0054,0017) is the syringe acquisition count rate following patient injection, measured in counts/sec, corrected to the Acquisition Start Time (0008,0032) if necessary.

Name of the radiopharmaceutical. Sequence that identifies the radiopharmaceutical. This sequence shall contain exactly one item. Sequence of Items that describes the intervention drugs used. Zero or more Items may be included in this sequence. Name of intervention drug. Sequence that identifies the intervention drug name. Only a single Item shall be permitted in this Sequence. Sequence that identifies the administration route for the intervention drug. This sequence shall contain exactly one item. Time of administration of the intervention drug, using the same time base as for the Acquisition Start Time (0008,0032). Time of completion of administration of the intervention drug, using the same time base as for the Acquisition Start Time (0008,0032). Intervention drug dose, in mg. Sequence of Items that describe the detectors used. Zero or more Items may be included in this sequence. The number of items shall be equal to Number of Detectors (0054,0021). The first item corresponds to frames with value of 1 in the Detector Vector (0054,0020), the second item with value 2, etc. Label describing the collimator used (LEAP, hires, etc.) Collimator type. Defined Terms: PARA = Parallel (default) PINH = Pinhole FANB = Fan-beam CONE = Cone-beam SLNT = Slant hole ASTG = Astigmatic DIVG = Diverging NONE = No collimator UNKN = Unknown Shape of the field of view of the Nuclear Medicine detector. Defined Terms: RECTANGLE ROUND HEXAGONAL Dimensions of the field of view, in mm. If Field of View Shape (0018,1147) is: RECTANGLE: row dimension followed by column. ROUND: diameter. HEXAGONAL: diameter of a circumscribed circle. Focal distance, in mm. A value of 0 means infinite distance for parallel collimation. See C.8.4.11.1.1 for further specialization.

Focal Distance (0018,1182) for NM Image data is the focal distance, in mm for converging or diverging collimators, measured from the front face of the detector to the focus. Positive values indicate converging and negative values indicate diverging collimators. A value of 0 means infinite distance for parallel collimation.

Center of focus along a row. See C.8.4.11.1.2 for further explanation.

X Focus Center (0018,1183) and Y Focus Center (0018,1184) for NM Image data is used to define the projection of the focus for a converging or diverging collimator within the un-zoomed Field of View. It is defined in mm for row and column relative to the center of the un-zoomed Field of View.

Center of focus along a column. See C.8.4.11.1.2 for further explanation.

The amount of offset from (0,0) applied to each pixel in the image before application of the zoom factor, specified by a numeric pair: row value (delimiter) column value (in mm). See C.8.4.11.1.3 for further explanation.

Zoom Center (0028,0032) is the offset between the un-zoomed camera field of view and field of view, measured from the center of the un-zoomed camera field of view to the center the of the zoomed field of view. The offset is measured in mm in the un-zoomed camera FOV dimensions. Positive values are to the right and down from the un-zoomed center, as viewed from the image plane. When this attribute is not given, the Zoom Center is assumed to be 0\0.

The amount of magnification applied to each pixel in the image, specified by a numeric pair: row value (delimiter) column value. See C.8.4.11.1.4 for further explanation.

Zoom Factor (0028,0031) is the magnification factor that was used during the acquisition. When this attribute is not given, it is assumed to be 1.0\1.0. Note: Zoom Factor (0028,0031) is informational only. Pixel Spacing (0028,0030) already takes account of this and any other changes to pixel size.

Average center of rotation offset of Nuclear Medicine detector in mm. See C.8.4.11.1.5 for further explanation.

Center of Rotation Offset (0018,1145) is the average amount of offset in mm between the Detector Field of View center and the physical center of rotation of the gantry for circular orbital scans. Positive values indicate the physical center is to the right of the image plane center. If: 1) Image Type (0008,0008) Value 3 is TOMO or GATED TOMO, and 2) Corrected Image (0028,0051) does not include the value "COR", and 3) Center of Rotation Offset (0018,1145) is non-zero, then the receiver should assume that Center of Rotation correction has not already been done. If the Center of Rotation Offset is zero, no correction shall be applied.

Angle of tilt in degrees of the detector. See C.8.4.11.1.6 for further explanation.

Gantry/Detector Tilt (0018,1120) for NM Image data is the angle in degrees of the detector face relative to the patient's major (Head to Feet) axis (or the table supporting the patient). Positive tilt is towards the patient’s feet.

Distance in mm from transmission source to the detector face. Required if Image Type (0008,0008) Value 4 is TRANSMISSION, Value 3 is not TOMO,. Position of the detector about the patient for the start of the acquisition, in degrees. Zero degrees is referenced to the origin at the patient's back. Viewing from the patient's feet, angle increases in a counter-clockwise direction (detector normal rotating from the patient's back towards the patient's left side). Should not be included if Image Type (0008,0008), Value 3, is TOMO, GATED TOMO, RECON TOMO or RECON GATED TOMO. Radial distance of the detector from the center of rotation, in mm. Should not be included if Image Type (0008,0008), Value 3, is TOMO, GATED TOMO, RECON TOMO or RECON GATED TOMO. The direction cosines of the first row and the first column with respect to the patient. See C.7.6.2.1.1 for further explanation.

The x, y, and z coordinates of the upper left hand corner (center of the first voxel transmitted) of the image, in mm. See C.7.6.2.1.1 for further explanation.

The Image Position (0020,0032) specifies the x, y, and z coordinates of the upper left hand corner of the image; it is the center of the first voxel transmitted. Image Orientation (0020,0037) specifies the direction cosines of the first row and the first column with respect to the patient. These Attributes shall be provide as a pair. Row value for the x, y, and z axes respectively followed by the Column value for the x, y, and z axes respectively. The direction of the axes is defined fully by the patient’s orientation. The x-axis is increasing to the left hand side of the patient. The y-axis is increasing to the posterior side of the patient. The z-axis is increasing toward the head of the patient. The patient based coordinate system is a right handed 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. Note If a patient lies parallel to the ground, face-up on the table, with his feet-to-head direction same as the front-to-back direction of the imaging equipment, the direction of the axes of this patient based coordinate system and the equipment based coordinate system in previous versions of this Standard will coincide. The Image Plane Attributes, in conjunction with the Pixel Spacing Attribute, describe the position and orientation of the image slices relative to the patient-based coordinate system. In each image frame the Image Position (Patient) (0020,0032) specifies the origin of the image with respect to the patient-based coordinate system. RCS and the Image Orientation (Patient) (0020,0037) attribute values specify the orientation of the image frame rows and columns. The mapping of pixel location to the RCS is calculated as follows: P rSub { size 8{x} } {} ## P rSub { size 8{y} } {} ## P rSub { size 8{z} } {} ## 1 } right ]= left [ matrix { X rSub { size 8{x} } Δi {} # Y rSub { size 8{x} } Δj {} # 0 {} # S rSub { size 8{x} } {} ## X rSub { size 8{y} } Δi {} # Y rSub { size 8{y} } Δj {} # 0 {} # S rSub { size 8{y} } {} ## X rSub { size 8{z} } Δi {} # Y rSub { size 8{z} } Δj {} # 0 {} # S rSub { size 8{z} } {} ## 0 {} # 0 {} # 0 {} # 1{} } right ] left [ matrix { i {} ## j {} ## 0 {} ## 1 } right ]} {} = M Where: Pxyz The coordinates of the voxel (i,j) in the frame’s image plane in units of mm. Sxyz The three values of the Image Position (Patient) (0020,0032) attributes. It is the location in mm from the origin of the RCS. Xxyz The values from the row (X) direction cosine of the Image Orientation (Patient) (0020,0037) attribute. Yxyz The values from the column (Y) direction cosine of the Image Orientation (Patient) (0020,0037) attribute. i Column index to the image plane. The first column is index zero. i Column pixel resolution of the Pixel Spacing (0028,0030) attribute in units of mm. j Row index to the image plane. The first row index is zero. j Row pixel resolution of the Pixel Spacing (0028,0030) attribute in units of mm. Additional constraints apply: 1) The row and column direction cosine vectors shall be orthogonal, i.e. their dot product shall be zero. 2) The row and column direction cosine vectors shall be normal, i.e. the dot product of each direction cosine vector with itself shall be unity.

Sequence that describes the projection of the anatomic region of interest on the image receptor. Only a single Item shall be permitted in this sequence. View Modifier. Required if needed to fully specify the View. Zero or one Items shall be permitted in this sequence. Sequence of Items that describe TOMO rotational groups. A new rotation is defined whenever the direction of the detector motion changes, or the Table Traverse (0018,1131) changes. Zero or more Items may be included in this sequence. The number of items shall be equal to Number of Rotations (0054,0051). If Rotation Vector (0054,0050) is present, the first item corresponds to frames with value of 1 in the Rotation Vector (0054,0050), the second item with value 2, etc. Position of the detector about the patient for the start of this rotation, in degrees. Zero degrees is referenced to the origin at the patient's back. Viewing from the patient's feet, angle increases in a counter-clockwise direction (detector normal rotating from the patient's back towards the patient's left side). The angular scan arc step between views of the TOMO acquisition, in degrees. See C.8.4.12.1.1 for further explanation.

Angular Step (0018,1144) is the nominal frame-to-frame incremental angle for TOMO and GATED TOMO acquisition images, defined in degrees. The Angular Step (0018,1144) shall be a positive number. Summation of Angular Step values is not defined to give accurate Angular Position or Scan Arc values. The Angular Step is the effective angular spacing between resultant frames of the Multi-framed planar image data.

Direction of rotation of the detector about the patient. See Start Angle (0054,0200) for further explanation of direction. Enumerated Values: CW = clockwise (decreasing angle) CC = counter-clockwise (increasing angle). The effective angular range of the scan data in degrees. The value shall be positive. Nominal acquisition time per angular position, in msec. Radial distance of the detector from the center of rotation, in mm. It shall have a single value which is an average value for this rotation, or it shall have one value per angular view. Distance in mm from transmission source to the detector face. Required if Image Type (0008,0008) and Value 4, is TRANSMISSION. Number of angular views in this rotation. Location of the patient table (or gantry relative to the table) in mm.The range and values of this element are determined by the manufacturer. The distance in mm of the top of the patient table to the center of rotation. Table height below the center of rotation has a positive value. Describes the detector motion during acquisition. Enumerated Values: STEP AND SHOOT = Interrupted motion, acquire only while stationary. CONTINUOUS = Gantry motion and acquisition are simultaneous and continuous. ACQ DURING STEP = Interrupted motion, acquisition is continuous. Heart beat duration sorting has been applied. Enumerated Values: Y = yes N = no Description of type of arrhythmic beat rejection criteria used. Number of beats skipped after a detected arrhythmia Average number of heart beats per minute for the collection period for these frames. This shall include all accepted beats as well as rejected beats. Sequence of Items that describe R-R intervals. Each gated interval is defined by an upper and lower range of heart beat durations. Required if the Frame Increment Pointer (0028,0009) contains the Tag for R-R Interval Vector (0054,0060). Zero or more Items may be included in this sequence. The number of items shall be equal to Number of R-R Intervals (0054,0061). The first item corresponds to frames with value of 1 in the R-R Interval Vector (0054,0060), the second item with value 2, etc. Time interval measured in msec from the start of the R-wave to the beginning of the data taking. Description of type of framing performed such as forward, backward, forward/backward by percentage. See C.7.6.18.1.1.1.

Sequence of Items that describe gating criteria. Zero or more Items may be included in this sequence. See C.8.4.13.1.1.

Data Information Sequence (0054,0063) shall contain a single sequence item which applies to the sum of all angular views, except when Image Type (0008,0008) Value 3 is GATED TOMO. In this case it shall have either a single item which applies to the sum of all angular views, or it shall have one item for each angular view.

Nominal time per individual frame in msec. Average duration of accepted beats, in msec. R-R interval lower limit for beat rejection, in msec R-R interval upper limit for beat rejection, in msec Number of heartbeats that fall within Low R-R Value (0018,1081) and High R-R Value (0018,1082), and were therefore accepted and contribute gamma events to this R-R Interval. Number of heartbeats that fall outside Low R-R (0018,1081) and High R-R Value (0018,1082), and do not contribute gamma events to this R-R Interval. However, they may contribute gamma events to other R-R Intervals. Sequence of Items that describe Time Slot Information. Required if the Frame Increment Pointer (0028,0009) contains the Tag for Time Slot Vector (0054,0070). Zero or more Items may be included in this sequence. The number of items shall be equal to Number of Time Slots (0054,0071). The first item corresponds to frames with value of 1 in the Time Slot Vector (0054,0070), the second item with value 2, etc. The total amount of time, in msec, that the acquisition accumulates gamma events into this frame. See C.8.4.13.1.2.

The Time Slot Time (0054,0073) records the effective imaging time of each Time Slot. For example, if some of the accepted beats are shorter than others then the last frames may not receive a contribution from the shorter beats. The Time Slot Time for a Time Slot is the total acquisition time for that Time Slot. It is approximately equal to the Frame Time (0018,1063) multiplied by the number of accepted beats contributing to the Time Slot.

Sequence of Items that describes each dynamic phase. Required if the Frame Increment Pointer (0028,0009) contains the Tag for Phase Vector (0054,0030). Zero or more Items may be included in this sequence. The number of items shall be equal to Number of Phases (0054,0031). The first item corresponds to frames with value of 1 in the Phase Vector (0054,0030), the second item with value 2, etc. Time paused between the last frame of the previous phase and the first frame of this phase, in msec. Nominal time of acquisition per individual frame, in msec. Time paused between each frame of this phase (in msec). Number of frames in this phase. An array of trigger times when gating information is acquired simultaneously with the dynamic image data. See Section C.8.4.14.1.1 for further explanation.

Trigger Vector (0054,0210) is an array containing a list of the inter-trigger interval times in milliseconds in the order in which they were acquired, with the first being measured from the start time of the first frame of the image data in the Phase. If this element is used, the start times are required to be the same so that a mathematical correlation can be made between trigger times and frame start times.

The number of entries in the Trigger Vector (0054,0210) for this phase. Required if Trigger Vector (0054,0210) is present. Description of this phase of the Dynamic image. Defined Terms: FLOW WASHOUT UPTAKE EMPTYING EXCRETION Spacing between slices, in mm, measured from center-to-center of each slice along the normal to the first image. The sign of the Spacing Between Slices (0018,0088) determines the direction of stacking. The normal is determined by the cross product of the direction cosines of the first row and first column of the first frame, such that a positive spacing indicates slices are stacked behind the first slice and a negative spacing indicates slices are stacked in front of the first slice. See Image Orientation (0020,0037) in the NM Detector module. Diameter, in mm, of the region from within which the data was used in creating the reconstruction of the image. Data may exist outside this region and portions of the patient may exist outside this region. A label describing the convolution kernel or algorithm used to reconstruct the data. Nominal slice thickness, in mm. Relative position of the image plane expressed in mm. See C.7.6.2.1.2 for further explanation.

The Slice Location (0020,1041) is defined as the relative position of the image plane expressed in mm. This information is relative to an unspecified implementation specific reference point.

Describes the anatomical direction that slices are progressing as the slices are considered in order (as defined by the Slice Vector (0054,0080)). Meaningful only for cardiac images. When View Code Sequence (0054,0220) indicates a short axis view, then Enumerated Values are: APEX_TO_BASE BASE_TO_APEX Defines a sequence of Ultrasound Regions. One or more Items may be included in this Sequence. The bounds of a rectangle specifying the location of the region, x0,y0,x1,y1. See C.8.5.5.1.14 for further explanation.

These attributes specify the location of the region, Region Location Min x0 (0018,6018), Region Location Min y0 (0018,601A), Region Location Max x1 (0018,601C), Region Location Max y1 (0018,601E) expressed as offsets to the pixel coordinates. The upper left corner of the entire image is x=0,y=0 and the lower right corner is x=image width - 1, and y=image length - 1. Thus, a region will be specified as within these bounds. Where x0,y0 is the coordinate of the upper left corner of the region and x1,y1 is the coordinate of the lower right corner of the region.

The bounds of a rectangle specifying the location of the region, x0,y0,x1,y1. See C.8.5.5.1.14 for further explanation.

The physical units of the dimensions of the region. See C.8.5.5.1.15 for Enumerated Values.

Physical Units X Direction (0018,6024) and Physical Units Y Direction (0018,6026) provide Enumerated Values indicating the physical units of the dimensions of the region.

The physical units of the dimensions of the region. See C.8.5.5.1.15 for Enumerated Values.

Physical Units X Direction (0018,6024) and Physical Units Y Direction (0018,6026) provide Enumerated Values indicating the physical units of the dimensions of the region.

The physical value increments per positive X pixel increment. The units are as specified in the Physical Units X Direction (0018,6024). See C.8.5.5.1.17 for further explanation.

The Physical Delta X (0018,602C) is the physical value increment per positive X pixel increment, which is left to right. The Physical Delta Y (0018,602E) is the physical value increment per positive Y pixel increment which is top to bottom. Note: When displaying Doppler data, ultrasound applications typically display the Doppler strip horizontally, with data sweeping (moving time origin) from left (oldest) to right (newest) or scrolling (static time origin) from right to left. The default display of positive velocity values normally indicates flow toward the transducer; negative velocity values indicate flow away from the transducer. In this case a negative Physical Delta Y is required to specify that the direction of positive velocities or frequencies is upward.

The physical value increments per positive Y pixel increment. The units are as specified in the Physical Units Y Direction (0018,6026). See C.8.5.5.1.17 for further explanation.

This coordinate pair, x0,y0 defines the location of a virtual "reference" pixel. See C.8.5.5.1.16 for further explanation.

This coordinate pair, Reference Pixel x0 (0018,6020), Reference Pixel y0 (0018,6022) defines the location of a virtual "reference" pixel. This reference pixel location is used to tie the image's pixel coordinate system to the physical coordinate system. For example, the reference pixel could be defined where a depth of zero centimeters occurs in the 2D image, or it could define where the baseline (i.e.: zero frequency) resides in a spectral display. The reference pixel location is the relative offset from the Region Location Min x0 (0018,6018) and Region Location Min y0 (0018,601A), not the image origin. The location is not required to be within the region or even within the image boundary. For this reason, the Reference Pixel x0 and Reference Pixel y0values can be positive or negative. The reference pixel location varies depending on the type and spatial organization of the data within the region.

This coordinate pair, x0,y0 defines the location of a virtual "reference" pixel. See C.8.5.5.1.16 for further explanation.

The Physical Value at the reference pixel x location. The units are specified in the Physical Units field. The Physical Value at the reference pixel y location. The units are specified in the Physical Units field. The spatial organization of the data within the region. See C.8.5.5.1.1 for Enumerated Values.

Enumerated Values for Region Spatial Format (0018,6012) indicate the spatial organization of the data within the region.

The type of data within the region. See C.8.5.5.1.2 for Enumerated Values.

Enumerated Values for Region Data Type (0018,6014) indicate the type of data within the region.

Flags used for special handling of the region. See C.8.5.5.1.3 for Enumerated Values and further explanation.

Region Flags (0018,6016) specify characteristics of US Regions. Bit 0 of the Region Flags specifies the relative priority of the pixel component calibration specified by an US Region in the case where the US Region intersects with other US Regions. The calibration supplied by one or more of the regions may not be valid in the area that they intersect. Enumerated Values for Bit 0 (lsb): 1 = Region pixels are low priority 0 = Region pixels are high priority A high priority region overwrites data of a low priority region when they overlap, thus invalidating any pixel component calibration specified for a low priority region. pixel component calibration of overlapping regions of the same priority is indeterminate where they overlap. Figure C.8-6 shows an example of intersecting regions. Figure C.8-6 Intersecting Spatial Format Regions and Overlapping Measurement In this example, Region B is Color Flow while Region A is Tissue Echo. If Region B Color Flow values share the same bit planes as Region A Tissue Echo values, then it is indeterminate whether a pixel in this region is a Color Flow pixel or a Tissue Echo pixel. Since the pixels of the Color Flow region overwrite those of the Tissue Echo region, the Region Flag of the Tissue Echo region is assigned low priority and the Region Flag of the color region is assigned high priority. This means that if both the Tissue Echo and Color Flow regions define pixel component calibration that only the calibration specified by the Color Flow region can be applied to the pixel data value at Point X. The measurement in Figure C.8-6 is a line between Point Y and Point Z. Both points are in Region A so the distance between them can be calculated using the Region A scaling (assuming that Region A defines both the Physical Units X Direction and Y Direction as being cm). If the points are in Region B, and hence also in Region A, it is still possible to calculate the distance because the region scaling is identical in both regions. The lower priority of Region B only applies to its pixel component calibration, not its X and Y direction scaling. Enumerated Values for Bit 1 Scaling Protection: 1 = Protected 0 = Not Protected Ultrasound systems should set this to 1 if the image is scaled automatically by the ultrasound system. If the image is frame-grabbed and scaling is not available then it should be set to 0. If the region is protected, the region can not be manually rescaled. That is the data defined by the region calibration Module can not be overridden by a reader of that image. Enumerated Values for Bit 2 Doppler Scale Type: 1 = Frequency 0 = Velocity Valid for PW and CW regions only. Indicates which type of Doppler scale is used. Enumerated Values for Bit 3-4 Scrolling Region: 00 = Unspecified 01 = Scrolling 10 = Sweeping 11 = Sweeping then Scrolling Bit 5-31 Reserved for future use, shall be set to zero.

Describes how the components of a pixel can be described. Required if pixel component calibration exists for this region. See C.8.5.5.1.4 for Enumerated Values and further explanation.

Pixel Component Organization (0018,6044) provides an Enumerated Value describing how the components of a pixel can be described. The absence of this data element means that pixel component calibration does not exist for this region. Where: 0 = Bit aligned positions 1 = Ranges 2 = Table look up 3 = Code Sequence look up Other values reserved for future use. Pixel Component Organization defines the way in which the composite pixel values are mapped into real world values with physical units, as illustrated in Figure C.8-7. Figure C.8-7 Pixel Component Calibration An example of Component Calibration for an ultrasound image is shown in Figure C.8-8. Figure C.8-8 Pixel Component Calibration Example In this example, some pixels lie within two Regions. One Region specifies pixel component calibration for Doppler velocity values. The second Region specifies pixel component calibration for Doppler magnitude. A particular Pixel Data (7FE0,0010) value will thus map to a displayed value, a Doppler velocity and magnitude value. The example has a Palette Color Photometric Interpretation with 16 Bits Allocated and Bits Stored per sample. The Palette Color Lookup Tables also have 16 bits for each entry. The fact that the example has just one sample per pixel means that each composite pixel value is identical to the single Pixel Data value. An example Pixel Data value is shown in brackets along with the output values resulting from each step where it is processed. The Pixel Data value is mapped to red, green, and blue values from the supplied Palette Color Lookup Tables before being displayed. The display device supports 8 bits per sample and thus requires the scaling of the output values from the 16 bit per entry LUTs. The Doppler Velocity Region maps each pixel value in the Region to the Doppler velocity. The Pixel Component Organization (0018,6044) has a value of zero, indicating bit aligned positions with a bit mask. The Pixel Component Mask (0018,6046) specifies that the least significant 4 bits of the most significant byte convey the Doppler velocity of each pixel. The Pixel Component Physical Units (0018,604C) are cm/sec, and the Pixel Component Data Type (0018,604E) indicates color flow velocity. The Table of X Break Points (0018,6052) and Table of Y Break Points (0018,6054) map each masked composite pixel value to a Doppler velocity value in cm/sec. The Doppler Magnitude Region maps each pixel value in the Region to the Doppler magnitude. The Pixel Component Organization (0018,6044) has a value of zero, indicating bit aligned positions with a bit mask. The Pixel Component Mask (0018,6046) specifies that the most significant 4 bits of the most significant byte convey the Doppler magnitude of each pixel. The Pixel Component Physical Units (0018,604C) is set to dB, and the Pixel Component Data Type (0018,604E) indicates color flow magnitude. The Table of X Break Points (0018,6052) and Table of Y Break Points (0018,6054) map each masked composite pixel value to a Doppler magnitude value in dB.

This value is ANDed with the composite pixel code for each pixel within the region, then shifted right by the number of contiguous least significant zeros in the mask to obtain what will be referred to as the "Shifted Masked Composite Pixel Code" (SMCPC). Required if Pixel Component Organization = Bit aligned. See C.8.5.5.1.5 for further explanation.

Pixel Component Mask (0018,6046) is ANDed with the Composite Pixel Code (see Section C.7.6.3.1.1) for each pixel within the region, then shifted right by the number of contiguous least significant zeros in the mask to obtain what will be referred to as the "Shifted Masked Composite Pixel Code". The mask will most likely (but not necessarily) contain a block of contiguous ones, surrounded by leading and trailing zeros. The purpose of this mask is to keep only those bits within the composite pixel code that pertain to the region. It is to be used only when Pixel Organization is bit aligned positions.

Defines the start of the numeric range of values within the composite pixel where calibration is to be defined by the "pixel physical calibration table". To be used only when ranges are used to describe the portion of the composite pixel. Required if Pixel Component Organization = Ranges. Defines the stop of the numeric range of values within the composite pixel where calibration is to be defined by the "pixel physical calibration table". To be used only when ranges are used to describe the portion of the composite pixel. Required if Pixel Component Organization = Ranges. The physical units to be applied to the pixel component. Required if Pixel Component Organization exists. See C.8.5.5.1.6 for further explanation.

For Pixel Component Physical Units (0018,604C), the Enumerated Values describing the physical units to be applied to the pixel component are:

The type of data for the pixel component. Required if Pixel Component Organization exists. See C.8.5.5.1.7 for further explanation.

For Pixel Component Data Type (0018,604E), the Enumerated Values indicating the type of data for the pixel component are: 000AH Tissue Classification

The number of break point coordinate pairs used to describe a piece wise linear curve. Required if Pixel Component Organization equals 0 or 1. Otherwise not used. See C.8.5.5.1.8 for further explanation.

The Number of Table Break Points (0018,6050) gives the number of entries in each of two tables: the Table of X Break Points (0018,6052) and Table of Y Break Points (0018,6054). These tables are used to designate a curve mapping the value of a pixel component to its actual physical value, as described in Section C.8.5.5.1.9.

An array of X values used to create the piece wise linear curve. Required if Pixel Component Organization equals 0 or 1. Otherwise not used. See C.8.5.5.1.9 for further explanation.

Table of X Break Points (0018,6052) and Table of Y Break Points (0018,6054) are individual arrays of coordinates which interpreted together are used to create a piecewise linear curve. Each X value from the Table of X Break Points is matched with the corresponding Y value from the Table of Y Break Points yielding an (X,Y) coordinate. The set of (X,Y) coordinates describes a piecewise linear curve mapping the value of a pixel component to its actual physical value (in units defined in Pixel Component Physical Units data element (0018,604C) ). The X direction on the curve has no units, and represents actual pixel component values. If the Pixel Component Organization (0018,6044) is "Bit aligned positions", and the width of the Pixel Component Mask is n bits then the X coordinates are in the range 0 through 2n -1. If the Pixel Component Organization is Ranges, then the X coordinates are in the range 0 through 2 number of bits in the composite pixel - 1. Note: The X value is NOT relative to the Pixel Component Range Start (0018,6048). Not all possible X values in the range need be covered by the curve. For any pixel component value in the range of the curve described by this table, the corresponding Y value is the actual physical value for that pixel, in units specified in the Pixel Component Physical Units data element (0018,604C). If the pixel component value is NOT within the range of specified X values for the curve, then no pixel calibration is defined by this region. It may be possible for pixel calibration to be defined by other spatial regions intersecting this one.

An array of Y values used to create the piece wise linear curve. Required if Pixel Component Organization equals 0 or 1. Otherwise not used. See C.8.5.5.1.9 for further explanation.

The number of entries in the Table of Pixel Values. Required if the value of Pixel Component Organization (0018,6044) is 2 or 3. Otherwise not used. See C.8.5.5.1.11 for further explanation.

The Number of Table Entries (0018,6056) gives the number of entries in the Table of Pixel Values, the number of entries in the Table of Parameter Values (0018,605A), if present, and the number of items in the Pixel Value Mapping Code Sequence (0040,9098) , if present.

A table of Pixel Values used in conjunction with the Table of Parameter Values (0018,605A) or Pixel Value Mapping Code Sequence (0040,9098) to provide a mapping from Pixel Value to a real world value. Required if the Pixel Component Organization equals 2. Otherwise not used. See C.8.5.5.1.12 for further explanation.

The Table of Pixel Values (0018,6058) specifies the pixel values that are mapped to real world parameter values or coded concepts (tissue characterizations). The number of entries in the table is given by Number of Table Entries (0018,6056). A pixel is calibrated (mapped to a real-world value) by finding an entry in the Table of Pixel Values that matches its Composite Pixel Code (see Section C.7.6.3.1.1). The offset index of this entry is used as an index into the Parameter Value Table (0018,605A) or as a sequence item number in the Pixel Value Mapping Code Sequence (0040,9098) to select the real world value. The first Table of Pixel Values entry corresponds to sequence item 1. Note: If a Composite Pixel Code has no matching value in the Pixel Value Table then there is no unambiguous way to determine the corresponding Parameter Value. A method may exist to determine a valid Parameter Value but the specification of such a method is outside the scope of the DICOM standard. No assumption should be made that linear interpolation will produce a valid result.

A table of Parameter Values used in conjunction with the Table of Pixel Values (0018,6058) to provide a mapping from Pixel Value to Parameter Value. Required if the value of Pixel Component Organization (0018,6044) is 2. Otherwise not used. See C.8.5.5.1.13 for further explanation

The Table of Parameter Values (0018,605A) provides the real world values for pixel values identified in the Table of Pixel Values (0018,6058). The number of table entries is given by Number of Table Entries (0018,6056) and the physical units are given by Pixel Component Physical Units (0018,604C). Values may repeat when a parameter value is associated with more than one Composite Pixel Code value.

Sequence that, in conjunction with the Table of Pixel Values (0018,6058), provides a mapping from a Pixel Value to an associated Coded Concept. One or more Items shall be present; the number of Items shall be equal to the value of Number of Table Entries (0018,6056). Required if the value of Pixel Component Organization (0018,6044) is 3 (Code Sequence look up). See Sections C.8.5.6.1.18 for further explanation. The manufacturer defined description of center frequency of the interrogating ultrasound energy. The units are kilohertz. The ultrasound pulse repetition frequency, as defined by the manufacturer, used to collect data in the region. The units are in hertz. The Doppler correction angle. The units are degrees. The steering angle, as defined by the manufacturer, used for a steered 2D image. The units are degrees. The x displacement, in pixels, from the Reference pixel to the center of the Doppler sample volume. The y displacement, in pixels, from the Reference pixel to the center of the Doppler sample volume. The starting and ending coordinates pairs of the m-line. Where the X0,Y0 are the starting point and X1,Y1 are the end point of the tm-line. See C.8.5.5.1.10 for further explanation.

TM-Line Position X1 ,TM-Line Position Y1 The TM-Line Position X0 (0018,603D) and TM-Line Position Y0 (0018,603F) are the coordinates of the starting point and TM-Line Position X1 (0018,6041), TM-Line Position Y1 (0018,6043) are the coordinates of the end point of the TM-line. The coordinate is defined as the displacement, in pixels, from the Reference pixel. Typically used for M-mode line and CW Doppler.

The starting and ending coordinates pairs of the m-line. Where the X0,Y0 are the starting point and X1,Y1 are the end point of the tm-line. See C.8.5.5.1.10 for further explanation.

Number of samples (planes) in this image. See C.8.5.6.1.12 for specialization

For US Images, Samples Per Pixel (0028,0002) is specified to use the following values for specific Photometric Interpretations: Table C.8-19 US SAMPLES PER PIXEL

Specifies the intended interpretation of the pixel data. See C.8.5.6.1.2 for specialization.

For US Images, Photometric Interpretation (0028,0004) is specified to use the following Defined Terms: Note: It is recommended that future implementations should not use ARGB photometric interpretation. See PS 3.5 for restrictions imposed by compressed Transfer Syntaxes.

Number of bits allocated for each pixel sample. See C.8.5.6.1.13 for specialization.

For US Images, Bits Allocated (0028,0100) is specified to use the following values for specific Photometric Interpretations: Table C.8-20 US BITS ALLOCATED

Number of bits stored for each pixel sample. See C.8.5.6.1.14 for specialization.

For US Images, Bits Stored (0028,0101) is specified to use the following values for specific Photometric Interpretations: Table C.8-21 US BITS STORED

Most significant bit for pixel sample data. See C.8.5.6.1.15 for specialization.

For US Images, High Bit (0028,0102) is specified to use the following values for specific Photometric Interpretations: Table C.8-22 US HIGH BIT

Indicates whether the pixel data are sent color-by-plane or color-by-pixel. Required if Samples per Pixel (0028,0002) has a value greater than 1. See C.8.5.6.1.16 for specialization.

For US Images, Planar Configuration (0028,0006) is specified to use the following values for specific Photometric Interpretations: Table C.8-23 US PLANAR CONFIGURATION

Data representation of pixel samples. See C.8.5.6.1.3 for specialization.

For US Images, Pixel Representation (0028,0103) is specified to use the following Enumerated Value: 0000H = unsigned integer

Contains the Data Element Tag of the attribute which is used as the frame increment in Multi-frame pixel data (see C.7.6.6). Required if Number of Frames is sent. See C.8.5.6.1.4 for specialization.

For US Multi-frame images, the Attribute Frame Increment Pointer (0028,0009) of the Multi-frame Module (see Section C.7.6.6) is specified by the following Defined Terms: 00181063 = sequencing by Frame Time (0018,1063) 00181065 = sequencing by Frame Time Vector (0018,1065)

Image identification characteristics. See C.8.5.6.1.1 for specialization.

For US Images, Image Type (0008,0008) is specified to be Type 2. The Defined Terms for Value 3 are: Value 4 is constructed as a modality bit map to allow for a description of multi-modality displays. In using this bit map, the sum of the values of the various modalities will unambiguously determine the constituent modalities. Notes: 1. All Values are hexadecimal encoded as a CS. See PS 3.5. 2. For example, Color Flow with CW spectral Doppler would have a value 4 = 0015. Note that no assumption should be made in Color Doppler or Color M-Mode regarding underlying B or M-Mode, respectively.

Specifies whether an Image has undergone lossy compression. Enumerated Values: 00 = Image has NOT been subjected to lossy compression. 01 = Image has been subjected to lossy compression. See C.7.6.1.1.5 Required if Lossy Compression has been performed on the Image.

Number of Stages in this protocol. Required if image was acquired in a Staged protocol. Number of views in this Stage. Required if image was acquired in a Staged protocol. The time offset(s) of the reported R Wave peaks, each relative to the time of the start of the acquisition of the first frame in msec. Multi-valued, with one value per reported R Wave. This element indicates if any ultrasound color data is present in an image. Enumerated Values: 00 = Ultrasound color data not present in image 01 = Ultrasound color data is present in image. See C.8.5.6.10 A Stage is a particular time slice of a protocol in which a set of images are collected. The names can be free form text. Recommended text for Stress Echo stage names are: PRE-EXERCISE, POST-EXERCISE, PEAK-EXERCISE, RECOVERY, BASELINE, LOW DOSE, PEAK DOSE Sequence of items describing the performed Ultrasound Protocol Stage(s). One or more Items may be included in this Sequence. A number that identifies the Stage. Stage Number starts at one. A View is a particular combination of the position and orientation when a set of images are acquired. Images are acquired at the same View in different Stages for the purpose of comparison. A number that identifies the View. View Number starts at one. The number of event timers used at the time of acquisition of a Multi-frame image. An array of values associated with each event timer. Units in milliseconds. Name that identifies the event timer. Sequence that describes the view of the patient anatomy in this image. Only a single Item shall be permitted in this Sequence. See Section C.8.5.6.1.19.

The view of the patient anatomy may be described using coded terminology in the View Code Sequence (0054,0220). The view is typically specified by transducer position relative to the patient anatomy and/or transducer orientation, The view may be described by a single Code Sequence Item, or by combination of post-coordinated Code Sequence Items. The principal coded item is specified in View Code Sequence, and modifier terms in the View Modifier Code Sequence (0054,0222). The Baseline Context IDs for post-coordinated encoding of view are:

Sequence that provides modifiers for the view of the patient anatomy. Zero or more Items shall be permitted in this Sequence. See Section C.8.5.6.1.19.

The date and time that the acquisition of data that resulted in this image started. Required if Modality (0008,0060) = IVUS May be present otherwise. Note: The synchronization of this time with an external clock is specified in the Synchronization Module in Acquisition Time Synchronized (0018,1800). Time interval measured in msec from the start of the R-wave to the beginning of data taking Average R-R interval used for these data, in msec Beat length sorting has been applied. Enumerated Values: Y = yes N = no R-R interval low limit for beat rejection, in msec R-R interval high limit for beat rejection, in msec Beats per minute. Defined Terms: MOTOR_PULLBACK MANUAL_PULLBACK SELECTIVE GATED_PULLBACK See C.8.5.6.1.21 Required if Modality (0008,0060) = IVUS

This attribute denotes which of the following defined terms describes the method used to acquire the IVUS Images. MOTOR_PULLBACK: The IVUS imaging catheter is positioned in the blood vessel under examination distal to the anatomical structures to be examined. Then the catheter is attached to a motorized mechanism capable of withdrawing the catheter through the vessel at a constant velocity specified by the attribute IVUS Pullback Rate (0018,3101) from the defined IVUS Pullback Start Frame Number (0018,3103) (see C.8.5.6.1.24) to the IVUS Pullback Stop Frame Number (0018,3104) (see C.8.5.6.1.25). MANUAL_PULLBACK: The IVUS imaging catheter is positioned in the blood vessel under examination distal to the anatomical structures to be examined. Then the catheter is manually withdrawn through the vessel region of interest. SELECTIVE: The IVUS imaging catheter is positioned in the blood vessel under examination near the anatomical structures to be examined. Then the catheter is manually withdrawn or advanced through the vessel region of interest. GATED_PULLBACK: The IVUS imaging catheter is positioned in the blood vessel under examination distal to the anatomical structures to be examined. Then the catheter is attached to a motorized mechanism capable of withdrawing the catheter through the vessel at a rate specified by the attribute IVUS Gated Rate (0018,3102), once per heart cycle, from the defined IVUS Pullback Start Frame Number (0018,3103) (see C.8.5.6.1.24) to the IVUS Pullback Stop Frame Number (0018,3104) (see C.8.5.6.1.25).

Required if IVUS Acquisition (0018,3100) value is MOTOR_PULLBACK. Specified in units of mm/sec. See C.8.5.6.1.22

The attribute IVUS Pullback Rate (0018,3101) is required when IVUS Acquisition (0018,3100) is MOTOR_PULLBACK and it specifies the velocity of withdrawal of the IVUS imaging catheter in millimeters per second.

Required if IVUS Acquisition (0018,3100) value is GATED_PULLBACK. Specified in units of mm/beat. See C.8.5.6.1.23

The attribute IVUS Gated Rate (0018,3102) is required when IVUS Acquisition (0018,3100) is GATED_PULLBACK and it specifies the velocity of withdrawal of the IVUS imaging catheter in millimeters per beat.

Required if IVUS Acquisition (0018,3100) value is MOTOR_PULLBACK or GATED_PULLBACK. See C.8.5.6.1.24

The IVUS Pullback Start Frame Number (0018,3103) specifies the frame number of a IVUS multi-frame acquisition upon which motorized or gated pullback begins.

Required if IVUS Acquisition (0018,3100) value is MOTOR_PULLBACK or GATED_PULLBACK. See C.8.5.6.1.25

The IVUS Pullback Stop Frame Number (0018,3104) specifies the frame number of a IVUS multi-frame acquisition upon which motorized or gated pullback ends.

Identifier(s) of the lesion(s) of interest imaged within the current SOP Instance. Each lesion shall have a unique numeric integer identifier within the study. See C.8.5.6.1.26.

Attribute Lesion Number identifies the lesion(s) of interest imaged within the current SOP Instance. Each lesion shall have a unique numeric integer identifier within the study. If during a study the same lesion is imaged more than once, the same Lesion Number should be used for both SOP Instances. Notes: 1.Lesion Number is not a DICOM UID. 2.An IVUS pullback may contain multiple values in Lesion Number.

Manufacturer defined character string description of ultrasound output level(s) used in generating a given image. Data may be expressed in dB, %, W/cm2, etc. Manufacturer defined code or description of ultrasound transducer used. Defined Terms: SECTOR_PHASED SECTOR_MECH SECTOR_ANNULAR LINEAR CURVED LINEAR SINGLE CRYSTAL SPLIT XTAL CWD IV_PHASED IV_ROT XTAL IV_ROT MIRROR ENDOCAV_PA ENDOCAV_MECH ENDOCAV_CLA ENDOCAV_AA ENDOCAV_LINEAR VECTOR_PHASED The depth, from the transducer face, of the manufacturer defined beam focus used for the image, in cm. Manufacturer defined description of processing of echo information. Data may include code or description of gain (initial, overall, TGC, dynamic range, etc.), preprocessing, postprocessing, Doppler processing parameters, e.g. cutoff filters, etc., as used in generating a given image. See C.8.5.6.1.8 for Description.

The thermal and/or mechanical indices, when made available by a manufacturer, are defined according to the Standard for Real-Time Display of Thermal and Mechanical Acoustic Output Indices on Diagnostic Ultrasound Equipment, a voluntary performance standard jointly published by AIUM and NEMA.

See C.8.5.6.1.8 for Description.

The depth, in mm, from the transducer face to the deepest point included in the displayed image- the field of view. Defined term which identifies the intended purpose of the ROI Overlay Type. See C.8.5.6.1.11 for specialization.

For US Images, Overlay Subtype (60xx,0045) shall use the following Defined Terms: ACTIVE 2D/BMODE IMAGE AREA = identification of the active area of a 2D/B-mode image.

Describes the kind of image conversion. Defined Terms : DV = Digitized Video DI = Digital Interface DF = Digitized Film WSD = Workstation SD = Scanned Document SI = Scanned Image DRW = Drawing SYN = Synthetic Image Source equipment for the image. This type definition shall override the definition in the General Series Module. See C.7.3.1.1.1 for Defined Terms.

Defined Terms for the Modality (0008,0060) are: Retired Defined Terms for the Modality (0008,0060) are: Note: 1. The XA modality incorporates the retired modality DS. 2. The RF modality incorporates the retired modalities CF, DF, VF. 3. The modality listed in the Modality Data Element (0008,0060) may not match the name of the IOD in which it appears. For example, a SOP instance from XA IOD may list the RF modality when an RF implementation produces an XA object. 4. The MR modality incorporates the retired modalities MA and MS.

User defined identification of the device that converted the image Manufacturer of the Secondary Capture Device Manufacturer's model number of the Secondary Capture Device Manufacturer's designation of software version of the Secondary Capture Device Original format of the captured video image (e.g. NTSC, PAL, Videomed-H) Additional information about digital interface used to acquire the image The date the Secondary Capture Image was captured. The time the Secondary Capture Image was captured. Physical distance on the media being digitized or scanned between the center of each pixel, specified by a numeric pair - adjacent row spacing (delimiter) adjacent column spacing in mm. See 10.7.1.3 for further explanation of the value order. Shall be consistent with Pixel Aspect Ratio (0028,0034), if present. Indicates whether or not image contains sufficient burned in annotation to identify the patient and date the image was acquired. Enumerated Values: YES NO Specifies an identity transformation for the Presentation LUT, such that the output of all grayscale transformations defined in the IOD containing this Module are defined to be P-Values. Enumerated Values: IDENTITY - output is in P-Values. Required if Photometric Interpretation (0028,0004) is MONOCHROME2, and BitsStored (0028,0101) is greater than 1. Note: If the VOI LUT Module is required by the IOD but no VOI LUT Sequence (0028,3010) or Window Center (0028,1050) is present, then the VOI LUT stage is an identity transformation. Luminance of a hypothetical viewing device illuminating a piece of monochrome transmissive film, or for the case of reflective media, luminance obtainable from diffuse reflection of the illumination present. Expressed as L0, in candelas per square meter (cd/m2). Note: May be used together with Reflected Ambient Light (2010,0160) to recover Optical Density information from P-Values. See C.8.6.3.1.

Illumination (2010,015E) and Reflected Ambient Light (2010,0160) may be used to recover Optical Density information from P-Values. Monochrome media that is being digitized is often measured in Optical Density values. These values need to be converted to P-Values for storage and display. The P-Values used in an image correspond to the perception of a human observer viewing the film on a hypothetical viewing device (such as a light box), using the specified values of Illumination (2010,015E) and Reflected Ambient Light (2010,0160). The Grayscale Standard Display Function defined in PS 3.14 is used to convert Luminance to P-Values. In the case of scanned film, the Luminance is derived from Optical Density using the specified values of Illumination (2010,015E) and Reflected Ambient Light (2010,0160). An example of this derivation, as well as typical “default” values for these parameters, is specified in PS 3.14.

For scanned monochrome transmissive film viewed on a hypothetical viewing device, the luminance contribution due to reflected ambient light. Expressed as La, in candelas per square meter (cd/m2). Note: May be used together with Illumination (2010,015E) to recover Optical Density information from P-Values. See C.8.6.3.1.

The value b in the relationship between stored values (SV) in Pixel Data (7FE0,0010) and the output units specified in Rescale Type (0028,1054). Output units = m*SV + b. Enumerated Value: 0 Required if Photometric Interpretation (0028,0004) is MONOCHROME2, and BitsStored () is greater than 1. Note: This specifies an identity Modality LUT transformation. m in the equation specified by Rescale Intercept (0028,1052). Enumerated Value: 1 Required if Photometric Interpretation (0028,0004) is MONOCHROME2, and BitsStored (0028,0101) is greater than 1. Note: This specifies an identity Modality LUT transformation. Specifies the output units of Rescale Slope (0028,1053) and Rescale Intercept (0028,1052). Enumerated Value: US = Unspecified Required if Photometric Interpretation (0028,0004) is MONOCHROME2, and BitsStored (0028,0101) is greater than 1. Note: This specifies an identity Modality LUT transformation. Contains the Data Element Tag of the attribute which is used as the frame increment in Multi-frame pixel data. See C.7.6.6.1.1 for further explanation. Shall be present if Number of Frames is greater than 1, overriding (specializing) the Type 1 requirement on this attribute in the Multi-frame Module.

Physical distance on the media being digitized or scanned between the center of each pixel, specified by a numeric pair - adjacent row spacing (delimiter) adjacent column spacing in mm. See 10.7.1.3 for further explanation of the value order. Required if Conversion Type (0008,0064) is DF (Digitized Film). May also be present if Conversion Type (0008,0064) is SD (Scanned Document) or SI (Scanned Image). Shall be consistent with Pixel Aspect Ratio (0028,0034), if present. Enumerated Values: ROW COLUMN Angle of the edge of the film relative to the transport direction in degrees greater than or equal to -45 and less than or equal to +45. An array which contains the real time increments (in msec) between frames for a Multi-frame image. See C.7.6.5.1.2 for further explanation. Required if Frame Increment Pointer (0028,0009) points to Frame Time Vector (0018,1065). Note: Frame Time Vector arrays may not be properly encoded if Explicit-VR transfer syntax is used and the VL of this attribute exceeds 65534 bytes.

Frame Time Vector (0018,1065) is an array that contains the time increments (in milliseconds) between the nth frame and the previous frame for a Multi-frame image. The first frame always has a time increment of 0. If the Frame Increment Pointer points to this Attribute, the Frame Time Vector shall be used in the following manner to calculate 'relative time' T(n) for frame n: where ti is the ith Frame Time Vector component.

An array which contains, for each of the image frames, the corresponding page numbers of the original document. Required if Frame Increment Pointer (0028,0009) points to Page Number Vector (0018,2001). An array which contains, for each of the image frames, a descriptive label. Required if Frame Increment Pointer (0028,0009) points to Frame Label Vector (0018,2002). An array which contains, for each of the image frames, the primary angle of rotation about an undefined axis, in degrees. May be used for annotative purposes for "cine loops" of 3D reprojected images Required if Frame Increment Pointer (0028,0009) points to Frame Primary Angle Vector (0018,2003). An array which contains, for each of the image frames, the secondary angle of rotation about an undefined axis that is orthogonal to that used for Frame Primary Angle Vector (0018,2003), in degrees. May be used for annotative purposes for "cine loops" of 3D reprojected images Required if Frame Increment Pointer (0028,0009) points to Frame Secondary Angle Vector (0018,2004). An array that contains, for each of the image frames, the relative position of the image plane expressed in mm, as defined for Slice Location (0020,1041). See C.7.6.2.1.2 for further explanation. Required if Frame Increment Pointer (0028,0009) points to Slice Location Vector (0018,2005).

The Slice Location (0020,1041) is defined as the relative position of the image plane expressed in mm. This information is relative to an unspecified implementation specific reference point.

An array which contains, for each of the image frames, a label or number of the display window of a graphical user interface from which the frame was captured. Required if Frame Increment Pointer (0028,0009) points to Display Window Label Vector (0018,2006). Required if Multi-Frame Image. Contains the Data Element Tag of the attribute that is used as the Frame increment in Multi-frame image pixel data (See C.7.6.6). Specialized for X-Ray as Enumerated Value: 00181063H = Frame Time (0018,1063); 00181065H = Frame Time Vector (0018,1065).

Table C.7-14 specifies the Attributes of a Multi-frame pixel data Image. Table C.7-14 MULTI-FRAME MODULE ATTRIBUTES

Image identification characteristics. See C.8.7.1.1.1 for specialization.

The Image Type attribute identifies important image characteristics in a multiple valued data element. For X-Ray, Image Type is specialized as follows: a. Value 1 shall identify the Pixel Data Characteristics in accordance with Section C.7.6.1.1.2; Enumerated Values are: ORIGINAL and DERIVED; b. Value 2 shall identify the Patient Examination Characteristics in accordance with Section C.7.6.1.1.2; Enumerated Values are: PRIMARY and SECONDARY. Note: X-Ray images generally use PRIMARY value for images captured from patient exposure. c. Value 3 shall identify the image set in terms of the imaging planes. Enumerated Values are: d. Other Values are implementation specific (optional).

The relationship between the Pixel sample values and the X-Ray beam intensity. See Section C.8.7.1.1.2.

Pixel Intensity Relationship (0028,1040) shall identify the relationship of the pixel values to the X-Ray beam intensity. Defined terms are:

Number of samples (color planes) in this image shall have a value of 1. Specifies the intended interpretation of the pixel data. Only MONOCHROME2 may be used. Number of bits allocated for each pixel sample. See Section C.8.7.1.1.6.

For X-Ray Images, Bits Allocated (0028,0100) shall have the Enumerated Value of 8 or 16.

Number of bits stored for each pixel sample. See Section C.8.7.1.1.7.

For X-Ray Images, Bits Stored (0028,0101) shall have the Enumerated Values of 8, 10, 12, or 16.

Most significant bit for pixel sample data. See Section C.8.7.1.1.8.

For X-Ray Images, High Bit (0028,0102) shall have the Enumerated Value of one less than the value in Bit Stored.

Data representation of the pixel samples. Shall have the value: 0000H = Unsigned Integer. Parameters of scanning sequence. See Section C. 8.7.1.1.4. Marks the location(s) of the R Wave in the cardiac cycles by referencing frame numbers; frame numbers begin with 1. A sequence which provides reference to a set of Image SOP Class/Instance identifying other images significantly related to this image. Shall be present if Image Type (0008,0008) Value 3 is BIPLANE A or BIPLANE B. May be present otherwise. One or more items may be included in this sequence.. See Section C.8.7.1.1.13.

When Image Type (0008,0008) Value 3 is BIPLANE A or BIPLANE B, Referenced Image Sequence (0008,1140) shall be used to identify the corresponding SOP Instance of the Biplane acquisition. In this case, either:

Describes the purpose for which the reference is made. Only a single Item shall be permitted in this Sequence. A text description of how this image was derived. See C.8.7.1.1.5 for further explanation.

If an Image is identified to be a Derived image (see C.8.9.1.1.1 Image Type), Derivation Description (0008,2111) is an optional and implementation specific text description of the way the image was derived from an original image. As applied to X-Ray images, it may be used to describe derivation operations such as edge enhancement, temporal filtering, digital subtraction, or other linear and non-linear transformations.

Indicates any visual processing performed on the images prior to exchange. See Section C.8.7.1.1.3.

Acquisition Device Processing Description (0018,1400) provides some indication in human readable text of the digital processing on the images before exchange. Examples of this processing are: edge enhanced, subtracted, time filtered, gamma corrected, convolved (spatially filtered).

A multi-valued attribute that contains a descriptive label for each of the image frames. The number of values shall equal the number of frames. Contains the Data Element Tags of one or more attributes that vary or increment for the frames of a multi-frame image. See C.8.7.1.1.12. Shall not be present if it would contain only one value and that value would be Frame Time (0018,1063) or Frame Time Vector (0018,1065).

Frame Dimension Pointer (0028,000A) identifies attributes that vary or increment with each frame, and which are clinically significant for viewing or processing the image. This is intended for SOP Instances whose preferred clinical presentation is dependent on frame relationships other than simply time. Defined Terms for multiframe cine from the Cine Module (see C.7.6.5) are: 00181063H = Frame Time (0018,1063) 00181065H = Frame Time Vector (0018,1065) Defined Terms for rotational acquisition from the XA Positioner Module (see C.8.7.5) are: 00181520H = Positioner Primary Angle Increment (0018,1520) 00181521H = Positioner Secondary Angle Increment (0018,1521) Defined Terms for stepped acquisition from the X-Ray Table Module (see C.8.7.4) are: 00181135H = Table Vertical Increment (0018,1135) 00181137H = Table Longitudinal Increment (0018,1137) 00181136H = Table Lateral Increment (0018,1136) Defined Terms for an arbitrary labeled increment: 00182002H = Frame Label Vector (0018,2002) Notes: 1. Previous editions of the standard did not include the optional Frame Dimension Pointer (0028,000A), but instead depended entirely on the mandatory Frame Increment Pointer (0028,0009), and envisaged that only time and no other dimension would relate frames. Image creators that add the Frame Dimension Pointer (0028,000A) must anticipate that many implementations will ignore or discard this attribute when displaying or storing images and continue to assume that frames are temporally related. 2. Frame Time (0018,1063) or Frame Time Vector (0018,1065) will also be present and will contain appropriate values consistent with the times of acquisition of the frames.

Indicates whether a reference object (phantom) of known size is present in the image and was used for calibration. Enumerated Values: YES NO Device is identified using the Device module. See C.7.6.12.

Table C.7-18 describes the Attributes of devices or calibration objects (e.g., catheters, markers, baskets) that are associated with a study and/or image. Table C.7-18 DEVICE MODULE ATTRIBUTES

Peak kilo voltage output of the X-Ray generator used. Identify the general level of X-Ray dose exposure. Enumerated values are: SC = low dose exposure generally corresponding to fluoroscopic settings (e.g. preparation for diagnostic quality image acquisition); GR = high dose for diagnostic quality image acquisition (also called digital spot or cine); X-Ray Tube Current in mA. Required if Exposure (0018,1152) is not present. May be present otherwise. X-Ray Tube Current in µA. Duration of X-Ray exposure in msec. See 8.7.2.1.1. Required if Exposure (0018,1152) is not present. May be present otherwise. Duration of X-Ray exposure in µsec. The exposure expressed in mAs, for example calculated from Exposure Time and X-Ray Tube Current. Required if either Exposure Time (0018,1150) or X-Ray Tube Current (0018,1151) are not present. May be present otherwise. The exposure expressed in µAs, for example calculated from Exposure Time and X-Ray Tube Current. Identify the grid. Only a single value shall be present. Defined Terms are: IN = A Grid is positioned; NONE = No Grid is used. Average width of X-Ray pulse in msec. Specifies X-Ray radiation mode. Defined Terms: CONTINUOUS PULSED Type of filter(s) inserted into the X-Ray beam (e.g. wedges). Diameter of X-Ray intensifier in mm Shape of the Image Intensifier Field of View. See C.8.7.2.1.2. Defined Terms are: ROUND RECTANGLE

The Field of View Attribute describes the shape and dimensions of the Image Intensifier Field of View (zoom mode). This could be further restricted by the Collimator. See Section C.8.7.3.

Dimensions of the Image Intensifier Field of View in mm. If Rectangle, row dimension followed by column; if Round, diameter. Physical distance measured at the front plane of the Image Receptor housing between the center of each pixel specified by a numeric pair - row spacing value(delimiter) column spacing value in mm. See 10.7.1.3 for further explanation of the value order. The value of this attribute shall never be adjusted to account for correction for the effect of geometric magnification or calibration against an object of known size; Pixel Spacing (0028,0030) is specified for that purpose. Nominal focal spot size in mm used to acquire this image. X-Ray dose, measured in dGy*cm*cm, to which the patient was exposed for the acquisition of this image plus any non-digitally recorded fluoroscopy which may have been performed to prepare for the acquisition of this image. Note: The sum of the area dose product of all images of a Series or a Study may not result in the total area dose product to which the patient was exposed. Shape(s) of the collimator. Enumerated Values: RECTANGULAR CIRCULAR POLYGONAL This multi-valued Attribute shall contain at most one of each Enumerated Value. Required if Collimator Shape (0018,1700) is RECTANGULAR. Location of the left edge of the rectangular collimator with respect to pixels in the image given as column. See C.8.7.3.1.1.

These attributes specify the pixel row or column where the X-Ray beam is fully obscured by a rectangular collimator: - if the left edge of the collimator is not visible, Collimator Left Vertical Edge (0018,1702) shall have a value of 0; - if the right edge of the collimator is not visible, Collimator Right Vertical Edge (0018,1704) value shall be 1 greater than the value of the Columns (0028,0011) attribute; - if the top edge of the collimator is not visible, Collimator Upper Horizontal Edge (0018,1706) shall have a value of 0; - if the bottom edge of the collimator is not visible, Collimator Lower Horizontal Edge (0018,1708) value shall be 1 greater than the value of the Rows (0028,0010) attribute.

Required if Collimator Shape (0018,1700) is RECTANGULAR. Location of the right edge of the rectangular collimator with respect to pixels in the image given as column. See C.8.7.3.1.1.

Required if Collimator Shape (0018,1700) is RECTANGULAR. Location of the upper edge of the rectangular collimator with respect to pixels in the image given as row. See C.8.7.3.1.1.

Required if Collimator Shape (0018,1700) is RECTANGULAR. Location of the lower edge of the rectangular collimator with respect to pixels in the image given as row. See C.8.7.3.1.1.

Required if Collimator Shape (0018,1700) is CIRCULAR. Location of the center of the circular collimator with respect to pixels in the image given as row and column. See C.8.7.3.1.1.

Required if Collimator Shape (0018,1700) is CIRCULAR. Radius of the circular collimator with respect to pixels in the image given as a number of pixels along the row direction. See C.8.7.3.1.1.

The direction of the longitudinal movement is perpendicular to the primary axis of rotation of the positioner. A positive value of Table Longitudinal Increment (0018,1137) attributes indicates a movement towards the +90° position of the positioner, see figure C.8-9a. Figure C.8-9a Table Longitudinal Movement

Incremental change in Lateral position of the table relative to first frame of Multi-frame image given in mm. Table motion towards +90°position of the secondary angle of the positioner is positive. See C.8.7.4.1.3. Required if Table Motion is DYNAMIC.

The direction of the lateral movement is perpendicular to the secondary axis of rotation of the positioner. A positive value of Table Lateral Increment (0018,1136) attributes indicates a movement towards the +90° position of the positioner, see figure C.8-9b. Figure C.8-9b Table Lateral Movement Note: The terms “longitudinal” and “lateral” are relative to an operator standing tableside, and facing the patient. Thus lateral movement is to the left and right of the operator, and longitudinal movement is towards or away from the operator.

Angle of table plane in degrees relative to horizontal plane [Gravity plane]. Positive values indicate that the head of the table is upwards. Distance in mm from source to isocenter (center of field of view). Note: This value is traditionally referred to as Source Object Distance (SOD). Distance in mm from source to detector center. Note: This value is traditionally referred to as Source Image Receptor Distance (SID). Ratio of Source Image Receptor Distance (SID) over Source Object Distance (SOD). Used to describe the activity of the imaging devices. Defined terms: DYNAMIC, STATIC. Required if Multi-frame data. See C.8.7.5.1.1.

Positioner Motion attribute is STATIC if the imaging table moves during a multi-frame acquisition, but the X-Ray positioner do not move. Note: If the positioner undergoes translation (non-rotational movement) during the acquisition, then that motion shall be described by an opposite table motion (See Section C.8.7.4).

Position of the X-Ray Image Intensifier about the patient from the RAO to LAO direction where movement from RAO to vertical is positive. See C.8.7.5.1.2.

The definitions of Positioner Angles shall be with respect to the patient as illustrated in Figures C.8-11 and C.8-12 Zero degree is referenced to the origin perpendicular to the patient's chest. The Positioner Primary Angle definition is like longitude (in the equatorial plan); the Positioner Secondary Angle definition is like latitude (in the sagittal plane). The Positioner Angle attributes apply to the first frame of a multi-frame image. The valid range of Primary Positioner Angle is -180 to +180 degrees and the Secondary Positioner Angle range is -90 to + 90 degrees. The Patient Plane is defined by the isocenter of the imaging device and slices through the patient such that it is perpendicular to the sagittal plane of the body. The Primary Axis of rotation is defined at the intersection of the Patient Plane and of the Sagittal Plane. The Positioner Primary Angle is defined in the transaxial plane at the isocenter with zero degrees in the direction perpendicular to the patient's chest and + 90 degrees at the Patient left hand side (LAO) and -90 at the Patient right hand side (RAO). The valid range of Primary Positioner Angle is -180 to +180 degrees. The Secondary Axis is in the Patient Plane and is perpendicular to the Primary Axis at the isocenter. The Positioner Secondary Angle is defined in the Sagittal Plane at the isocenter with zero degrees in the direction perpendicular to the patient's chest. +90 degrees corresponds to the cranial direction. The Secondary Positioner Angle range is -90 to + 90 degrees. At a 0 angle for both the Primary Angle (0018,1510) and Secondary Angle (0018,1511), the patient faces the Image Intensifier. The Positioner Primary Angle (0018,1510) and Secondary Angle (0018,1511) apply to the first frame of a multi-frame image. Figure C.8-11 Positioner Primary Angle Figure C.8-12 Positioner Secondary Angle

Position of the X-Ray Image Intensifier about the patient from the CAU to CRA direction where movement from CAU to vertical is positive. See C.8.7.5.1.2

Incremental change in primary positioner angle for each frame. See C.8.7.5.1.3. Required if Positioner Motion is DYNAMIC.

If the positioner angles change during acquisition of a multi-frame image, the Positioner Angle Increment attributes describe the angular change per frame. If the change in positioner angle is nominally constant for each frame, these fields may contain a single value of the average angular change per frame. Alternatively, the fields may contain a vector of offsets from the (initial) Positioner Angle attributes, with one value for each frame in the multi-frame image. The number of values in the Positioner Angle Increment attributes must be one, or must be equal to the Number of Frames attribute (0028,0008) in the Multi-Frame Module (see Section C.7.6.6). Note: It is permissible to generate a vector of the absolute positioner angles in the Positioner Angle Increment attributes, and set the Positioner Primary and Secondary Angle attributes to value 0.

Incremental change in secondary positioner angle for each frame. See C.8.7.5.1.3. Required if Positioner Motion is DYNAMIC.

Angle of the X-Ray beam in the row direction in degrees relative to the normal to the detector plane. Positive values indicate that the X-Ray beam is tilted towards higher numbered columns. Negative values indicate that the X-Ray beam is tilted towards lower numbered columns. See C.8.7.5.1.4.

Detector Angles are defined in a fashion similar to the positioner angles, except that the angle of the central x-ray beam vector is relative to the detector plane rather than the patient plane. The central x-ray beam vector is defined as the vector from the x-ray source through the isocenter to the detector plane. Zero degree is referenced to the normal to the detector plane pointing away from the x-ray source. The Detector Angle attributes apply to the first frame of a multi-frame image. The valid range of the Detector Angles is -90 to + 90 degrees. The Primary Axis of rotation is defined along the line in the column direction of the detector plane which intersects the central x-ray beam vector. The Detector Primary Angle is defined in the plane perpendicular to the Primary Axis of rotation at the point where the central x-ray beam vector intersects the detector plane, with zero degrees in the direction normal to the detector plane and -90 degrees at the left hand side of the image (i.e., toward column 1) and +90 at the right hand side of the image (i.e., toward the highest numbered column). The valid range of Primary Detector Angle is -90 to +90 degrees. The Secondary Axis is in the detector plane and is perpendicular to the Primary Axis at the intersection of the beam vector with the detector plane (i.e., it is along the row direction). The Detector Secondary Angle is defined in the plane perpendicular to the Secondary Axis at the point where the central x-ray beam vector intersects the detector plane, with zero degrees in the direction normal to the detector plane. +90 degrees corresponds to the direction toward the top of the image. The Secondary Detector Angle range is -90 to + 90 degrees.

Angle of the X-Ray beam in the column direction in degrees relative to the normal to the detector plane. Positive values indicate that the X-Ray beam is tilted towards lower numbered rows. Negative values indicate that the X-Ray beam is tilted towards higher numbered rows. See C.8.7.5.1.4.

Distance in mm from source to detector center. Note: This value is traditionally referred to as Source Image Receptor Distance (SID). Distance in mm from source to isocenter (center of field of view). Note: This value is traditionally referred to as Source Object Distance (SOD). Ratio of SID (Source Image Receptor Distance) over SOD (Source Object Distance). Angle of the X-Ray beam in degree relative to an orthogonal axis to the detector plane. Positive values indicate that the tilt is towards the head of the table. Note: The detector plane is assumed to be parallel to the table plane. Distance in mm between the table surface and the sharp image plane. Angle span in degrees of rotation of X-Ray Source during X-Ray acquisition. Time in seconds the source has taken to rotate the Tomo Angle during X-Ray acquisition. Type of tomography. Defined Terms: LINEAR SPIRAL POLYCYCLOIDAL CIRCULAR Form of tomography: Defined Terms: MOTION TOMOSYNTHESIS The number of source images used to construct this tomosynthetic image. Only meaningful if Tomo Class (0018,1491) is TOMOSYNTHESIS. These may be listed in Source Image Sequence (0008,2112) of the General Image Module. Peak kilo voltage output of the X-Ray generator used. X-Ray Tube Current in mA. X-Ray Tube Current in µA. Duration of X-Ray exposure in msec. Duration of X-Ray exposure in µsec. The exposure expressed in mAs, for example calculated from Exposure Time and X-Ray Tube Current. The exposure expressed in µAs, for example calculated from Exposure Time and X-Ray Tube Current. Distance in mm from source to detector center. Note: This value is traditionally referred to as Source Image Receptor Distance (SID). Distance in mm from source to the table, support or bucky side that is closest to the Imaging Subject, as measured along the central ray of the X-Ray beam. Note: 1. This definition is less useful in terms of estimating geometric magnification than a measurement to a defined point within the Imaging Subject, but accounts for what is realistically measurable in an automated fashion in a clinical setting. 2. This measurement does not take into account any air gap between the Imaging Subject and the "front" of the table or bucky. 3. If the detector is not mounted in a table or bucky, then the actual position relative to the patient is implementation or operator defined. 4. This value is traditionally referred to as Source Object Distance (SOD). X-Ray dose, measured in dGy*cm*cm, to which the patient was exposed for the acquisition of this image plus any non-digitally recorded fluoroscopy which may have been performed to prepare for the acquisition of this image. Notes: 1. The sum of the area dose product of all images of a Series or a Study may not result in the total area dose product to which the patient was exposed. 2. This may be an estimated value based on assumptions about the patient's body size and habitus. The average thickness in mm of the body part examined when compressed, if compression has been applied during exposure. Indication of the applied dose, in manufacturer specific units. Notes: 1. This value is intended to provide a single location where manufacturer specific information can be found for annotation on a display or film, that has meaning to a knowledgeable observer. 2. This may be a calculated or measured value. Examples are the detector entrance dose (KB), the CR sensitivity value (S), or the logarithmic median (lgM). Average entrance dose value measured in dGy at the surface of the patient during the acquisition of this image. Note: This may be an estimated value based on assumptions about the patient's body size and habitus. Average entrance dose value measured in mGy at the surface of the patient during the acquisition of this image. Note: This may be an estimated value based on assumptions about the patient's body size and habitus. Typical dimension of the exposed area at the detector plane. If Rectangular: row dimension followed by column; if Round: diameter. Measured in cm. Notes: 1. The exposed area should be consistent with values specified in the X-Ray Collimator Module, if present. 2. This may be an estimated value based on assumptions about the patient's body size and habitus. 3. This attribute is used in the Radiation Dose Module with units in mm (see Section C.4.16 Table C.4-16). Distance in mm from the source to the surface of the patient closest to the source during the acquisition of this image. Note: This may be an estimated value based on assumptions about the patient's body size and habitus. User-defined comments on any special conditions related to radiation dose encountered during the acquisition of this image. The X-Ray output at the patient entrance surface and kVp used to acquire the image, measured in mGy/mAs. Note: This value may be a calibrated value rather than measured during the exposure. The thickness of Aluminum in mm required to reduce the X-Ray Output (0040,0312) by a factor of two. Note: This value may be a calibrated value rather than measured during the exposure. Average organ dose value measured in dGy during the acquisition of this image. Note: This may be an estimated value. Organ to which Organ Dose (0040,0316) applies. Defined Terms: BREAST GONADS BONE MARROW FETUS LENS Note: The anatomic regions described by these terms are those that are particularly radiosensitive and for which it is conventional to obtain organ specific dose parameters. The primary material in the anode of the X-Ray source. Defined Terms: TUNGSTEN MOLYBDENUM RHODIUM The X-Ray absorbing material used in the filter. May be multi-valued. Defined Terms: MOLYBDENUM ALUMINUM COPPER RHODIUM NIOBIUM EUROPIUM LEAD The minimum thickness in mm of the X-Ray absorbing material used in the filters. May be multi-valued, with values corresponding to the respective values in Filter Material (0018,7050). The maximum thickness in mm of the X-Ray absorbing material used in the filters. May be multi-valued, with values corresponding to the respective values in Filter Material (0018,7050). Type of rectification used in the X-Ray generator. Defined Terms: SINGLE PHASE THREE PHASE CONST POTENTIAL Peak kilo voltage output of the X-Ray generator used. X-Ray Tube Current in mA. X-Ray Tube Current in µA. Duration of X-Ray exposure in msec. Duration of X-Ray exposure in µsec. The exposure expressed in mAs, for example calculated from Exposure Time and X-Ray Tube Current. The exposure expressed in µAs, for example calculated from Exposure Time and X-Ray Tube Current. Type of exposure control. Defined Terms: MANUAL AUTOMATIC Text description of the mechanism of exposure control. May describe the number and type of exposure sensors or position of the sensitive area of the imaging detector. Whether the exposure was normally completed or not. Defined Terms: NORMAL ABORTED Nominal percentage phototimer setting, where a more positive value indicates greater exposure and a more negative value indicates less exposure. Nominal focal spot size in mm used to acquire this image. The primary material in the anode of the X-Ray source. Defined Terms: TUNGSTEN MOLYBDENUM RHODIUM Type of rectification used in the X-Ray generator. Defined Terms: SINGLE PHASE THREE PHASE CONST POTENTIAL Identifier of the generator Type of filter(s) inserted into the X-Ray beam (e.g. wedges). Defined Terms: STRIP WEDGE BUTTERFLY MULTIPLE NONE The X-Ray absorbing material used in the filter. May be multi-valued. Defined Terms: MOLYBDENUM ALUMINUM COPPER RHODIUM NIOBIUM EUROPIUM LEAD The minimum thickness in mm of the X-Ray absorbing material used in the filters. May be multi-valued, with values corresponding to the respective values in Filter Material (0018,7050). The maximum thickness in mm of the X-Ray absorbing material used in the filters. May be multi-valued, with values corresponding to the respective values in Filter Material (0018,7050). Identifies the grid. May be multi-valued. Defined Terms are: FIXED FOCUSED RECIPROCATING PARALLEL CROSSED NONE The X-Ray absorbing material used in the grid. The spacing material used in the grid. The thickness in mm of the X-Ray absorbing material used in the grid. The pitch in mm of the X-Ray absorbing material used in the grid. Ratio of the vertical spacing and horizontal spacing of the X-Ray absorbing material used in the grid. Specified by a pair of integer values where the first value is the vertical size, and the second value is the horizontal size. Period in mSec of reciprocation cycle. Only meaningful if Grid (0018,1166) is RECIPROCATING. Focal distance in mm of a FOCUSED grid. Identifier of the grid Type of equipment that originally acquired the data. Enumerated Values: RTIMAGE = RT Image RTDOSE = RT Dose RTSTRUCT = RT Structure Set RTPLAN = RT Plan RTRECORD = RT Treatment Record See C.8.8.1.1.

The Enumerated Value for Modality (0008,0060) shall determined by the IOD: RTIMAGE if RT Image IOD, RTDOSE if RT Dose IOD, RTSTRUCT if RT Structure Set IOD, RTPLAN if RT Plan IOD or RT Ion Plan IOD, RTRECORD if RT Beams Treatment Record IOD, RT Ion Beams Treatment Record IOD, RT Brachy Treatment Record IOD, or RT Treatment Summary Record IOD. Note: DICOM specifies that a given series shall contain objects of only one Modality, and shall be created by a single device (described in the General Equipment Module). However, in general there may be many series defined for a given modality/device pair. Note that a radiotherapy series is generally created over an extended time interval (unlike in radiology, where all images in an image series are generally created together).

Unique identifier of the series. A number that identifies this series. User provided description of the series. Uniquely identifies the Performed Procedure Step SOP Instance to which the Series is related (e.g. a Modality or General-Purpose Performed Procedure Step SOP Instance). One or more items may be included in this sequence. Sequence that contains attributes from the Imaging Service Request. The sequence may have one or more Items. Number of samples (planes) in this image. See C.8.8.2.6.1 for specialization.

For RT Images, Samples per Pixel (0028,0002) shall have the Enumerated Value of 0001H.

Specifies the intended interpretation of the pixel data. See C.8.8.2.6.2 for specialization.

For RT Images, Photometric Interpretation (0028,0004) shall have the Enumerated Value of MONOCHROME2.

Number of bits allocated for each pixel sample. Each sample shall have the same number of bits allocated. See C.8.8.2.6.3 for specialization.

For RT Images, Bits Allocated (0028,0100) shall have an Enumerated Value of 8 or 16.

Number of bits stored for each pixel sample. Each sample shall have the same number of bits stored. See C.8.8.2.6.4 for specialization.

For RT Images, Bits Stored (0028,0101) shall have an Enumerated Value of: 8 when Bits Allocated (0028,0100) is 8 12-16 when Bits Allocated (0028,0100) is 16

Most significant bit for each pixel sample. Each sample shall have the same high bit. See C.8.8.2.6.5 for specialization.

For RT Images, High Bit (0028,0102) shall have the Enumerated Value of one less than the value sent in Bits Stored (0028,0101).

Data representation of the pixel samples. Each sample shall have the same pixel representation. See C.8.8.2.6.6 for specialization.

For RT Images, Pixel Representation (0028,0103) shall have the Enumerated Value of 0000H (unsigned integer).

The relationship between the Pixel sample values and the X-Ray beam intensity. Enumerated Values: LIN = Linearly proportional to X-Ray beam intensity LOG = Logarithmically proportional to X-Ray beam intensity See C.8.11.3.1.2 for further explanation.

Pixel Intensity Relationship (0028,1040) and Pixel Intensity Relationship Sign (0028,1041) describe how the stored pixel values in Pixel Data (7FE0,0010) are related to the X-Ray beam intensity incident on the detector. They do not define a transformation intended to be applied to the pixel data for presentation. Note: For example, if Pixel Intensity Relationship (0028,1040) is LIN and Pixel Intensity Relationship Sign (0028,1041) is -1, then lower values of Pixel Data (7FE0,0010) indicate higher X-Ray beam intensities corresponding to less radiographically dense regions projected on the image such as through air, and higher values of Pixel Data (7FE0,0010) indicate lower X-Ray beam intensities corresponding to more radiographically dense regions projected on the image such as through bone and radio-opaque contrast agents. The transformation to be applied to the pixel data for presentation is defined by the successive application of the conceptual Modality LUT, the VOI Attributes and the conceptual Presentation LUT. This shall result in the output of P-Values. Rescale Slope (0028,1053) and Rescale Intercept (0028,1052) define a linear subset of a conceptual Modality LUT transformation. For IODs that include this Module, these Attributes define an identity transformation. IODs that include the DX Image Module shall not include the Modality LUT Module. The Presentation LUT Shape (2050,0020) defines a subset of a conceptual Presentation LUT. For IODs that include this Module, this Attribute defines an identity transformation or inverse identity transformation. IODs that include the DX Image Module shall not include the Presentation LUT Module. Photometric Interpretation (0028,0004) indicates whether lower values that are the output of the VOI Attributes should be displayed as darker or lighter. Since the output of the equivalent of a conceptual Presentation LUT is in P-Values, which are defined in PS 3.14 such that lower values correspond to lower luminance levels, then the definition of the Presentation LUT Shape (2050,0020), otherwise intended to be an identity transformation, must take into account the effect of the value specified for Photometric Interpretation (0028,0004). Note: Regardless of the values of Pixel Intensity Relationship (0028,1040) and Pixel Intensity Relationship Sign (0028,1041), the grayscale transformations to be applied to the Pixel Data (7FE0,0010) are defined by the equivalent of the Modality LUT (Rescale Slope (0028,1053) and Rescale Intercept (0028,1052)), Value of Interest Attributes, Photometric Interpretation (0028,0004) and the equivalent of the Presentation LUT (Presentation LUT Shape (2050,0020)). However, the combination of the grayscale transformations and the description of the pixel intensity relationship, together define whether, for example, air is expected to be displayed as black or white.

The sign of the relationship between the Pixel sample values stored in Pixel Data (7FE0,0010) and the X-Ray beam intensity. Required if Pixel Intensity Relationship (0028,1040) is present. Enumerated Values; 1 = Lower pixel values correspond to less X-Ray beam intensity -1 = Higher pixel values correspond to less X-Ray beam intensity See C.8.11.3.1.2 for further explanation.

User-defined label for RT Image. User-defined name for RT Image. User-defined description of RT Image. Name of operator(s) acquiring or creating RT Image. Image identification characteristics (see Section C.7.6.1.1.2). RT Images shall use one of the following Defined Terms for Value 3: DRR = digitally reconstructed radiograph PORTAL = digital portal image or portal film image SIMULATOR = conventional simulator image RADIOGRAPH = radiographic image BLANK = image pixels set to background value FLUENCE = fluence map Describes the kind of image conversion. Defined Terms: DV = Digitized Video DI = Digital Interface DF = Digitized Film WSD = Workstation Describes the origin of the parameter values reported in the image. Required if Value 3 of Image Type (0008,0008) is SIMULATOR or PORTAL. Enumerated Values: OPERATOR = manually entered by operator PLAN = planned parameter values ACTUAL = electronically recorded Describes whether or not image plane is normal to beam axis. Enumerated Values: NORMAL = image plane normal to beam axis NON_NORMAL = image plane non-normal to beam axis Position in (x,y,z) coordinates of origin of IEC X-RAY IMAGE RECEPTOR System in the IEC GANTRY coordinate system (mm). See Note 2. X-Ray Image Receptor Angle i.e. orientation of IEC X-RAY IMAGE RECEPTOR coordinate system with respect to IEC GANTRY coordinate system (degrees). See C.8.8.2.2.

The X-Ray Image Receptor Angle (3002,000E) specifies the rotation of the image receptor device in the IEC X-RAY IMAGE RECEPTOR PLANE. A positive angle corresponds to a counter-clockwise rotation of the X-Ray Image Receptor as viewed from the radiation source in the IEC GANTRY coordinate system. The normal (non-rotated) value for this parameter is zero degrees.

The direction cosines of the first row and the first column with respect to the IEC X-RAY IMAGE RECEPTOR coordinate system. Required if RT Image Plane (3002,000C) is NON_NORMAL. May be present otherwise. Physical distance (in mm) between the center of each image pixel, specified by a numeric pair - adjacent row spacing (delimiter) adjacent column spacing. See C.8.8.2.3 and 10.7.1.3 for further explanation.

The Image Plane Pixel Spacing (3002,0011) attribute shall always be defined on the image plane, i.e. at the radiation machine source to image plane distance specified by RT Image SID (3002,0026). For images where the source-image distance is undefined or unknown (e.g. DRR images), RT Image SID (3002,0026) shall equal Radiation Machine SAD (3002,0022) and Image Plane Pixel Spacing (3002,0011) shall be defined on this common plane.

The x and y coordinates (in mm) of the upper left hand corner of the image, in the IEC X-RAY IMAGE RECEPTOR coordinate system. This is the center of the first pixel transmitted. See C.8.8.2.7.

When RT Image Plane (3002,000C) is NORMAL and RT Image Orientation (3002,0010) is not provided, the orientation is defined as follows: The image viewing direction goes from the radiation source to the image (i.e. in the sense of a beam’s eye view, or along the negative Zr direction of the IEC X-RAY IMAGE RECEPTOR coordinate system). The direction of rows goes along the positive Xr direction and the direction of the columns goes along the negative Yr direction of the IEC X-RAY IMAGE RECEPTOR coordinate system. Other interpretations shall be documented in an implementation's conformance statement.

User-defined name identifying radiation machine used in acquiring or computing image (i.e. name of conventional simulator, electron accelerator, X-Ray device, or machine modeled when calculating DRR). Measurement unit of machine dosimeter. Enumerated Values: MU = Monitor Unit MINUTE = minute Radiation source to Gantry rotation axis distance of radiation machine used in acquiring or computing image (mm). Source to patient surface distance (in mm) of radiation machine used in acquiring or computing image. Distance from radiation machine source to image plane (in mm) along radiation beam axis. See C.8.8.2.3.

Source to reference object distance (in mm), as used for magnification calculation of RADIOGRAPH and SIMULATOR images. Introduces sequence of one Class/Instance pair describing RT Plan associated with image. Only a single item shall be permitted in this sequence. Uniquely identifies the corresponding N-segment treatment beam specified by Beam Number (300A,00C0) within Beam Sequence in RT Beams Module within the RT Plan referenced in Referenced RT Plan Sequence (300C,0002). Identifier of Fraction Group within RT Plan referenced in Referenced RT Plan Sequence (300C,0002). Fraction Number of fraction during which image was acquired, within Fraction Group referenced by Referenced Fraction Group Number (300C,0022) within RT Plan referenced in Referenced RT Plan Sequence (300C,0002). Cumulative Meterset Weight within Beam referenced by Referenced Beam Number (300C,0006) at which image acquisition starts. Cumulative Meterset Weight within Beam referenced by Referenced Beam Number (300C,0006) at which image acquisition ends. Introduces sequence of Exposure parameter sets, corresponding to exposures used in generating the image. One or more items may be included in this sequence. See C.8.8.2.4.

The Exposure Sequence (3002,0030) allows specification of imaging parameters and aperture definitions for single exposure images (single item sequence) or multiple exposures (multiple item sequence). A multiple exposure image can be expressed as a multi-frame image containing either a single frame, or more than one frame. Referenced Frame Number (0008,1160) shall be specified for each Exposure Sequence item for multiple exposure images expressed using more than one frame.

Identifies corresponding image frame in multi-frame image. Required if there is more than one item in Exposure Sequence (3002,0030), and image is a multi-frame image. Peak kilo voltage output (kV) of X-Ray generator used to acquire image. Required if Value 3 of Image Type (0008,0008) is PORTAL, SIMULATOR or RADIOGRAPH. Imaging device X-Ray Tube Current (mA). Required if Value 3 of Image Type (0008,0008) is SIMULATOR or RADIOGRAPH. Time of X-Ray exposure (msec). Required if Value 3 of Image Type (0008,0008) is SIMULATOR or RADIOGRAPH. Treatment machine Meterset duration over which image has been acquired, specified in Monitor units (MU) or minutes as defined by Primary Dosimeter Unit (300A,00B3). Required if Value 3 of Image Type (0008,0008) is PORTAL. Positions of diaphragm jaw pairs (in mm) in IEC BEAM LIMITING DEVICE coordinate axis in the IEC order X1, X2, Y1, Y2. Introduces sequence of beam limiting device (collimator) jaw or leaf (element) positions for given exposure. One or more items may be included in this sequence. Type of beam limiting device (collimator). Enumerated Values: X = symmetric jaw pair in IEC X direction Y = symmetric jaw pair in IEC Y direction ASYMX = asymmetric jaw pair in IEC X direction ASYMY = asymmetric pair in IEC Y direction MLCX = multileaf (multi-element) jaw pair in IEC X direction MLCY = multileaf (multi-element) jaw pair in IEC Y direction Radiation source to beam limiting device (collimator) distance (mm). Number of leaf (element) or jaw pairs (equal to 1 for standard beam limiting device jaws). Boundaries (in mm) of beam limiting device (collimator) leaves (elements) in IEC BEAM LIMITING DEVICE coordinate axis appropriate to RT Beam Limiting Device Type (300A,00B8), i.e. X-axis for MLCY, Y-axis for MLCX. Contains N+1 values, where N is the Number of Leaf/Jaw Pairs (300A,00BC), starting from Leaf (Element) Pair 1. Required if RT Beam Limiting Device Type (300A,00B8) is MLCX or MLCY. Positions of beam limiting device (collimator) leaf or jaw (element) pairs (in mm) in IEC BEAM LIMITING DEVICE coordinate axis appropriate to RT Beam Limiting Device Type (300A,00B8), e.g. X-axis for MLCX, Y-axis for MLCY). Contains 2N values, where N is the Number of Leaf/Jaw Pairs (300A,00BC), in IEC leaf (element) subscript order 101, 102, ... 1N, 201, 202, ... 2N. Introduces sequence of Applicators associated with Beam. Only a single item shall be permitted in this sequence. User or machine supplied identifier for Applicator. Type of Applicator. Defined Terms: ELECTRON_SQUARE = square electron applicator ELECTRON_RECT = rectangular electron applicator ELECTRON_CIRC = circular electron applicator ELECTRON_SHORT = short electron applicator ELECTRON_OPEN = open (dummy) electron applicator INTRAOPERATIVE = intraoperative (custom) applicator STEREOTACTIC = stereotactic applicator User-defined description for Applicator. Number of shielding blocks associated with Beam. Introduces sequence of blocks associated with Beam. Required if Number of Blocks (300A,00F0) is non-zero. Zero or more items may be included in this sequence. User-supplied identifier for block tray. Radiation Source to attachment edge of block tray assembly (mm). Type of block. Enumerated Values: SHIELDING = blocking material is inside contour APERTURE = blocking material is outside contour Indicates presence or otherwise of geometrical divergence Enumerated Values: PRESENT = block edges are shaped for beam divergence ABSENT = block edges are not shaped for beam divergence Indicates on which side of the Block Tray the block is mounted. Enumerated Values: PATIENT_SIDE = the block is mounted on the side of the Block Tray which is towards the patient. SOURCE_SIDE = the block is mounted on the side of the Block Tray which is towards the radiation source. Identification Number of the Block. The value of Block Number (300A,00FC) shall be unique within the Beam in which it is created. User-defined name for block. User-supplied identifier for material used to manufacture Block. Physical thickness of block (in mm) parallel to radiation beam axis. Number of (x,y) pairs defining the block edge. A data stream of (x,y) pairs which comprise the block edge. The number of pairs shall be equal to Block Number of Points (300A,0104), and the vertices shall be interpreted as a closed polygon. Coordinates are projected onto the machine isocentric plane in the IEC BEAM LIMITING DEVICE coordinate system (mm). A Sequence of data describing the fluence map attributes for a radiotherapy beam. Only one item may be included in this sequence. Required if the third value of Image Type (0008,0008) is FLUENCE. Source of fluence data. Enumerated Values: CALCULATED = Calculated by a workstation MEASURED=Measured by exposure to a film or detector. The meterset corresponding with a fluence map cell value of 1.0 expressed in units specified by Primary Dosimeter Units (300A,00B3). This is the meterset value used for treatment, not the meterset used to expose the film as defined by Meterset Exposure (3002,0032). Treatment machine gantry angle, i.e. orientation of IEC GANTRY coordinate system with respect to IEC FIXED REFERENCE coordinate system (degrees). Gantry Pitch Angle. i.e. the rotation of the IEC GANTRY coordinate system about the X-axis of the IEC GANTRY coordinate system (degrees). See C.8.8.25.6.5.

The Gantry Pitch angle is not defined in IEC 61217. This angle is defined in the DICOM standard in a way compatible with the current notion of IEC by introducing it as rotation of the IEC GANTRY System as indicated below. The Gantry Pitch Angle is defined as the rotation of the coordinate axes Yg, Zg about axis Xg by an angle g; see Figure C.8.8.25-7. An increase in the value of angle g corresponds to the clockwise rotation as viewed from the isocenter along the positive Xg axis Figure C.8.8.25-7 Gantry Pitch Angle

Treatment machine beam limiting device (collimator) angle, i.e. orientation of IEC BEAM LIMITING DEVICE coordinate system with respect to IEC GANTRY coordinate system (degrees). Patient Support angle, i.e. orientation of IEC PATIENT SUPPORT coordinate system with respect to IEC FIXED REFERENCE coordinate system (degrees). Distance (positive) from the IEC PATIENT SUPPORT vertical axis to the IEC TABLE TOP ECCENTRIC vertical axis (mm). Table Top (non-isocentric) angle, i.e. orientation of IEC TABLE TOP ECCENTRIC coordinate system with respect to IEC PATIENT SUPPORT system (degrees). Table Top Pitch Angle, i.e. the rotation of the IEC TABLE TOP coordinate system about the X-axis of the IEC TABLE TOP coordinate system (degrees). See C.8.8.25.6.2.

Pitch and Roll Coordinate Systems of the Table Top are not defined in IEC 61217. These angles are defined in the DICOM standard in a way compatible with the current notion of IEC by introducing them as rotations of the IEC Table Top System as indicated below. The Table Top Pitch Angle is defined as the rotation of the coordinate axes Yt, Zt about axis Xt by an angle t; see Figure C.8.8.25-3. An increase in the value of angle t corresponds to the clockwise rotation of the Table Top as viewed from the Table Top coordinate system origin along the positive Xt axis. The Table Top Roll Angle is defined as the rotation of the coordinate axes Xt, Zt about axis Yt by an angle t; see Figure C.8.8.25-4. An increase in the value of angle t corresponds to the clockwise rotation of the Table Top as viewed from the Table Top coordinate system origin along the positive Yt axis. Figure C.8.8.25-3 Table Top Pitch Angle Figure C.8.8.25-4 Table Top Roll Angle

Table Top Roll Angle, i.e. the rotation of the IEC TABLE TOP coordinate system about the Y-axis of the IEC TABLE TOP coordinate system (degrees). See C.8.8.25.6.2.

Table Top Vertical position in IEC TABLE TOP coordinate system (mm). Table Top Longitudinal position in IEC TABLE TOP coordinate system (mm). Table Top Lateral position in IEC TABLE TOP coordinate system (mm). Isocenter coordinates (x,y,z), in mm. Specifies the location of the machine isocenter in the patient-based coordinate system associated with the Frame of Reference. It allows transformation from the equipment-based IEC coordinate system to the patient-based coordinate system. Patient position descriptor relative to the patient support device. Required if Isocenter Position (300A,012C) is present. May be present otherwise. See Section C.8.8.12.1.2 for Defined Terms and further explanation. Note: The orientation of the patient relative to the patient support device is denoted in the same manner as in the RT Patient Setup module. It defines the relation of the patient-based DICOM coordinate system identified by the frame of reference module of the RT Image to the IEC coordinate system and together with the Isocenter Position (300A,012C) allows the RT Image to be placed into the patient frame of reference. It also allows a system using an RT Image to verify that the patient is setup in a similar position relative to the patient support device.

Defined Terms for Patient Position shall be those specified in Section C.7.3.1.1.2, plus the following: SITTING In the sitting position, the patient’s face is towards the front of the chair.

Number of samples (planes) in this image. See C.8.8.3.4.1 for specialization. Required if Pixel Data (7FE0,0010) is present.

For RT Doses, Samples per Pixel (0028,0002) shall have the Enumerated Value of 1.

Specifies the intended interpretation of the pixel data. See C.8.8.3.4.2 for specialization. Required if Pixel Data (7FE0,0010) is present.

For RT Doses, Photometric Interpretation (0028,0004) shall have the Enumerated Value of MONOCHROME2.

Number of bits allocated for each pixel sample. Each sample shall have the same number of bits allocated. See C.8.8.3.4.3 for specialization. Required Pixel Data (7FE0,0010) is present.

For RT Doses, Bits Allocated (0028,0100) shall have an Enumerated Value of 16 or 32.

Number of bits stored for each pixel sample. Each sample shall have the same number of bits stored. See C.8.8.3.4.4 for specialization. Required if Pixel Data (7FE0,0010) is present.

For RT Doses, Bits Stored (0028,0101) shall have an Enumerated Value equal to Bits Allocated (0028,0100).

Most significant bit for each pixel sample. Each sample shall have the same high bit. See C.8.8.3.4.5 for specialization. Required if Pixel Data (7FE0,0010) is present.

For RT Doses, High Bit (0028,0102) shall have the Enumerated Value of one less than the value sent in Bits Stored (0028,0101).

Data representation of the pixel samples. Each sample shall have the same pixel representation. See C.8.8.3.4.6 for specialization. Required Pixel Data (7FE0,0010) is present.

For RT Doses, Pixel Representation (0028,0103) is specified to use the following Enumerated Values: 0001H = two’s complement integer, when Dose Type (3004,0004) = ERROR 0000H = unsigned integer, otherwise.

Units used to describe dose. Enumerated Values: GY = Gray RELATIVE = dose relative to implicit reference value Type of dose. Defined Terms: PHYSICAL = physical dose EFFECTIVE = physical dose after correction for biological effect using user-defined modeling technique ERROR = difference between desired and planned dose A number that identifies this object instance. User-defined comments for dose data. Coordinates (x, y, z) of normalization point in the patient based coordinate system described in C.7.6.2.1.1 (mm). See C.8.8.3.1.

The Normalization Point (3004,0008) aids in the interpretation and subsequent use of the transmitted data. If used, it shall be a point receiving dose contributions from all referenced components of the dose summation.

Type of dose summation. Defined Terms: PLAN = dose calculated for entire RT Plan FRACTION = dose calculated for a single Fraction Group within RT Plan BEAM = dose calculated for one or more Beams within RT Plan BRACHY = dose calculated for one or more Brachy Application Setups within RT Plan CONTROL_POINT = dose calculated for one or more Control Points within a Beam Introduces sequence of one Class/Instance pair describing RT Plan associated with dose. Required if Dose Summation Type (3004,000A) is PLAN, FRACTION, BEAM, BRACHY or CONTROL_POINT. Only a single item shall be permitted in this sequence. See Note 1. Introduces sequence of one Fraction Group containing beams or brachy application setups contributing to dose. Required if Dose Summation Type (3004,000A) is FRACTION, BEAM, BRACHY or CONTROL_POINT. Only a single item shall be permitted in this sequence. See Note 1. Uniquely identifies Fraction Group specified by Fraction Group Number (300A,0071) in Fraction Group Sequence of RT Fraction Scheme Module within RT Plan referenced in Referenced RT Plan Sequence (300C,0002). Introduces sequence of Beams in current Fraction Group contributing to dose. Required if Dose Summation Type (3004,000A) is BEAM or CONTROL_POINT. One or more items may be included in this sequence. Uniquely identifies Beam specified by Beam Number (300A,00C0) in Beam Sequence of RT Beams Module within RT Plan referenced in Referenced RT Plan Sequence (300C,0002). Sequence defining the Control Points in current Beam contributing to dose. Required if Dose Summation Type (3004,000A) is CONTROL_POINT. Only a single item shall be present in this sequence. Identifies Control Point specified by Control Point Index (300A,0112) within Beam referenced by Referenced Beam Number (300C,0006). This is the first of the two Control Points from which the Dose contribution to the Control Point can be calculated. Identifies Control Point specified by Control Point Index (300A,0112) within Beam referenced by Referenced Beam Number (300C,0006). This is the second of the two Control Points from which the Dose contribution to the Control Point can be calculated. The Control Point Index (300A,0112) referenced by Referenced Stop Control Point Index (300C,00F6) shall be the Control Point Index (300A,0112) immediately following the Control Point Index (300A,0112) referenced by Referenced Start Control Point Index (300C,00F4) within the Referenced Beam Number (300C,0006). Introduces sequence of Brachy Application Setups in current Fraction Group contributing to dose. Required if Dose Summation Type (3004,000A) is BRACHY. One or more items may be included in this sequence. Uniquely identifies Brachy Application Setup specified by Brachy Application Setup Number (300A,0234) in Brachy Application Setup Sequence (300A,0230) of RT Brachy Application Setups Module within RT Plan referenced in Referenced RT Plan Sequence (300C,0002). An array which contains the dose image plane offsets (in mm) of the dose image frames in a multi-frame dose. Required if multi-frame pixel data are present and Frame Increment Pointer (0028,0009) points to Grid Frame Offset Vector (3004,000C). See C.8.8.3.2.

Grid Frame Offset Vector (3004,000C) shall be provided if a dose distribution is sent as a multi-frame image. Values of the Grid Frame Offset Vector (3004,000C) shall vary monotonically and are to be interpreted as follows: a. If Grid Frame Offset Vector (3004,000C) is present and its first element is zero, this attribute contains an array of n elements indicating the plane location of the data in the right-handed image coordinate system, relative to the position of the first dose plane transmitted, i.e., the point at which the Image Position (Patient) (0020,0032) attribute is defined, with positive offsets in the direction of the cross product of the row and column directions. b. If Grid Frame Offset Vector (3004,000C) is present, its first element is equal to the third element of Image Position (Patient) (0020,0032), and Image Orientation (Patient) (0020,0037) has the value (1,0,0,0,1,0), then Grid Frame Offset Vector contains an array of n elements indicating the plane location (patient z coordinate) of the data in the patient coordinate system. In future implementations, use of option a) is strongly recommended. This attribute is conditional since the RT Dose module may be included even if pixel doses are not being transmitted, or the image may be a single-frame image. If the Multi-frame Module is present, Frame Increment Pointer (0028,0009) shall have the Enumerated Value of 3004000C (Grid Frame Offset Vector). Note: Option (a) can represent a rectangular-parallelepiped dose grid with any orientation with respect to the patient, while option (b) can only represent a rectangular-parallelepiped dose grid whose planes are in the transverse patient dimension and whose x- and y-axes are parallel to the patient x- and y-axes. Example: Figure C.8.8.3-1 shows an example of plane positions for a dose grid with transverse planes. Figure C.8.8.3-1 Dose Grid Frame Example For this example, Table C.8.39b gives the values of elements in the Grid Frame Offset Vector (3004,000C) for both relative (option (a)) and absolute (option (b)) interpretations, under the following conditions: 1. The value of Image Orientation (Patient) (0020,0037) is (1,0,0,0,1,0). I.e., the dose grid is transverse with x- and y-axes parallel to the patient x- and y-axes; 2. The value of Image Position (Patient) (0020,0032), i.e. the position of the first element of the dose grid, is (4, 5, 6); and 3. The spacing between adjacent dose grid planes is 2mm (uniform). Table C.8-39b. Values of Dose Grid Frame Offset Vector under Relative (a) and Absolute (b) Interpretations

Scaling factor that when multiplied by the dose grid data found in the Pixel Data (7FE0,0010) attribute of the Image Pixel Module, yields grid doses in the dose units as specified by Dose Units (3004,0002). Specifies a list of patient heterogeneity characteristics used for calculating dose. This Atttibute shall be multi-valued if beams used to compute the dose have differing correction techniques. Enumerated Values: IMAGE = image data ROI_OVERRIDE = one or more ROI densities override image or water values where they exist WATER = entire volume treated as water equivalent Introduces sequence of one class/instance pair describing Structure Set containing structures which are used to calculate Dose-Volume Histograms (DVHs). Only a single item shall be permitted in this sequence. See C.8.8.4.1.

The Referenced Structure Set Sequence (300C,0060) is required for direct cross-reference of the dose bin data with the corresponding ROI(s) from which they were derived. ROIs referenced by the DVH Referenced ROI Sequence (3004,0050) shall only contain contours with a Contour Geometric Type (3006,0042) of POINT or CLOSED_PLANAR.

Coordinates (x, y, z) of common DVH normalization point in the patient based coordinate system described in C.7.6.2.1.1 (mm). Dose Value at DVH Normalization Point (3004,0040) used as reference for individual DVHs when Dose Units (3004,0002) is RELATIVE. Introduces sequence of DVHs. One or more items may be included in this sequence. Introduces sequence of referenced ROIs used to calculate DVH. One or more items may be included in this sequence. Uniquely identifies ROI used to calculate DVH specified by ROI Number (3006,0022) in Structure Set ROI Sequence (3006,0020) in Structure Set Module within RT Structure Set referenced by referenced RT Plan in Referenced RT Plan Sequence (300C,0002) in RT Dose Module. Specifies whether volume within ROI is included or excluded in DVH. See C.8.8.4.2. Enumerated Values: INCLUDED, EXCLUDED.

The volume used to calculate the DVH shall be the geometric union of ROIs where DVH ROI Contribution Type (3004,0062) is INCLUDED, minus the geometric union of ROIs where DVH ROI Contribution Type (3004,0062) is EXCLUDED.

Type of DVH. Enumerated Values: DIFFERENTIAL = differential dose-volume histogram CUMULATIVE = cumulative dose-volume histogram NATURAL = natural dose volume histogram Dose axis units. Enumerated Values: GY = Gray RELATIVE = dose relative to reference value specified in DVH Normalization Dose Value (3004,0042) Type of dose. Defined Terms: PHYSICAL = physical dose EFFECTIVE = physical dose after correction for biological effect using user-defined modeling technique ERROR = difference between desired and planned dose Scaling factor that when multiplied by the dose bin widths found in DVH Data (3004,0058), yields dose bin widths in the dose units as specified by Dose Units (3004,0002). Volume axis units. Defined Terms: CM3 = cubic centimeters PERCENT = percent PER_U= volume per u with u(dose)=dose-3/2. See C.8.8.4.3.

The unit PER_U is defined in: Anderson, LL: “A “natural” volume-dose histogram for brachytherapy”, Medical Physics 13(6) pp 898-903, 1986.

Number of bins n used to store DVH Data (3004,0058). A data stream describing the dose bin widths Dn and associated volumes Vn in DVH Volume Units (3004,0054) in the order D1V1, D2V2, ... DnVn. Note: DVH Data arrays may not be properly encoded if Explicit-VR transfer syntax is used and the VL of this attribute exceeds 65534 bytes. Minimum calculated dose to ROI(s) described by DVH Referenced ROI Sequence (3004,0060). Maximum calculated dose to ROI(s) described by DVH Referenced ROI Sequence (3004,0060). Mean calculated dose to ROI(s) described by DVH Referenced ROI Sequence (3004,0060). User-defined label for Structure Set. User-defined name for Structure Set. User-defined description for Structure Set. A number that identifies this object instance. Date at which Structure Set was last modified. Time at which Structure Set was last modified. Introduces sequence of items describing Frames of Reference in which the ROIs are defined. One or more items may be included in this sequence. See C.8.8.5.1.

The Referenced Frame of Reference Sequence (3006,0010) describes a set of frames of reference in which some or all of the ROIs are expressed. Since the Referenced Frame of Reference UID (3006,0024) is required for each ROI, each frame of reference used to express the coordinates of an ROI shall be listed in the Referenced Frame of Reference Sequence (3006,0010) once and only once. Notes: 1.As an example, a set of ROIs defined using a single image series would list the image series in a single Referenced Frame of Reference Sequence (3006,0010) item, providing the UID for this referenced frame of reference (obtained from the source images), and listing all pertinent images in the Contour Image Sequence (3006,0016). 2. As an example, a set of ROIs containing ROIs referencing more than one frame of reference would list the referenced images in two or more different Referenced Frame of Reference Sequence (3006,0010) items, providing in each case the UID for this referenced frame of reference (obtained from the source images), and listing all pertinent images in the Contour Image Sequence (3006,0016). Each ROI would then reference the appropriate Frame of Reference UID (0020,0052).

Uniquely identifies Frame of Reference within Structure Set. Introduces sequence of transforms that relate other Frames of Reference to this Frame of Reference. One or more items may be included in this sequence. Frame of Reference Coordinate System to be transformed to the current Frame of Reference. Type of Transformation. Required if Frame of Reference Relationship Sequence (3006,00C0) is sent. Defined Terms: HOMOGENEOUS Four-by-four transformation Matrix from Related Frame of Reference to current Frame of Reference. Matrix elements shall be listed in row-major order. See C.8.8.5.2.

In a rigid body system, two coordinate systems can be related using a single 4 x 4 transformation matrix to describe any rotations and/or translations necessary to transform coordinates from the related coordinate system (frame of reference) to the primary system. The equation performing the transform from a point (X’,Y’,Z’) in the related coordinate system to a point (X,Y,Z) in the current coordinate system can be shown as follows, where for homogeneous transforms M41 = M42 = M43 = 0 and M44 = 1: X M11 M12 M13 M14 X’ Y = M21 M22 M23 M24 x Y’ Z M31 M32 M33 M34 Z’ 1 M41 M42 M43 M44 1

Comment regarding the transformation between the related and current Frames of Reference. Introduces sequence of Studies containing series to be referenced. One or more items may be included in this sequence. Introduces sequence of items describing series of images within the referenced study which are used in defining the Structure Set. One or more items may be included in this sequence. Unique identifier for the series containing the images. Introduces sequence of items describing images in a given series used in defining the Structure Set (typically CT or MR images). One or more items may be included in this sequence. Introduces sequence of ROIs for current Structure Set. One or more items may be included in this sequence. Identification number of the ROI. The value of ROI Number (3006,0022) shall be unique within the Structure Set in which it is created. Uniquely identifies Frame of Reference in which ROI is defined, specified by Frame of Reference UID (0020,0052) in Referenced Frame of Reference Sequence (3006,0010). User-defined name for ROI. User-defined description for ROI. Volume of ROI (cubic centimeters). Type of algorithm used to generate ROI. Defined Terms: AUTOMATIC = calculated ROI SEMIAUTOMATIC = ROI calculated with user assistance MANUAL = user-entered ROI User-defined description of technique used to generate ROI. Introduces sequence of Contour Sequences defining ROIs. One or more items may be included in this sequence. Uniquely identifies the referenced ROI described in the Structure Set ROI Sequence (3006,0020). RGB triplet color representation for ROI, specified using the range 0-255. Introduces sequence of Contours defining ROI. One or more items may be included in this sequence. Identification number of the contour. The value of Contour Number (3006,0048) shall be unique within the Contour Sequence (3006,0040) in which it is defined. No semantics or ordering shall be inferred from this attribute. List of Contour Number (3006,0048) defining lower-numbered contour(s) to which the current contour is connected. Introduces sequence of images containing the contour. One or more items may be included in this sequence. Geometric type of contour. See C.8.8.6.1. Enumerated Values: POINT = single point OPEN_PLANAR = open contour containing coplanar points OPEN_NONPLANAR = open contour containing non-coplanar points CLOSED_PLANAR = closed contour (polygon) containing coplanar points

A contour can be one of the following geometric types: - A Contour Geometric Type (3006,0042) of POINT indicates that the contour is a single point, defining a specific location of significance. - A Contour Geometric Type (3006,0042) of OPEN_PLANAR indicates that the last vertex shall not be connected to the first point, and that all points in Contour Data (3006,0050) shall be coplanar. - A Contour Geometric Type (3006,0042) of OPEN_NONPLANAR indicates that the last vertex shall not be connected to the first point, and that the points in Contour Data (3006,0050) may be non-coplanar. Contours having a Geometric Type (3006,0042) of OPEN_NONPLANAR can be used to represent objects best described by a single, possibly non-coplanar curve, such as a brachytherapy applicator. - A Contour Geometric Type (3006,0042) of CLOSED_PLANAR indicates that the last point shall be connected to the first point, where the first point is not repeated in the Contour Data (3006,0050). All points in Contour Data (3006,0050) shall be coplanar.

Thickness of slab (in mm) represented by contour, where the Contour Data (3006,0050) defines a plane in the center of the slab, offset by the Contour Offset Vector (3006,0045) if it is present. See C.8.8.6.2.

A set of Contour slabs may define a multi-slab Volume of Interest. Contour Slab Thickness (3006,0044) shall specify the thickness of a slab, the central plane of which shall be defined by the set of points offset from Contour Data (3006,0050) by the value of Contour Offset Vector (3006,0045). One contour slab may contain one to many sets of Contour Data (3006,0050) that may define regions of one complex Volume of Interest. If no valid value of Contour Slab Thickness (3006,0044) is sent, then the offset value shall be (0,0,0) and the original Contour Data (3006,0050) shall define the central plane of the Contour slab.

Vector (x,y,z) in the the patient based coordinate system described in C.7.6.2.1.1 which is normal to plane of Contour Data (3006,0050), describing direction and magnitude of the offset (in mm) of each point of the central plane of a contour slab from the corresponding original point of Contour Data (3006,0050). See C.8.8.6.2.

Number of points (triplets) in Contour Data (3006,0050). Sequence of (x,y,z) triplets defining a contour in the patient based coordinate system described in C.7.6.2.1.1 (mm). See C.8.8.6.1 and C.8.8.6.3. Note: Contour Data may not be properly encoded if Explicit-VR transfer syntax is used and the VL of this attribute exceeds 65534 bytes.

Introduces sequence of items specifying dose levels for isodose curves or dose points described in the ROI module. One or more items may be included in this sequence. See C.8.8.7.1.

ROIs referenced in the RT Dose ROI Module shall have a Contour Geometric Type (3006,0042) of POINT, OPEN_PLANAR or CLOSED_PLANAR.

Uniquely identifies the referenced ROI within the current RT Dose. See Note 1 and C.8.8.7.2. Units used for ROI Dose. Enumerated Values: GY = Gray RELATIVE = dose relative to implicit reference value Dose value for ROI, in units defined by Dose Units (3004,0002). See C.8.8.7.3.

Dose Value (3004,0012) shall be the dose value corresponding to the referenced isodose curve, named dose point, or unnamed dose point.

Introduces sequence of observations related to ROIs defined in the ROI Module. One or more items may be included in this sequence. Identification number of the Observation. The value of Observation Number (3006,0082) shall be unique within the RT ROI Observations Sequence (3006,0080). Uniquely identifies the referenced ROI described in the Structure Set ROI Sequence (3006,0020). User-defined label for ROI Observation. User-defined description for ROI Observation. Introduces sequence of significantly related ROIs, e.g. CTVs contained within a PTV. One or more items may be included in this sequence. Uniquely identifies the related ROI described in the Structure Set ROI Sequence (3006,0020). Relationship of referenced ROI with respect to referencing ROI. Defined Terms: SAME = ROIs represent the same entity ENCLOSED = referenced ROI completely encloses referencing ROI ENCLOSING = referencing ROI completely encloses referenced ROI Introduces sequence containing Code used to identify ROI. If this sequence is included, only one item shall be present. Baseline Context ID Number = 96. See Section 5.3 for further explanation. Introduces sequence of related ROI Observations. One or more items may be included in this sequence. Uniquely identifies a related ROI Observation. Type of ROI. See C.8.8.8.1. Defined Terms: EXTERNAL = external patient contour PTV = Planning Target Volume (as defined in ICRU50) CTV = Clinical Target Volume (as defined in ICRU50) GTV = Gross Tumor Volume (as defined in ICRU50) TREATED_VOLUME = Treated Volume (as defined in ICRU50) IRRAD_VOLUME = Irradiated Volume (as defined in ICRU50) BOLUS = patient bolus to be used for external beam therapy AVOIDANCE = region in which dose is to be minimized ORGAN = patient organ MARKER = patient marker or marker on a localizer REGISTRATION = registration ROI ISOCENTER = treatment isocenter to be used for external beam therapy CONTRAST_AGENT = volume into which a contrast agent has been injected CAVITY = patient anatomical cavity BRACHY_CHANNEL = brachytherapy channel BRACHY_ACCESSORY = brachytherapy accessory device BRACHY_SRC_APP = brachytherapy source applicator BRACHY_CHNL_SHLD = brachytherapy channel shield SUPPORT = external patient support device FIXATION = external patient fixation or immobilisation device DOSE_REGION = ROI to be used as a dose reference CONTROL = ROI to be used in control of dose optimization and calculation

RT ROI Interpreted Type (3006,00A4) shall describe the class of ROI (e.g. CTV, PTV). Individual instances of each class of structure (e.g. CTV1, CTV2) can be distinguished using ROI Observation Label (3006,0085).

Name of person performing the interpretation. User-supplied identifier for ROI material. Introduces sequence describing physical properties associated with current ROI interpretation. One or more items may be included in this sequence. Physical property specified by ROI Physical Property Value (3006,00B4). Defined Terms: REL_MASS_DENSITY = mass density relative to water REL_ELEC_DENSITY = electron density relative to water EFFECTIVE_Z = effective atomic number EFF_Z_PER_A = ratio of effective atomic number to mass (AMU-1) REL_STOP_RATIO = linear stopping power ratio relative to water ELEM_FRACTION = elemental composition of the material The elemental composition of the ROI and the atomic mass fraction of the elements in the ROI. Required if ROI Physical Property (3006,00B2) equals ELEM_FRACTION. One or more items may be included in this sequence. The atomic number of the element for which the ROI Elemental Composition Sequence (3006,00B6) is sent. The fractional weight of the element for which the ROI Elemental Composition Sequence (3006,00B6) is sent. The sum of all ROI Elemental Composition Atomic Mass Fractions (3006,00B8) sent in the ROI Elemental Composition Sequence (3006,00B6) shall equal 1.0 within acceptable limits of floating point precision. User-assigned value for physical property. User-defined label for treatment plan. User-defined name for treatment plan. User-defined description of treatment plan. A number that identifies this object instance. Name of operator(s) creating treatment plan. Date treatment plan was last modified. Time treatment plan was last modified. Planned treatment protocols. Intent of this plan. Defined Terms: CURATIVE = curative therapy on patient PALLIATIVE = palliative therapy on patient PROPHYLACTIC = preventative therapy on patient VERIFICATION = verification of patient plan using phantom MACHINE_QA= Quality assurance of the delivery machine (independently of a specific patient) RESEARCH = Research project SERVICE = Machine repair or maintenance operation Planned treatment sites. Describes whether RT Plan is based on patient or treatment device geometry. See C.8.8.9.1. Defined Terms: PATIENT = RT Structure Set exists TREATMENT_DEVICE = RT Structure Set does not exist

An RT Plan Geometry (300A,000C) of PATIENT shall signify that an RT Structure Set has been defined upon which the plan geometry is based, and this RT Structure Set shall be specified in the Referenced Structure Set Sequence (300C,0060). An RT Plan Geometry (300A,000C) of TREATMENT_DEVICE shall indicate that no patient geometry is available, and that the RT Plan is being defined with respect to the IEC FIXED Coordinate System.

Introduces sequence of one Class/Instance pair describing instance of RT Structure Set on which the RT Plan is based. Only a single item shall be permitted in this sequence. Required if RT Plan Geometry (300A,000C) is PATIENT. Introduces sequence of related SOP Class/Instance pairs describing related instances of RT Dose (for grids and named/unnamed point doses). One or more items may be included in this sequence. See Note 1. Introduces sequence of related SOP Class/Instance pairs describing related instances of RT Plan. One or more items may be included in this sequence. Relationship of referenced plan with respect to current plan. Defined Terms: PRIOR = plan delivered prior to current treatment ALTERNATIVE = alternative plan prepared for current treatment PREDECESSOR = plan used in derivation of current plan VERIFIED_PLAN = plan which is verified using the current plan. This value shall only be used if Plan Intent (300A,000A) is present and has a value of VERIFICATION. User-defined description of treatment prescription. Introduces sequence of Dose References. One or more items may be included in this sequence. Identification number of the Dose Reference. The value of Dose Reference Number (300A,0012) shall be unique within the RT Plan in which it is created. A unique identifier for a Dose Reference that can be used to link the same entity across multiple RT Plan objects. Structure type of Dose Reference. Defined Terms: POINT = dose reference point specified as ROI VOLUME = dose reference volume specified as ROI COORDINATES = point specified by Dose Reference Point Coordinates (300A,0018) SITE = dose reference clinical site User-defined description of Dose Reference. Uniquely identifies ROI representing the dose reference specified by ROI Number (3006,0022) in Structure Set ROI Sequence (3006,0020) in Structure Set Module within RT Structure Set in Referenced Structure Set Sequence (300C,0060) in RT General Plan Module. Required if Dose Reference Structure Type (300A,0014) is POINT or VOLUME. Coordinates (x,y,z) of Reference Point in the patient based coordinate system described in C.7.6.2.1.1 (mm). Required if Dose Reference Structure Type (300A,0014) is COORDINATES. Dose (in Gy) from prior treatment to this Dose Reference (e.g. from a previous course of treatment). Type of Dose Reference. Defined Terms: TARGET = treatment target (corresponding to GTV, PTV, or CTV in ICRU50) ORGAN_AT_RISK = Organ at Risk (as defined in ICRU50) Relative importance of satisfying constraint, where high values represent more important constraints. The dose (in Gy) which when reached or exceeded should cause some action to be taken. The maximum dose (in Gy) which can be delivered to the dose reference. Minimum permitted dose (in Gy) to Dose Reference if Dose Reference Type (300A,0020) is TARGET. Prescribed dose (in Gy) to Dose Reference if Dose Reference Type (300A,0020) is TARGET. Maximum permitted dose (in Gy) to Dose Reference if Dose Reference Type (300A,0020) is TARGET. Maximum permitted fraction (in percent) of Target to receive less than the Target Prescription Dose if Dose Reference Type (300A,0020) is TARGET and Dose Reference Structure Type (300A,0014) is VOLUME. See C.8.8.10.1.

If the Target Underdose Volume Fraction (300A,0028) is not present, it shall be interpreted as zero.

Maximum dose (in Gy) to entire Dose Reference if Dose Reference Type (300A,0020) is ORGAN_AT_RISK and Dose Reference Structure Type (300A,0014) is VOLUME. Maximum permitted dose (in Gy) to any part of Dose Reference if Dose Reference Type (300A,0020) is ORGAN_AT_RISK and Dose Reference Structure Type (300A,0014) is VOLUME. Maximum dose (in Gy) to non-overdosed part of Dose Reference if Dose Reference Type (300A,0020) is ORGAN_AT_RISK and Dose Reference Structure Type (300A,0014) is VOLUME. Maximum permitted fraction (in percent) of the Organ at Risk to receive more than the Organ at Risk Maximum Dose if Dose Reference Type (300A,0020) is ORGAN_AT_RISK and Dose Reference Structure Type (300A,0014) is VOLUME. Introduces sequence of tolerance tables to be used for delivery of treatment plan. One or more items may be included in this sequence. See Note 1. Identification number of the Tolerance Table. The value of Tolerance Table Number (300A,0042) shall be unique within the RT Plan in which it is created. Required if Tolerance Table Sequence (300A,0040) is sent. User-defined label for Tolerance Table. Maximum permitted difference (in degrees) between planned and delivered Gantry Angle. Maximum permitted difference (in degrees) between planned and delivered Gantry Pitch Angle. Maximum permitted difference (in degrees) between planned and delivered Beam Limiting Device Angle. Introduces sequence of beam limiting device (collimator) tolerances. One or more items may be included in this sequence. Type of beam limiting device (collimator). Required if Beam Limiting Device Tolerance Sequence (300A,0048) is sent. Enumerated Values: X = symmetric jaw pair in IEC X direction Y = symmetric jaw pair in IEC Y direction ASYMX = asymmetric jaw pair in IEC X direction ASYMY = asymmetric pair in IEC Y direction MLCX = multileaf (multi-element) jaw pair in IEC X direction MLCY = multileaf (multi-element) jaw pair in IEC Y direction Maximum permitted difference (in mm) between planned and delivered leaf (element) or jaw positions for current beam limiting device (collimator). Required if Beam Limiting Device Tolerance Sequence (300A,0048) is sent. Maximum permitted difference (in degrees) between planned and delivered Patient Support Angle. Maximum permitted difference (in degrees) between planned and delivered Table Top Eccentric Angle. Maximum permitted difference (in degrees) between the planned and delivered Table Top Pitch Angle. Maximum permitted difference (in degrees) between the planned and delivered Table Top Roll Angle. Maximum permitted difference (in mm) between planned and delivered Table Top Vertical Position. Maximum permitted difference (in mm) between planned and delivered Table Top Longitudinal Position. Maximum permitted difference (in mm) between planned and delivered Table Top Lateral Position. Introduces sequence of patient setup data for current plan. One or more items may be included in this sequence. Identification number of the Patient Setup. The value of Patient Setup Number (300A,0182) shall be unique within the RT Plan in which it is created. The user-defined label for the patient setup. Patient position descriptor relative to the equipment. Required if Patient Additional Position (300A,0184) is not present. See Section C.8.8.12.1.2 for Defined Terms and further explanation.

Defined Terms for Patient Position shall be those specified in Section C.7.3.1.1.2, plus the following: SITTING In the sitting position, the patient’s face is towards the front of the chair.

User-defined additional description of patient position. Required if Patient Position (0018,5100) is not present. Introduces sequence of setup verification images for this patient setup. One or more items may be included in this sequence. See C.8.8.12.1.1

Images with modality SC or VL serve as visible light photos for visual setup control. Images with modality RTIMAGE serve as reference images on plan level. RT Images present in this sequence shall not be referenced in the Referenced Reference Image Sequence (300C,0042) of the RT Beams module.

Comment on the Setup Image. Introduces sequence of Fixation Devices used in Patient Setup. One or more items may be included in this sequence. Type of Fixation Device used during in Patient Setup. Required if Fixation Device Sequence (300A,0190) is sent. Defined Terms: BITEBLOCK HEADFRAME MASK MOLD CAST HEADREST BREAST_BOARD BODY_FRAME VACUUM_MOLD WHOLE_BODY_POD RECTAL_BALLOON User-defined label identifier for Fixation Device. Required if Fixation Device Sequence (300A,0190) is sent. User-defined description of Fixation Device. Position/Notch number of Fixation Device. The Fixation Device Pitch Angle, i.e. orientation of PITCHED FIXATION DEVICE coordinate system with respect to IEC PATIENT SUPPORT coordinate system (degrees). Pitching is the rotation around IEC PATIENT SUPPORT X-axis. The Fixation Device Roll Angle, i.e. orientation of ROLLED FIXATION DEVICE coordinate system with respect to IEC PITCHED FIXATION DEVICE coordinate system (degrees). Rolling is the rotation around IEC PATIENT SUPPORT Y-axis. An identifier for the accessory intended to be read by a device such as a bar-code reader. Introduces sequence of Shielding Devices used in Patient Setup. One or more items may be included in this sequence. Type of Shielding Device used in Patient Setup. Required if Shielding Device Sequence (300A,01A0) is sent. Defined Terms: GUM EYE GONAD User-defined label for Shielding Device. Required if Shielding Device Sequence (300A,01A0) is sent. User-defined description of Shielding Device. Position/Notch number of Shielding Device. An identifier for the accessory intended to be read by a device such as a bar-code reader. Setup Technique used in Patient Setup. Defined Terms: ISOCENTRIC FIXED_SSD TBI BREAST_BRIDGE SKIN_APPOSITION User-defined description of Setup Technique. Introduces sequence of devices used for patient alignment in Patient Setup. One or more items may be included in this sequence. Type of Setup Device used for Patient alignment. Required if Setup Device Sequence (300A,01B4) is sent. Defined Terms: LASER_POINTER DISTANCE_METER TABLE_HEIGHT MECHANICAL_PTR ARC User-defined label for Setup Device used for patient alignment. Required if Setup Device Sequence (300A,01B4) is sent. User-defined description for Setup Device used for patient alignment. Setup Parameter for Setup Device in appropriate IEC 61217 coordinate system. Units shall be mm for distances and degrees for angles. Required if Setup Device Sequence (300A,011B4) is sent. User-defined description of Setup Reference used for patient alignment. Vertical Displacement in IEC TABLE TOP coordinate system (in mm) relative to initial Setup Position, i.e. vertical offset between patient positioning performed using setup and treatment position. Longitudinal Displacement in IEC TABLE TOP coordinate system (in mm) relative to initial Setup Position, i.e. longitudinal offset between patient positioning performed using setup and treatment position. Lateral Displacement in IEC TABLE TOP coordinate system (in mm) relative to initial Setup Position, i.e. lateral offset between patient positioning performed using setup and treatment position. Introduces sequence of Motion Synchronization. One or more items may be included in this sequence. Technique applied to reduce respiratory motion artifacts. Defined Terms: NONE BREATH_HOLD REALTIME = image acquisition shorter than respiratory cycle GATING = Prospective gating TRACKING = prospective through-plane or in-plane motion tracking PHASE_ORDERING = prospective phase ordering PHASE_RESCANNING = prospective techniques, such as real-time averaging, diminishing variance and motion adaptive gating RETROSPECTIVE = retrospective gating CORRECTION = retrospective image correction UNKNOWN = technique not known Signal source from which respiratory motion is derived. Defined Terms: NONE BELT NASAL_PROBE CO2_SENSOR NAVIGATOR = MR navigator and organ edge detection MR_PHASE = phase (of center k-space line) ECG = baseline demodulation of the ECG SPIROMETER = Signal derived from flow sensor EXTERNAL_MARKER = Signal determined from external motion surrogate INTERNAL_MARKER = Signal determined from internal motion surrogate IMAGE = Signal derived from an image UNKNOWN = Signal source not known Description of respiratory motion compensation technique. Identifies the device providing the respiratory signal. Introduces sequence of Fraction Groups in current Fraction Scheme. One or more items may be included in this sequence. Identification number of the Fraction Group. The value of Fraction Group Number (300A,0071) shall be unique within the RT Plan in which it is created. The user defined description for the fraction group. Introduces sequence of related SOP Class/Instance pairs describing related instances of RT Dose (for grids, isodose curves and named/unnamed point doses). One or more items may be included in this sequence. See Note 1. Introduces sequence of Dose References for the current Fraction Group. One or more items may be included in this sequence. Uniquely identifies Dose Reference specified by Dose Reference Number (300A,0012) within Dose Reference Sequence (300A,0010) in RT Prescription Module. Required if Referenced Dose Reference Sequence (300C,0050) is sent. Relative importance of satisfying constraint, where high values represent more important constraints. The dose (in Gy) which when reached or exceeded should cause some action to be taken. The maximum dose (in Gy) which can be delivered to the dose reference. Minimum permitted dose (in Gy) to Dose Reference if Dose Reference Type (300A,0020) of referenced Dose Reference is TARGET. Prescribed dose (in Gy) to Dose Reference if Dose Reference Type (300A,0020) of referenced Dose Reference is TARGET. Maximum permitted dose (in Gy) to Dose Reference if Dose Reference Type (300A,0020) of referenced Dose Reference is TARGET. Maximum permitted fraction (in percent) of Target to receive less than the Target Prescription Dose (300A,0027) if Dose Reference Type (300A,0020) of referenced Dose Reference is TARGET and Dose Reference Structure Type (300A,0014) of referenced Dose Reference is VOLUME. Maximum dose (in Gy) to entire Dose Reference if Dose Reference Type (300A,0020) of referenced Dose Reference is ORGAN_AT_RISK and Dose Reference Structure Type (300A,0014) of referenced Dose Reference is VOLUME. Maximum permitted dose (in Gy) to any part of Dose Reference if Dose Reference Type (300A,0020) of referenced Dose Reference is ORGAN_AT_RISK and Dose Reference Structure Type (300A,0014) of referenced Dose Reference is VOLUME. Maximum dose (in Gy) to non-overdosed part of Dose Reference if Dose Reference Type (300A,0020) of referenced Dose Reference is ORGAN_AT_RISK and Dose Reference Structure Type (300A,0014) of referenced Dose Reference is VOLUME. Maximum permitted fraction (in percent) of Organ at Risk to receive more than the Organ at Risk Maximum Dose if Dose Reference Type (300A,0020) of referenced Dose Reference is ORGAN_AT_RISK and Dose Reference Structure Type (300A,0014) of referenced Dose Reference is VOLUME. Total number of treatments (Fractions) prescribed for current Fraction Group. Number of digits in Fraction Pattern (300A,007B) used to represent one day. See Note 2. Number of weeks needed to describe treatment pattern. See Note 2. String of 0's (no treatment) and 1's (treatment) describing treatment pattern. Length of string is 7 x Number of Fraction Pattern Digits Per Day x Repeat Fraction Cycle Length. Pattern shall start on a Monday. See Note 2. Number of Beams in current Fraction Group. If Number of Beams is greater then zero, Number of Brachy Application Setups (300A,00A0) shall equal zero. Introduces sequence of treatment beams in current Fraction Group. Required if Number of Beams (300A,0080) is greater than zero. One or more items may be included in this sequence. Uniquely identifies Beam specified by Beam Number (300A,00C0) within Beam Sequence (300A,00B0) in RT Beams Module. Required if Referenced Beam Sequence (300C,0004) is sent. Coordinates (x,y,z) of point at which Beam Dose is specified in the patient based coordinate system described in C.7.6.2.1.1 (mm). See Note 3. Dose (in Gy) at Beam Dose Specification Point (300A,0082) due to current Beam. The depth (in mm) in the patient along a ray from the source to the dose point specified by the Beam Dose Specification Point (300A,0082). The radiological depth in mm (water-equivalent depth, taking tissue heterogeneity into account) in the patient along a ray from the source to the dose point specified by the Beam Dose Specification Point (300A,0082). Source to patient surface distance along a ray from the source to the dose point specified by the Beam Dose Specification Point (300A,0082). Machine setting to be delivered for current Beam, specified in Monitor Units (MU) or minutes as defined by Primary Dosimeter Unit (300A,00B3) (in RT Beams Module) for referenced Beam. See Note 4. Number of Brachy Application Setups in current Fraction Group. If Number of Brachy Application Setups is greater then zero, Number of Beams (300A,0080) shall equal zero. Introduces sequence of treatment Brachy Application Setups in current Fraction Group. Required if Number of Brachy Application Setups (300A,00A0) is greater than zero. One or more items may be included in this sequence. Uniquely identifies Brachy Application Setup specified by Brachy Application Setup Number (300A,0234) within Brachy Application Setup Sequence (300A,0230) in RT Brachy Application Setups Module. Required if Referenced Brachy Application Setup Sequence (300C,000A) is sent. Coordinates (x,y,z) of point in the patient based coordinate system described in C.7.6.2.1.1 at which Brachy Application Setup Dose (300A,00A4) is specified (mm). Dose (in Gy) at Brachy Application Setup Dose Specification Point (300A,00A2) due to current Brachy Application Setup. Introduces sequence of treatment beams for current RT Plan. One or more items may be included in this sequence. Identification number of the Beam. The value of Beam Number (300A,00C0) shall be unique within the RT Plan in which it is created. See Note 1. User-defined name for Beam. See Note 1. User-defined description for Beam. See Note 1. Motion characteristic of Beam. See Note 5. Enumerated Values: STATIC = All Control Point Sequence (300A,0111) attributes remain unchanged between consecutive pairs of control points with changing Cumulative Meterset Weight (300A,0134). DYNAMIC = One or more Control Point Sequence (300A,0111) attributes change between one or more consecutive pairs of control points with changing Cumulative Meterset Weight (300A,0134). Particle type of Beam. Defined Terms: PHOTON ELECTRON NEUTRON PROTON Type of high-dose treatment technique. Defined Terms: NORMAL = Standard treatment TBI = Total Body Irradiation HDR = High Dose Rate Required if treatment technique requires a dose that would normally require overriding of treatment machine safety controls. User-defined name identifying treatment machine to be used for beam delivery. See Note 2. Manufacturer of the equipment to be used for beam delivery. Institution where the equipment is located that is to be used for beam delivery. Mailing address of the institution where the equipment is located that is to be used for beam delivery. Department in the institution where the equipment is located that is to be used for beam delivery. Manufacturer's model name of the equipment that is to be used for beam delivery. Manufacturer's serial number of the equipment that is to be used for beam delivery. Measurement unit of machine dosimeter. See C.8.8.14.1. Enumerated Values: MU = Monitor Unit MINUTE = minute

The Meterset at a given Control Point is equal to the Beam Meterset (300A,0086) specified in the Referenced Beam Sequence (300C,0004) of the RT Fraction Scheme Module, multiplied by the Cumulative Meterset Weight (300A,0134) for the Control Point, divided by the Final Cumulative Meterset Weight (300A,010E). The Meterset is specified in units defined by Primary Dosimeter Unit (300A,00B3). If the calculation for Meterset results in a meterset value which is not an exact multiple of the primary meterset resolution, then the result shall be rounded to the nearest allowed meterset value (i.e. less than a half resolution unit shall be rounded down to the nearest resolution unit, and equal or greater than half a resolution unit shall be rounded up to the nearest resolution unit). Note also that if Final Cumulative Meterset Weight (300A,010E) is equal to 100, then Cumulative Meterset Weight (300A,0134) becomes equivalent to the percentage of Beam Meterset (300A,0086) delivered at each control point. If Final Cumulative Meterset Weight (300A,010E) is equal to Beam Meterset (300A,0086), then the Cumulative Meterset Weight (300A,0134) at each control point becomes equal to the cumulative Meterset delivered at that control point.

Uniquely identifies Tolerance Table specified by Tolerance Table Number (300A,0042) within Tolerance Table Sequence in RT Tolerance Tables Module. These tolerances are to be used for verification of treatment machine settings. Radiation source to Gantry rotation axis distance of the equipment that is to be used for beam delivery (mm). Introduces sequence of beam limiting device (collimator) jaw or leaf (element) sets. One or more items may be included in this sequence. Type of beam limiting device (collimator). Enumerated Values: X = symmetric jaw pair in IEC X direction Y = symmetric jaw pair in IEC Y direction ASYMX = asymmetric jaw pair in IEC X direction ASYMY = asymmetric pair in IEC Y direction MLCX = multileaf (multi-element) jaw pair in IEC X direction MLCY = multileaf (multi-element) jaw pair in IEC Y direction Radiation source to beam limiting device (collimator) distance of the equipment that is to be used for beam delivery (mm). Number of leaf (element) or jaw pairs (equal to 1 for standard beam limiting device jaws). Boundaries of beam limiting device (collimator) leaves (in mm) in IEC BEAM LIMITING DEVICE coordinate axis appropriate to RT Beam Limiting Device Type (300A,00B8), i.e. X-axis for MLCY, Y-axis for MLCX. Contains N+1 values, where N is the Number of Leaf/Jaw Pairs (300A,00BC), starting from Leaf (Element) Pair 1. Required if Beam Limiting Device Sequence (300A,00B6) is sent and RT Beam Limiting Device Type (300A,00B8) is MLCX or MLCY. See Note 3. Uniquely identifies Patient Setup to be used for current beam, specified by Patient Setup Number (300A,0182) within Patient Setup Sequence of RT Patient Setup Module. Introduces sequence of reference images used for validation of current beam. One or more items may be included in this sequence. Uniquely identifies Reference Image within Referenced Reference Image Sequence (300A,0042). Required if Referenced Reference Image Sequence (300A,0042) is sent. Cumulative Meterset Weight within current Beam at which image acquisition starts. Cumulative Meterset Weight within current Beam at which image acquisition ends. Introduces sequence of planned verification images to be acquired during current beam. One or more items may be included in this sequence. See C.8.8.14.2.

The Planned Verification Image Sequence (300A,00CA) contains attributes which describe the planned verification images to be acquired during current beam. The Start Cumulative Meterset Weight (300C,0008) specifies the Cumulative Meterset Weight at which image acquisition is to begin. If Meterset Exposure (3002,0032) is present in a sequence item and End Cumulative Meterset Weight (300C,0009) is not present then a single image shall be acquired using the meterset duration specified in Meterset Exposure (3002,0032). If End Cumulative Meterset Weight (300C,0009) is present in a sequence item and Meterset Exposure (3002,0032) is not present then a single image shall be acquired over the beam delivery from Start Cumulative Meterset Weight (300C,0008) to End Cumulative Meterset Weight (300C,0009). If both Meterset Exposure (3002,0032) and End Cumulative Meterset Weight (300C,0009) are present in a sequence item then images shall be acquired every Meterset Exposure (3002,0032) from Start Cumulative Meterset Weight (300C,0008) to End Cumulative Meterset Weight (300C,0009). No images shall extend past End Cumulative Meterset Weight (300C,0009).

Cumulative Meterset Weight within current Beam at which image acquisition will start. Meterset duration over which image is to be acquired, specified in Monitor units (MU) or minutes as defined by Primary Dosimeter Unit (300A,00B3). Cumulative Meterset Weight within current Beam at which image acquisition will end. Describes whether or not image plane is normal to beam axis. Enumerated Values: NORMAL = image plane normal to beam axis NON_NORMAL = image plane non-normal to beam axis X-Ray Image Receptor Angle i.e. orientation of IEC X-RAY IMAGE RECEPTOR coordinate system with respect to IEC GANTRY coordinate system (degrees). See C.8.8.14.3.

The direction cosines of the first row and the first column with respect to the IEC X-RAY IMAGE RECEPTOR coordinate system. The x and y coordinates (in mm) of the upper left hand corner of the image, in the IEC X-RAY IMAGE RECEPTOR coordinate system. This is the center of the first pixel transmitted. Radiation machine source to image plane distance (mm). User-specified device-specific parameters that describe how the imager will acquire the image. Uniquely identifies Reference Image to which planned verification image is related, specified by Reference Image Number (300A,00C8) within Referenced Reference Image Sequence (300A,0042). Delivery Type of treatment. Defined Terms: TREATMENT = normal patient treatment OPEN_PORTFILM = portal image acquisition with open field TRMT_PORTFILM = portal image acquisition with treatment port CONTINUATION = continuation of interrupted treatment SETUP = no treatment beam is applied for this RT Beam. To be used for specifying the gantry, couch, and other machine positions where X-Ray set-up images or measurements are to be taken Introduces sequence of related SOP Class/Instance pairs describing related instances of RT Dose (for grids, isodose curves, and named/unnamed point doses). One or more items may be included in this sequence. Number of wedges associated with current Beam. Introduces sequence of treatment wedges. Required if Number of Wedges (300A,00D0) is non-zero. One or more items may be included in this sequence. Identification number of the Wedge. The value of Wedge Number (300A,00D2) shall be unique within the Beam in which it is created. Required if Wedge Sequence (300A,00D1) is sent. Type of wedge (if any) defined for Beam. Required if Wedge Sequence (300A,00D1) is sent. Defined Terms: STANDARD = standard (static) wedge DYNAMIC = moving beam limiting device (collimator) jaw simulating wedge MOTORIZED = single wedge which can be removed from beam remotely User-supplied identifier for Wedge. An identifier for the accessory intended to be read by a device such as a bar-code reader. Nominal wedge angle (degrees). Required if Wedge Sequence (300A,00D1) is sent. Nominal wedge factor under machine calibration conditions at the beam energy specified by the Nominal Beam Energy (300A,0114) of the first Control Point of the Control Point Sequence (300A,0111). Required if Wedge Sequence (300A,00D1) is sent. Orientation of wedge, i.e. orientation of IEC WEDGE FILTER coordinate system with respect to IEC BEAM LIMITING DEVICE coordinate system (degrees). Required if Wedge Sequence (300A,00D1) is sent. Radiation source to wedge tray attachment edge distance (in mm) for current wedge. Number of compensators associated with current Beam. Compensator Tray transmission factor (between 0 and 1), at the beam energy specified by the Nominal Beam Energy (300A,0114) of the first Control Point of the Control Point Sequence (300A,0111). Introduces sequence of treatment compensators. Required if Number of Compensators (300A,00E0) is non-zero. One or more items may be included in this sequence. User defined description for the compensator. Identification number of the Compensator. The value of Compensator Number (300A,00E4) shall be unique within the Beam in which it is created. Required if Number of Compensators (300A,00E0) is non-zero. Type of compensator (if any). Defined Terms: STANDARD = physical (static) compensator DYNAMIC = moving Beam Limiting Device (collimator) simulating physical compensator User-supplied identifier for material used to manufacture Compensator. Required if Number of Compensators (300A,00E0) is non-zero. User-supplied identifier for compensator. An identifier for the accessory intended to be read by a device such as a bar-code reader. Radiation source to compensator tray attachment edge distance (in mm) for current compensator. Required if Compensator Sequence (300A,00E3) is sent. Indicates presence or absence of geometrical divergence of the compensator. Enumerated Values: PRESENT = the compensator is shaped according to the beam geometrical divergence. ABSENT = the compensator is not shaped according to the beam geometrical divergence. Indicates on which side of the Compensator Tray the compensator is mounted. Enumerated Values: PATIENT_SIDE = the compensator is mounted on the side of the Compensator Tray which is towards the patient. SOURCE_SIDE = the compensator is mounted on the side of the Compensator Tray which is towards the radiation source. DOUBLE_SIDED = the compensator has a shaped (i.e. non-flat) surface on both sides of the Compensator Tray. Number of rows in the compensator. A row is defined to be in the X direction of the IEC Beam Limiting Device Coordinate system. Number of columns in the compensator. A column is defined to be in the Y direction of the IEC Beam Limiting Device Coordinate system. Physical distance (in mm) between the center of each pixel projected onto machine isocentric plane. Specified by a numeric pair - adjacent row spacing (delimiter) adjacent column spacing. See 10.7.1.3 for further explanation of the value order. Required if Compensator Sequence (300A,00E3) is sent. The x and y coordinates of the upper left hand corner (first pixel transmitted) of the compensator, projected onto the machine isocentric plane in the IEC BEAM LIMITING DEVICE coordinate system (mm). Required if Compensator Sequence (300A,00E3) is sent. A data stream of the pixel samples which comprise the compensator, expressed as broad-beam transmission values (between 0 and 1) along a ray line passing through the pixel, at the beam energy specified by the Nominal Beam Energy (300A,0114) of the first Control Point of the Control Point Sequence (300A,0111). The order of pixels sent is left to right, top to bottom, i.e., the upper left pixel is sent first followed by the remainder of the first row , followed by the first pixel of the 2nd row, then the remainder of the 2nd row and so on) when viewed from the radiation source. Required if Material ID (300A,00E1) is zero-length. May be present if Material ID (300A,00E1) is non-zero length. See C.8.8.14.10 and C.8.8.14.11. Note: Compensator Transmission Data may not be properly encoded if Explicit-VR transfer syntax is used and the VL of this attribute exceeds 65534 bytes.

The direction of the rows and columns in Compensator Transmission Data (300A,00EB) and Compensator Thickness Data (300A,00EC) is defined as follows: The direction of rows goes along the positive Xb direction and the direction of the columns does along the negative Yb direction of the IEC X-BEAM LIMITING DEVICE coordinate system. Other interpretations shall be documented in an implementation's conformance statement.

A data stream of the pixel samples which comprise the compensator, expressed as thicknesses (in mm). The order of pixels sent is left to right, top to bottom, i.e., the upper left pixel is sent first followed by the remainder of the first row , followed by the first pixel of the 2nd row, then the remainder of the 2nd row and so on) when viewed from the radiation source. Required if Material ID (300A,00E1) is non-zero length. May be present if Material ID (300A,00E1) is zero length. See C.8.8.14.9 and C.8.8.14.10 and C.8.8.14.11. Note: Compensator Thickness Data may not be properly encoded if Explicit-VR transfer syntax is used and the VL of this attribute exceeds 65534 bytes.

The values stored in Compensator Thickness Data (300A,00EC) and Source to Compensator Distance (300A,02E2) shall be parallel to the radiation beam axis if Compensator Divergence (300A,02E0) equals ABSENT, or divergent according to the beam geometrical divergence if Compensator Divergence (300A,02E0) equals PRESENT. If Compensator Divergence (300A,02E0) is not sent, then the parallel or divergent nature of the thicknesses is as if ABSENT was specified for Compensator Divergence (300A,02E0).

A data stream of the pixel samples which comprise the distance from the radiation source to the compensator surface closest to the radiation source (in mm). The order of pixels sent is left to right, top to bottom (upper left pixel, followed by the remainder of row 1, followed by the remainder of the columns). Required if Material ID (300A,00E1) is non-zero length, and Compensator Mounting Position (300A,02E1) is DOUBLE_SIDED. May be present if Material ID (300A,00E1) is zero length and Compensator Mounting Position (300A,02E1) is DOUBLE_SIDED. See C.8.8.14.9 and C.8.8.14.11.

Number of boli associated with current Beam. Introduces sequence of boli associated with Beam. Required if Number of Boli (300A,00ED) is non-zero. One or more items may be included in this sequence. Uniquely identifies ROI representing the Bolus specified by ROI Number (3006,0022) in Structure Set ROI Sequence (3006,0020) in Structure Set Module within RT Structure Set in Referenced Structure Set Sequence (300C,0060) in RT General Plan Module. Required if Referenced Bolus Sequence (300C,00B0) is sent. User-supplied identifier for the Bolus. User-defined description for the Bolus. An identifier for the accessory intended to be read by a device such as a bar-code reader. Number of shielding blocks associated with Beam. Total block tray transmission for all block trays (between 0 and 1) at the beam energy specified by the Nominal Beam Energy (300A,0114) of the first Control Point of the Control Point Sequence (300A,0111). Introduces sequence of blocks associated with Beam. Required if Number of Blocks (300A,00F0) is non-zero. One or more items may be included in this sequence. User-supplied identifier for block tray. An identifier for the accessory intended to be read by a device such as a bar-code reader. Radiation Source to attachment edge of block tray assembly (mm). Required if Block Sequence (300A,00F4) is sent. Type of block. Required if Block Sequence (300A,00F4) is sent. See C.8.8.14.4. Enumerated Values: SHIELDING = blocking material is inside contour APERTURE = blocking material is outside contour

All blocks with Block Type (300A,00F8) of APERTURE for a given beam shall have equal values of Block Transmission (300A,0102) and/or Block Thickness (300A,0100) if they are specified. The composite aperture shall be evaluated as the union of the individual apertures within a single Block. Shielding block transmission(s) shall be applied multiplicatively after the (composite) aperture has been evaluated.

Indicates presence or otherwise of geometrical divergence. Required if Block Sequence (300A,00F4) is sent. Enumerated Values: PRESENT = block edges are shaped for beam divergence ABSENT = block edges are not shaped for beam divergence Indicates on which side of the Block Tray the block is mounted. Enumerated Values: PATIENT_SIDE = the block is mounted on the side of the Block Tray which is towards the patient. SOURCE_SIDE = the block is mounted on the side of the Block Tray which is towards the radiation source. Identification number of the Block. The value of Block Number (300A,00FC) shall be unique within the Beam in which it is created. Required if Block Sequence (300A,00F4) is sent. User-defined name for block. User-supplied identifier for material used to manufacture Block. Required if Block Sequence (300A,00F4) is sent. Physical thickness of block (in mm) parallel to radiation beam axis. Required if Material ID (300A,00E1) is non-zero length. May be present if Material ID (300A,00E1) is zero length. See C.8.8.14.4 and C.8.8.14.11.

Transmission through the block (between 0 and 1) at the beam energy specified by the Nominal Beam Energy (300A,0114) of the first Control Point of the Control Point Sequence (300A,0111). Required if Material ID (300A,00E1) is zero length. May be present if Material ID (300A,00E1) is non-zero length. See C.8.8.14.4 and C.8.8.14.11.

Number of (x,y) pairs defining the block edge. Required if Block Sequence (300A,00F4) is sent. A data stream of (x,y) pairs which comprise the block edge. The number of pairs shall be equal to Block Number of Points (300A,0104), and the vertices shall be interpreted as a closed polygon. Coordinates are projected onto the machine isocentric plane in the IEC BEAM LIMITING DEVICE coordinate system (mm). Required if Block Sequence (300A,00F4) is sent. See Note 4. Introduces sequence of Applicators associated with Beam. Only a single item shall be permitted in this sequence. User or machine supplied identifier for Applicator. Required if Applicator Sequence (300A,0107) is sent. An identifier for the accessory intended to be read by a device such as a bar-code reader. Type of Applicator. Required if Applicator Sequence (300A,0107) is sent. Defined Terms: ELECTRON_SQUARE = square electron applicator ELECTRON_RECT = rectangular electron applicator ELECTRON_CIRC = circular electron applicator ELECTRON_SHORT = short electron applicator ELECTRON_OPEN = open (dummy) electron applicator INTRAOPERATIVE = intraoperative (custom) applicator STEREOTACTIC = stereotactic applicator User-defined description for Applicator. Introduces a Sequence of General Accessories associated with this Beam. One or more items may be included in this sequence. Identification Number of the General Accessory. The value shall be unique within the sequence. User or machine supplied identifier for General Accessory. User supplied description of General Accessory. Specifies the type of accessory. Defined Terms: GRATICULE = Accessory tray with a radio-opaque grid IMAGE_DETECTOR = Image acquisition device positioned in the beam line RETICLE = Accessory tray with radio-transparent markers or grid Machine-readable identifier for this accessory Value of Cumulative Meterset Weight (300A,0134) for final Control Point in Control Point Sequence (300A,0111). Required if Cumulative Meterset Weight is non-null in Control Points specified within Control Point Sequence (300A,0111). See C.8.8.14.1.

Number of control points in Beam. Introduces sequence of machine configurations describing treatment beam. Two or more items may be included in this sequence. See C.8.8.14.5 and C.8.8.14.6.

The DICOM RT Beams Module uses a single beam model to handle static, arc, and dynamic delivery of external beam radiation by a medical accelerator or gamma beam therapy equipment (cobalt unit). All applicable parameters shall be specified at Control Point 0, with the exception of couch positions (see C.8.8.14.6). All parameters that change at any control point of a given beam shall be specified explicitly at all control points (including those preceding the change). No assumptions are made about the behavior of machine parameters between specified control points, and communicating devices shall agree on this behavior outside the current standard. Gantry Rotation Direction (300A,011F), Beam Limiting Device Rotation Direction (300A,0121), Patient Support Rotation Direction (300A,0123), and Table Top Eccentric Rotation Direction (300A,0126) are defined as applying to the segment following the control point, and changes to these parameters during treatment may be specified without use of a “non-irradiation” segment. All other Control Point Sequence attributes are defined only at the control point. To unambiguously encode changes in discrete-valued attributes such as Wedge Position (300A,0118) and Nominal Beam Energy (300A,0114), a non-irradiation segment where Cumulative Meterset Weight (300A,0134) does not change, shall be used. Some examples of beam specification using control points are as follows: a) Static delivery: Control Point 0: All applicable treatment parameters defined, Cumulative Meterset Weight = 0 Control Point 1: Cumulative Meterset Weight = 1, no other parameters defined b) Arc delivery: Control Point 0: All applicable treatment parameters defined, Cumulative Meterset Weight = 0, Gantry Rotation Direction = rotation direction, Gantry Angle = initial angle Control Point 1: Cumulative Meterset Weight = 1, Gantry Rotation Direction = NONE, Gantry Angle = final angle c) Dynamic delivery of two equally weighted segments: Control Point 0: All applicable treatment parameters defined, Cumulative Meterset Weight = 0 Control Point 1: All changing treatment parameters defined (including those which do not change at this control point), Cumulative Meterset Weight = 0.5 Control Point 2: All changing treatment parameters defined (including those which do not change at this control point), Cumulative Meterset Weight = 1 d) Dynamic Delivery of two unequally weighted segments with a step change in table angle: Control Point 0: All applicable treatment parameters defined, Patient Support Angle = initial angle, Patient Support Rotation Direction = NONE, Cumulative Meterset Weight = 0 Control Point 1: All changing parameters defined (including those that do not change at this control point), Cumulative Meterset Weight = 0.3, Patient Support Angle = initial angle, Patient Support Rotation Direction = rotation direction Control Point 2: All changing parameters defined (although none should change at this control point), Cumulative Meterset Weight = 0.3, Patient Support Angle = new angle, Patient Support Rotation Direction = NONE Control Point 3: All changing parameters defined (including those that do not change at this control point), Cumulative Meterset Weight = 1, Patient Support Angle = new angle, Patient Support Rotation Direction = NONE

Index of current Control Point, starting at 0 for first Control Point. Required if Control Point Sequence (300A,0111) is sent. Cumulative weight to current control point. Cumulative Meterset Weight for the first item in Control Point Sequence shall always be zero. Cumulative Meterset Weight for the final item in Control Point Sequence shall always be equal to Final Cumulative Meterset Weight. Required if Control Point Sequence (300A,0111) is sent. See C.8.8.14.1.

Introduces a sequence of Dose References for current Beam. One or more items may be included in this sequence. Uniquely identifies Dose Reference specified by Dose Reference Number (300A,0012) in Dose Reference Sequence (300A,0010) in RT Prescription Module. Required if Referenced Dose Reference Sequence (300C,0050) is sent. Coefficient used to calculate cumulative dose contribution from this Beam to the referenced Dose Reference at the current Control Point. Required if Referenced Dose Reference Sequence (300C,0050) is sent. See C.8.8.14.7.

The Cumulative Dose Reference Coefficient (300A,010C) is the value by which Beam Dose (300A,0084) is multiplied to obtain the dose to the referenced dose reference site at the current control point (and after previous control points have been successfully administered). The Cumulative Dose Reference Coefficient (300A,010C) is by definition zero for the initial control point. The Cumulative Dose Reference Coefficient (300A,010C) of the final control point multiplied by Beam Dose (300A,0084) results in the final dose to the referenced dose reference site for the current beam. Dose calculation for dose reference sites other than points is not well defined.

Sequence describing related instances of RT Dose (for grids, isodose curves, and named/unnamed point doses). One or more items may be included in this sequence. Required if RT Dose is being sent, and Dose Summation Type (3004,000A) equals CONTROL_POINT. Nominal Beam Energy at control point (MV/MeV). Dose Rate to be set on treatment machine for segment beginning at current control point (e.g. MU/min). A Sequence of Items describing Wedge Positions for the current control point. Required for first item of Control Point Sequence if Number of Wedges (300A,00D0) is non-zero, and in subsequent control points if Wedge Position (300A,0118) changes during Beam. See C.8.8.14.5. The number of items in this sequence shall equal the value of Number of Wedges (300A,00D0).

Uniquely references Wedge described by Wedge Number (300A,00D2) in Wedge Sequence (300A,00D1). Required if Wedge Position Sequence (300A,0116) is sent. Position of Wedge at current Control Point. Required if Wedge Position Sequence (300A,0116) is sent. Enumerated Values: IN OUT Introduces sequence of beam limiting device (collimator) jaw or leaf (element) positions. Required for first item of Control Point Sequence, or if Beam Limiting Device changes during Beam. One or more items may be included in this sequence. Type of beam limiting device (collimator). The value of this attribute shall correspond to RT Beam Limiting Device Type (300A,00B8) defined in an item of Beam Limiting Device Sequence (300A,00B6). Required if Beam Limiting Device Position Sequence (300A,011A) is sent. Enumerated Values: X = symmetric jaw pair in IEC X direction Y = symmetric jaw pair in IEC Y direction ASYMX = asymmetric jaw pair in IEC X direction ASYMY = asymmetric pair in IEC Y direction MLCX = multileaf (multi-element) jaw pair in IEC X direction MLCY = multileaf (multi-element) jaw pair in IEC Y direction Positions of beam limiting device (collimator) leaf (element) or jaw pairs (in mm) in IEC BEAM LIMITING DEVICE coordinate axis appropriate to RT Beam Limiting Device Type (300A,00B8), e.g. X-axis for MLCX, Y-axis for MLCY. Contains 2N values, where N is the Number of Leaf/Jaw Pairs (300A,00BC) in Beam Limiting Device Sequence (300A,00B6). Values shall be listed in IEC leaf (element) subscript order 101, 102, ... 1N, 201, 202, ... 2N. Required if Beam Limiting Device Position Sequence (300A,011A) is sent. See Note 2. Gantry angle of radiation source, i.e. orientation of IEC GANTRY coordinate system with respect to IEC FIXED REFERENCE coordinate system (degrees). Required for first item of Control Point Sequence, or if Gantry Angle changes during Beam. Direction of Gantry Rotation when viewing gantry from isocenter, for segment following Control Point. Required for first item of Control Point Sequence, or if Gantry Rotation Direction changes during Beam. See C.8.8.14.8. Enumerated Values: CW = clockwise CC = counter-clockwise NONE = no rotation

For the machine rotation angles Gantry Angle (300A,011E), Beam Limiting Device Angle (300A,0120), Patient Support Angle (300A,0122) , and Table Top Eccentric Angle (300A,0125), rotation direction is specified as clockwise (CW), counter-clockwise (CC), or NONE. The maximum permitted rotation between two Control Points is 360 degrees. Examples: a) Gantry Angle moves from 5 degrees to 5 degrees, Gantry Rotation Direction = NONE: No movement. b) Gantry Angle moves from 5 degrees to 5 degrees, Gantry Rotation Direction = CW: Full clockwise rotation (360 degrees). c) Table Angle moves from 170 degrees to 160 degrees, Table Rotation Direction = CC: Counter-clockwise rotation by 350 degrees (note direction of increasing table angle as defined by IEC 61217).

Gantry Pitch Angle. i.e. the rotation of the IEC GANTRY coordinate system about the X-axis of the IEC GANTRY coordinate system (degrees). If used, must be present for first item of Control Point Sequence, or if used and Gantry Pitch Rotation Angle changes during Beam, must be present. See C.8.8.25.6.5.

Direction of Gantry Pitch Angle when viewing along the positive X-axis of the IEC GANTRY coordinate system, for segment following Control Point. If used, must be present for first item of Control Point Sequence, or if used and Gantry Pitch Rotation Direction changes during Beam, must be present. See C.8.8.14.8 and C.8.8.25.6.5. Enumerated Values: CW = clockwise CC = counter-clockwise NONE = no rotation

Patient Support angle, i.e. orientation of IEC PATIENT SUPPORT (turntable) coordinate system with respect to IEC FIXED REFERENCE coordinate system (degrees). Required for first item of Control Point Sequence, or if Patient Support Angle changes during Beam. Direction of Patient Support Rotation when viewing table from above, for segment following Control Point. Required for first item of Control Point Sequence, or if Patient Support Rotation Direction changes during Beam. See C.8.8.14.8. Enumerated Values: CW = clockwise CC = counter-clockwise NONE = no rotation

Distance (positive) from the IEC PATIENT SUPPORT vertical axis to the IEC TABLE TOP ECCENTRIC vertical axis (mm). Table Top (non-isocentric) angle, i.e. orientation of IEC TABLE TOP ECCENTRIC coordinate system with respect to IEC PATIENT SUPPORT coordinate system (degrees). Required for first item of Control Point Sequence, or if Table Top Eccentric Angle changes during Beam. Direction of Table Top Eccentric Rotation when viewing table from above, for segment following Control Point. Required for first item of Control Point Sequence, or if Table Top Eccentric Rotation Direction changes during Beam. See C.8.8.14.8. Enumerated Values: CW = clockwise CC = counter-clockwise NONE = no rotation

Table Top Pitch Angle, i.e. the rotation of the IEC TABLE TOP coordinate system about the X-axis of the IEC TABLE TOP coordinate system (degrees). If required by treatment delivery device, shall be present for first item of Control Point Sequence. If required by treatment delivery device and if Table Top Pitch Angle changes during Beam, shall be present in all subsequent items of Control Point Sequence. See C.8.8.25.6.2.

Direction of Table Top Pitch Rotation when viewing the table along the positive X-axis of the IEC TABLE TOP coordinate system, for segment following Control Point. If required by treatment delivery device, shall be present for first item of Control Point Sequence. If required by treatment delivery device and if Table Top Pitch Rotation Direction changes during Beam, shall be present in all subsequent items of Control Point Sequence. See C.8.8.14.8 and C.8.8.25.6.2. Enumerated Values: CW = clockwise CC = counter-clockwise NONE = no rotation

Table Top Roll Angle, i.e. the rotation of the IEC TABLE TOP coordinate system about the IEC Y-axis of the IEC TABLE TOP coordinate system (degrees). If required by treatment delivery device, shall be present for first item of Control Point Sequence. If required by treatment delivery device and if Table Top Roll Angle changes during Beam, shall be present in all subsequent items of Control Point Sequence. See C.8.8.25.6.2.

Direction of Table Top Roll Rotation when viewing the table along the positive Y-axis of the IEC TABLE TOP coordinate system, for segment following Control Point. If required by treatment delivery device, shall be present for first item of Control Point Sequence. If required by treatment delivery device and if Table Top Roll Rotation Direction changes during Beam, shall be present in all subsequent items of Control Point Sequence. See C.8.8.14.8 and C.8.8.25.6.2. Enumerated Values: CW = clockwise CC = counter-clockwise NONE = no rotation

Table Top Vertical position in IEC TABLE TOP coordinate system (mm). Required for first item of Control Point Sequence, or if Table Top Vertical Position changes during Beam. See C.8.8.14.6.

All treatment machine parameters except couch translations are specified in absolute machine coordinates as defined by IEC 61217. For the Table Top Vertical Position (300A,0128), Table Top Longitudinal Position (300A,0129), and Table Top Lateral Position (300A,012A), if the first Control Point contains a value of non-zero length, all subsequent Control Point position values are absolute values in their respective coordinate system. If the first Control Point contains a zero-length value, all subsequent Control Point position values are specified relative to the (unknown) initial value.

Table Top Longitudinal position in IEC TABLE TOP coordinate system (mm). Required for first item of Control Point Sequence, or if Table Top Longitudinal Position changes during Beam. See C.8.8.14.6.

Table Top Lateral position in IEC TABLE TOP coordinate system (mm). Required for first item of Control Point Sequence, or if Table Top Lateral Position changes during Beam. See C.8.8.14.6.

Isocenter coordinates (x,y,z) in the patient based coordinate system described in C.7.6.2.1.1 (mm). Required for first item of Segment Control Point Sequence, or if Segment Isocenter Position changes during Beam. Patient surface entry point coordinates (x,y,z) in the patient based coordinate system described in C.7.6.2.1.1 (mm). Source to Patient Surface distance (mm). Type of brachytherapy treatment technique. Enumerated Values: INTRALUMENARY INTRACAVITARY INTERSTITIAL CONTACT INTRAVASCULAR PERMANENT See C.8.8.15.1.

In permanent implant techniques the value for Channel Total Time (300A,0286) shall be mean life time of the isotope. The Brachy Control Point Sequence (300A,02D0) shall consist of two items: the first having Cumulative Time Weight (300A,02D6) = 0 and the second having Cumulative Time Weight (300A,02D6) = Final Cumulative Time Weight (300A,02C8).

Type of brachytherapy treatment. Defined Terms: MANUAL = manually positioned HDR = High dose rate MDR = Medium dose rate LDR = Low dose rate PDR = Pulsed dose rate Introduces single item sequence describing treatment machine to be used for treatment delivery. Only one item may be included in this sequence. User-defined name identifying treatment machine to be used for treatment delivery. Manufacturer of the equipment to be used for treatment delivery. Institution where the equipment is located that is to be used for treatment delivery. Mailing address of the institution where the equipment is located that is to be used for treatment delivery. Department in the institution where the equipment is located that is to be used for treatment delivery. Manufacturer's model name of the equipment that is to be used for treatment delivery. Manufacturer's serial number of the equipment that is to be used for treatment delivery. Introduces sequence of Sources to be used within Application Setups. One or more items may be included in this sequence. Identification number of the Source. The value of Source Number (300A,0212) shall be unique within the RT Plan in which it is created. Type of Source. Defined Terms: POINT LINE CYLINDER SPHERE Manufacturer of Source. Diameter of active Source (mm). Length of active Source (mm). User-supplied identifier for encapsulation material of active Source. Nominal thickness of wall of encapsulation (mm). See C.8.8.15.12.

If provided, Source Encapsulation Nominal Thickness (300A,0222), Brachy Accessory Device Nominal Thickness (300A,026A), Source Applicator Wall Nominal Thickness (300A,029C), and Channel Shield Nominal Thickness (300A,02B8) shall indicate that the related objects are of uniform thickness with the specified value. If this is not the case, these attributes shall not be provided. If provided, Source Encapsulation Nominal Transmission (300A,0224), Brachy Accessory Device Nominal Transmission (300A,026C), Source Applicator Wall Nominal Transmission (300A,029E), and Channel Shield Nominal Transmission (300A,02BA) shall indicate that the related objects are of uniform transmission with the specified value. If this is not the case, these attributes shall not be provided. No assumptions are made about the source characteristics beyond the parameters specified here.

Nominal transmission through wall of encapsulation (between 0 and 1). See C.8.8.15.12

Name of Isotope. Half-life of Isotope (days). Measurement unit of Source Strength. Required if the source is not a gamma-emitting (photon) source. May be present otherwise. Enumerated Values: AIR_KERMA_RATE = Air Kerma Rate if Source is Gamma emitting Isotope. DOSE_RATE_WATER = Dose Rate in Water if Source is Beta emitting Isotope. Air Kerma Rate in air of Isotope specified at Air Kerma Rate Reference Date (300A,022C) and Air Kerma Rate Reference Time (300A,022E) (in µGy h-1 at 1 m). Value shall be zero for non-gamma sources. Source Strength of Isotope at Source Strength Reference Date (300A,022C) and Source Strength Reference Time (300A,022E), in units specified in Source Strength Units (300A,0229). Required if the source is not a gamma-emitting (photon) source. See C.8.8.15.13.

For beta emitting isotopes, the Source Strength (300A,022B) shall be defined at reference point (r0,θ0), where r0 is the radial distance of 2 mm from the source longitudinal axis, and θ0 is the angle of 90 degrees between the source longitudinal axis and the line defined by the center of the source and the reference point. Refer to: • IEC 60601-2-17 (Medical electrical equipment – Particular requirements for the safety of automatically-controlled brachytherapy afterloading equipment), where the beta source strength is defined as: ABSORBED DOSE RATE [Gy s-1] in water at 2 mm along the perpendicular bisector from a RADIOACTIVE SOURCE emitting beta RADIATION. • Nath et. al.: Intravascular brachytherapy physics: Report of the AAPM Radiation Therapy Committee Task Group No. 60, Med. Phys 26 (2) Feb 1999, pp 119-152.

Nominal Transmission through Brachy Accessory Device (between 0 and 1). See C.8.8.15.12.

Uniquely identifies ROI representing the Brachy Accessory specified by ROI Number (3006,0022) in Structure Set ROI Sequence (3006,0020) in Structure Set Module within RT Structure Set referenced by Referenced RT Structure Set Sequence (300C,0060) in RT General Plan Module. Required if Brachy Accessory Device Sequence (300A,0260) is sent. See C.8.8.15.2.

The Structure Set ROI shall be used in the Brachy Application Setups Module to describe the 3D coordinates of Accessory Devices, Applicators and Channel Shields, but not individual source positions (see C.8.8.15.9 and C.8.8.15.10).

Introduces sequence of Channels for current Application Setup. One or more items may be included in this sequence. Identification number of the Channel. The value of Channel Number (300A,0282) shall be unique within the Application Setup in which it is created. Length of Channel (mm). See C.8.8.15.3.

If specified, the Channel Length (300A,0284) shall be the sum of the Source Applicator Length (300A,0296) and Transfer Tube Length (300A,02A4).

Total amount of time between first and final Control Points of the Brachy Control Point Sequence (300A,02D0) for current Channel (sec). Channel Total Time calculation is based upon the Reference Air Kerma Rate (300A,022A) of the Referenced Source Number (300C,000E). Type of Source movement. See C.8.8.15.4. Defined Terms: STEPWISE FIXED OSCILLATING UNIDIRECTIONAL

In brachytherapy treatment techniques involving oscillating source movement (i.e. when Source Movement Type (300A,0288) is OSCILLATING), the Brachy Control Point Sequence (300A,02D0) shall consist of two items. The first Control Point shall have Cumulative Time Weight (300A,02D6) = 0, and Control Point Relative Position (300A,02D2) equal to one end point of the oscillation. The second Control Point shall have Cumulative Time Weight (300A,02D6) = Final Cumulative Time Weight (300A,02C8), and Control Point Relative Position (300A,02D2) equal to the other end point of the oscillation. Transit time shall not be modeled explicitly for oscillating techniques.

Number of Pulses per fraction for current Channel. Required if Brachy Treatment Type (300A,0202) is PDR. Pulse repetition interval (sec) for current Channel. Required if Brachy Treatment Type (300A,0202) is PDR. Identification number of the Source Applicator. The value of Source Applicator Number (300A,0290) shall be unique within the Channel in which it is created. User or machine supplied identifier for Source Applicator. Required if Source Applicator Number (300A,0290) is sent. Type of Source Applicator. Required if Source Applicator Number (300A,0290) is sent. Defined Terms: FLEXIBLE RIGID User-defined name for Source Applicator. Length of Source Applicator (mm), defined as the distance between the connector of the applicator and the distal-most position of the source. Required if Source Applicator Number (300A,0290) is sent. Manufacturer of Source Applicator. User-supplied identifier for material of Source Applicator wall. See Note. Nominal Thickness of Source Applicator wall (mm). See C.8.8.15.12.

Nominal Transmission through Source Applicator wall (between 0 and 1). See C.8.8.15.12.

Distance of path along channel (in mm) between adjacent (potential) dwell positions. Required if Source Movement Type (300A,0288) is STEPWISE. Uniquely identifies ROI representing the Source Applicator specified by ROI Number (3006,0022) in Structure Set ROI Sequence (3006,0020) in Structure Set Module within RT Structure Set referenced by Referenced RT Structure Set Sequence (300C,0060) in RT General Plan Module. Required if Source Applicator Number (300A,0290) is sent. See C.8.8.15.2.

Identification number of the Transfer Tube. The value of Transfer Tube Number (300A,02A2) shall be unique within the Channel in which it is created. Length of Transfer Tube of current afterloading Channel (mm). Required if value Transfer Tube Number (300A,02A2) is non-null. Introduces sequence of Channel Shields associated with current Channel. One or more items may be included in this sequence. See C.8.8.15.5.

The effect of Channel Shields on dose contributions shall be specific to the Channel for which they are specified. There shall be no effect of these shields on the dose contributions from any other Channels.

Identification number of the Channel Shield. The value of Channel Shield Number (300A,02B2) shall be unique within the Channel in which it is created. Required if Channel Shield Sequence (300A,02B0) is sent. User or machine supplied identifier for Channel Shield. Required if Channel Shield Sequence (300A,02B0) is sent. User-defined name for Channel Shield. User-supplied identifier for material of Channel Shield. See Note. Nominal Thickness of Channel Shield (mm). See C.8.8.15.12.

Nominal Transmission of Channel Shield (between 0 and 1). See C.8.8.15.12.

Uniquely identifies ROI representing the Channel Shield specified by ROI Number (3006,0022) in Structure Set ROI Sequence (3006,0020) in Structure Set Module within RT Structure Set referenced by Referenced RT Structure Set Sequence (300C,0060) in RT General Plan Module. Required if Channel Shield Sequence (300A,02B0) is sent. See C.8.8.15.2.

Uniquely identifies the referenced Source within the Source Sequence (300A,0210) for current Application Setup. Number of control points in Channel. For an N-segment Channel there will be 2N (stepwise movement) or N+1 (continuous movement) control points. Value of Cumulative Time Weight (300A,02D6) for final Control Point in Brachy Control Point Sequence (300A,02D0). Required if Cumulative Time Weight (300A,02D6) is non-null in Control Points specified within Brachy Control Point Sequence (300A,02D0). See C.8.8.15.6.

The treatment time at a given Control Point is equal to the Channel Total Time (300A,0286), multiplied by the Cumulative Time Weight (300A,02D6) for the Control Point, divided by the Final Cumulative Time Weight (300A,02C8). If the calculation for treatment time results in a time value which is not an exact multiple of the timer resolution, then the result shall be rounded to the nearest allowed timer value (i.e. less than a half resolution unit shall be rounded down to the nearest resolution unit, and equal or greater than half a resolution unit shall be rounded up to the nearest resolution unit). Note also that if Final Cumulative Time Weight (300A,02C8) is equal to 100, then Cumulative Time Weight (300A,02D6) becomes equivalent to the percentage of Channel Total Time (300A,0286) delivered at each control point. If Final Cumulative Time Weight (300A,02C8) is equal to Channel Total Time (300A,0286), then the Cumulative Time Weight (300A,02D6) at each control point becomes equal to the cumulative treatment time delivered at that control point. If Treatment Type (300A,0202) is PDR, then the Channel Total Time (3008,0286) shall specify the duration of a single pulse.

Introduces sequence of machine configurations describing this Channel. Two or more items may be included in this sequence. See C.8.8.15.7.

The Control Points shall be arranged such that the first Control Point for a particular Channel describes the first dwell position and the final Control Point for the Channel describes the final dwell position. If Brachy Treatment Type (300A,0202) is PDR, the Brachy Control Point Sequence (300A,02D0) shall specify the sequence of machine configurations for a single pulse. Similarly, if Source Movement Type (300A,0288) is OSCILLATING, the Brachy Control Point Sequence (300A,02D0) shall specify the sequence of machine configurations for a single period. Some examples of Brachytherapy specification using control points are as follows: a) Stepwise motion; Four equally weighted dwell positions; Step size = 10; Final Cumulative Time Weight = 100: Control Point 0: Control Point Relative Position = 30, Cumulative Time Weight = 0 Control Point 1: Control Point Relative Position = 30, Cumulative Time Weight = 25 Control Point 2: Control Point Relative Position = 20, Cumulative Time Weight = 25 Control Point 3: Control Point Relative Position = 20, Cumulative Time Weight = 50 Control Point 4: Control Point Relative Position = 10, Cumulative Time Weight = 50 Control Point 5: Control Point Relative Position = 10, Cumulative Time Weight = 75 Control Point 6: Control Point Relative Position = 0, Cumulative Time Weight = 75 Control Point 7: Control Point Relative Position = 0, Cumulative Time Weight = 100 b) Fixed (manually placed) sources; Final Cumulative Time Weight = 100: Control Point 0: Control Point Relative Position = 0, Control Point 3D Position = (x,y,z), Cumulative Time Weight = 0 Control Point 1: Control Point Relative Position = 0, Control Point 3D Position = (x,y,z), Cumulative Time Weight = 100 c) Oscillating movement; Final Cumulative Time Weight = 100: Control Point 0: Control Point Relative Position = 100, Cumulative Time Weight = 0 Control Point 1: Control Point Relative Position = 0, Cumulative Time Weight = 100 d) Unidirectional movement; Final Cumulative Time Weight = 100: Control Point 0: Control Point Relative Position = 0, Cumulative Time Weight = 0 Control Point 1: Control Point Relative Position = 100, Cumulative Time Weight = 100 e) Stepwise motion with consideration of source transit times between dwell positions; Three equally weighted dwell positions; Step size = 10; Final Cumulative Time Weight = 79: Control Point 0: Control Point Relative Position = 30, Cumulative Time Weight = 0 Control Point 1: Control Point Relative Position = 30, Cumulative Time Weight = 25 Control Point 2: Control Point Relative Position = 20, Cumulative Time Weight = 27 Control Point 3: Control Point Relative Position = 20, Cumulative Time Weight = 52 Control Point 4: Control Point Relative Position = 10, Cumulative Time Weight = 54 Control Point 5: Control Point Relative Position = 10, Cumulative Time Weight = 79 f) Stepwise motion with consideration of source transit times between dwell positions and to first and from last dwell position; Three equally weighted dwell positions; Step size = 10; Final Cumulative Time Weight = 383: Control Point 0: Control Point Relative Position = 1200, Cumulative Time Weight = 0 Control Point 1: Control Point Relative Position = 30, Cumulative Time Weight = 150 Control Point 2: Control Point Relative Position = 30, Cumulative Time Weight = 175 Control Point 3: Control Point Relative Position = 20, Cumulative Time Weight = 177 Control Point 4: Control Point Relative Position = 20, Cumulative Time Weight = 202 Control Point 5: Control Point Relative Position = 10, Cumulative Time Weight = 204 Control Point 6: Control Point Relative Position = 10, Cumulative Time Weight = 229 Control Point 7: Control Point Relative Position = 1200, Cumulative Time Weight = 383

Index of current Control Point, starting at 0 for first Control Point. Cumulative time weight to current Control Point (where the weighting is proportional to time values delivered). Cumulative Time Weight for first item in Brachy Control Point Sequence (300A,02D0) is always zero. See C.8.8.15.6 and C.8.8.15.8.

Distance between current Control Point Position and the distal-most possible Source position in current Channel (mm). See C.8.8.15.9.

Control Point Relative Position (300A,02D2) shall describe where a given source in a channel is located with respect to the end of the channel. This position shall correspond to the end of the afterloader applicator, not the “safe position”.

Coordinates (x, y, z) of Control Point in the patient based coordinate system described in C.7.6.2.1.1 (mm). See C.8.8.15.10.

Control Point 3D Position (300A,02D4) shall describe the absolute 3D coordinates of a source. This position shall correspond to the center of a source in an applicator during a remote or manually controlled afterloading treatment.

(x,y,z) component of the direction vector of the brachy source or seed at the Control Point 3D Position (300A,02D4). See C.8.8.15.14.

The Control Point Orientation (300A,0412) shall be used to define the orientation of an anisotropic brachytherapy source or seed for the purpose of calculating the effect of the anisotropy on the dose calculation. The Control Point Orientation (300A,0412) shall be given by the direction vector of the long axis of the Brachy source or seed in the insertion direction, in the DICOM Patient Coordinate System. The direction vector shall be oriented from the source center as defined by the Control Point 3D Position (300A,02D4) along the long axis of the source and in the insertion direction.

Introduces a sequence of Dose References for current Channel. One or more items may be included in this sequence. Uniquely identifies Dose Reference described in Dose Reference Sequence. (300A,0010) within RT Prescription Module of current RT Plan. Required if Brachy Referenced Dose Reference Sequence (300C,0055) is sent. Coefficient used to calculate cumulative dose contribution from this Source to the referenced Dose Reference at the current Control Point. Required if Brachy Referenced Dose Reference Sequence (300C,0055) is sent. See C.8.8.15.11.

The Cumulative Dose Reference Coefficient (300A,010C) is the value by which Brachy Application Setup Dose (300A,00A4) is multiplied to obtain the dose to the referenced dose reference site at the current control point (and after previous control points have been successfully administered). The Cumulative Dose Reference Coefficient (300A,010C) is by definition zero for the initial control point. The Cumulative Dose Reference Coefficient (300A,010C) of the final control point multiplied by Brachy Application Setup Dose (300A,00A4) results in the final dose to the referenced dose reference site for the current channel. Dose calculation for dose reference sites other than points is not well defined. If Treatment Type (300A,0202) is PDR, then the Cumulative Dose Reference Coefficient (3008,010C) shall specify the dose delivered to the dose reference during a single pulse. The total dose delivered to the dose reference shall then be expressed by Cumulative Dose Reference Coefficient (3008,010C) multiplied by Number of Pulses (300A,028A) multiplied by Brachy Application Setup Dose (300A,00A4).

Approval status at the time the SOP Instance was created. Enumerated Values: APPROVED = Reviewer recorded that object met an implied criterion UNAPPROVED = No review of object has been recorded REJECTED = Reviewer recorded that object failed to meet an implied criterion Date on which object was reviewed. Required if Approval Status (300E,0002) is APPROVED or REJECTED. Time at which object was reviewed. Required if Approval Status (300E,0002) is APPROVED or REJECTED. Name of person who reviewed object. Required if Approval Status (300E,0002) is APPROVED or REJECTED. Instance number identifying this particular instance of the object. Date when current fraction was delivered, or Date last fraction was delivered in case of RT Treatment Summary Record IOD. See Note. Time when current fraction was delivered (begun), or Time last fraction was delivered (begun) in case of RT Treatment Summary Record IOD. See Note. A sequence which provides reference to a RT Plan SOP Class/Instance pair. Only a single Item shall be permitted in this Sequence. A sequence which provides reference to RT Treatment Record SOP Class/Instance pairs to which the current RT Treatment Record is significantly related. The sequence may contain one or more items. Introduces sequence describing treatment machine used for treatment delivery. Only a single Item shall be permitted in this Sequence. User-defined name identifying treatment machine used for treatment delivery. Manufacturer of the equipment used for treatment delivery. Institution where the equipment is located that was used for treatment delivery. Mailing address of the institution where the equipment is located that was used for treatment delivery. Department in the institution where the equipment is located that was used for treatment delivery. Manufacturer's model name of the equipment used for treatment delivery. Manufacturer's serial number of the equipment used for treatment delivery. Introduces sequence of doses measured during treatment delivery, summed over entire session. The sequence may contain one or more items. Uniquely identifies Dose Reference specified by Dose Reference Number (300A,0012) in Dose Reference Sequence (300A,0010) in RT Prescription Module of referenced RT Plan. Required only if Measured Dose Reference Number (3008,0064) is not sent. It shall not be present otherwise. Unique identifier of measured dose point. Required only if Referenced Dose Reference Number (300C,0051) is not sent. It shall not be present otherwise. Units used to describe measured dose. Enumerated Values: GY = Gray RELATIVE = Dose relative to implicit reference value Measured Dose in units specified by Dose Units (3004,0002). Type of dose measurement. Defined Terms: DIODE = semiconductor diode TLD = thermoluminescent dosimeter ION_CHAMBER = ion chamber GEL = dose sensitive gel EPID = electronic portal imaging device FILM = dose sensitive film User-defined description of Dose Reference (e.g. "Exit dose", "Point A"). Introduces sequence of doses estimated for each treatment delivery. The sequence may contain one or more items. Uniquely identifies Dose Reference specified by Dose Reference Number (300A,0012) in Dose Reference Sequence (300A,0010) in RT Prescription Module of referenced RT Plan. Required only if Calculated Dose Reference Number (3008,0072) is not sent. It shall not be present otherwise. Unique identifier of dose reference point within RT Treatment Record IOD. Required only if Referenced Dose Reference Number (300C,0051) is not sent. It shall not be present otherwise. Calculated Dose (Gy). User-defined description of Calculated Dose Reference. Name of operator administering treatment session. Identifier of Fraction Group within referenced RT Plan. Total number of treatments (Fractions) planned for current Fraction Group. Measurement unit of machine dosimeter. Enumerated Values: MU = Monitor Unit MINUTE = minute Introduces sequence of Beams administered during treatment session. The sequence may contain one or more items. References Beam specified by Beam Number (300A,00C0) in Beam Sequence (300A,00B0) in RT Beams Module within referenced RT Plan. User-defined name for delivered Beam. User-defined description for delivered Beam. Motion characteristic of delivered Beam. Enumerated Values: STATIC = all beam parameters remain unchanged during delivery DYNAMIC = one or more beam parameters changes during delivery Particle type of delivered Beam. Defined Terms: PHOTON, ELECTRON, NEUTRON, PROTON. Type of high-dose treatment technique. Defined Terms: NORMAL = Standard treatment TBI = Total Body Irradiation HDR = High Dose Rate Required if treatment technique requires a dose that would normally require overriding of treatment machine safety controls. Introduces sequence of verification images obtained during delivery of current beam. The sequence may contain one or more items. Cumulative Meterset Weight within Beam referenced by Referenced Beam Number at which image acquisition starts. Cumulative Meterset Weight within Beam referenced by Referenced Beam Number at which image acquisition ends. Introduces sequence of doses measured during treatment delivery for current Beam. The sequence may contain one or more items. Uniquely references Dose Reference specified by Dose Reference Number (300A,0012) in Dose Reference Sequence (300A,0010) in RT Prescription Module of referenced RT Plan. Required if Referenced Measured Dose Reference Sequence (3008,0080) is sent and Referenced Measured Dose Reference Number (3008,0082) is not sent. It shall not be present otherwise. Uniquely references Measured Dose Reference specified by Measured Dose Reference Number (3008,0064) in Measured Dose Reference Sequence (3008,0010). Required if Referenced Measured Dose Reference Sequence (3008,0080) is sent and Referenced Dose Reference Number (300C,0051) is not sent. It shall not be present otherwise. Measured Dose in units specified by Dose Units (3004,0002) in sequence referenced by Measured Dose Reference Sequence (3008,0010) or Dose Reference Sequence (300A,0010) in RT Prescription Module of referenced RT Plan as defined above. Required if Referenced Measured Dose Reference Sequence (3008,0080) is sent. Introduces sequence of doses estimated for each treatment delivery. The sequence may contain one or more items. Uniquely identifies Dose Reference specified by Dose Reference Number (300A,0012) in Dose Reference Sequence (300A,0010) in RT Prescription Module of referenced RT Plan. Required if Referenced Calculated Dose Reference Sequence (3008,0090) is sent and Referenced Calculated Dose Reference Number (3008,0092) is not sent. Uniquely identifies Calculated Dose Reference specified by Calculated Dose Reference Number (3008,0072) within Calculated Dose Reference Sequence (3008,0070). Required if Referenced Calculated Dose Reference Sequence (3008,0090) is sent and Referenced Dose Reference Number (300C,0051) is not sent. Calculated Dose (Gy). Required if Referenced Calculated Dose Reference Sequence (3008,0090) is sent. Radiation source to gantry rotation axis distance of the equipment that was used for beam delivery (mm). Introduces sequence of beam limiting device (collimator) jaw or leaf (element) leaf pair values. The sequence may contain one or more items. Type of beam limiting device (collimator). Enumerated Values: X = symmetric jaw pair in IEC X direction Y = symmetric jaw pair in IEC Y direction ASYMX = asymmetric jaw pair in IEC X direction ASYMY = asymmetric pair in IEC Y direction MLCX = multileaf (multi-element) jaw pair in IEC X direction MLCY = multileaf (multi-element) jaw pair in IEC Y direction Number of leaf (element) or jaw pairs (equal to 1 for standard beam limiting device jaws). Uniquely identifies Patient Setup used within current beam, specified by Patient Setup Number (300A,0182) within Patient Setup Sequence (300A,0180) of RT Treatment Record. Number of wedges associated with current delivered Beam. Introduces sequence of treatment wedges present during delivered Beam. Required if Number of Wedges (300A,00D0) is non-zero. The sequence may contain one or more items. Identification number of the Wedge. The value of Wedge Number (300A,00D2) shall be unique within the wedge sequence. Type of wedge defined for delivered Beam. Required if Recorded Wedge Sequence (3008,00B0) is sent. Defined Terms: STANDARD = standard (static) wedge DYNAMIC = moving Beam Limiting Device (collimator) jaw simulating wedge MOTORIZED = single wedge which can be removed from beam remotely User-supplied identifier for wedge. An identifier for the accessory intended to be read by a device such as a bar-code reader. Nominal wedge angle delivered (degrees). Orientation of wedge, i.e. orientation of IEC WEDGE FILTER coordinate system with respect to IEC BEAM LIMITING DEVICE coordinate system (degrees). Number of compensators associated with current delivered Beam. Introduces sequence of treatment compensators associated with current Beam. The sequence may contain one or more items. Uniquely identifies compensator specified by Compensator Number (300A,00E4) within Beam referenced by Referenced Beam Number (300C,0006). Required if Recorded Compensator Sequence (3008,00C0) is sent. Type of compensator (if any). Required if Recorded Compensator Sequence (3008,00C0) is sent. Defined Terms: STANDARD = physical (static) compensator DYNAMIC = moving Beam Limiting Device (collimator) simulating compensator User-supplied identifier for compensator. An identifier for the accessory intended to be read by a device such as a bar-code reader. Number of boli used with current Beam. Introduces sequence of boli associated with Beam. The sequence may contain one or more items. Uniquely identifies ROI representing the bolus specified by ROI Number (3006,0022) in Structure Set ROI Sequence (3006,0020) in Structure Set Module within RT Structure Set IOD referenced by referenced RT Plan in Referenced RT Plan Sequence (300C,0002) in RT General Treatment Record Module. Required if Referenced Bolus Sequence (300C,00B0) is sent. User-supplied identifier for the Bolus. An identifier for the accessory intended to be read by a device such as a bar-code reader. Number of shielding blocks or Electron Inserts associated with Beam. Introduces sequence of blocks associated with current Beam. The sequence may contain one or more items. User-supplied identifier for block tray or Electron Insert. An identifier for the accessory intended to be read by a device such as a bar-code reader. Uniquely identifies block specified by Block Number (300A,00FC) within Beam referenced by Referenced Beam Number (300C,0006). User-defined name for block. Required if Recorded Block Sequence (3008,00D0) is sent. Introduces sequence of Applicators associated with Beam. Only a single item shall be permitted in this sequence. User or machine supplied identifier for Applicator. Required if Applicator Sequence (300A,0107) is sent. An identifier for the accessory intended to be read by a device such as a bar-code reader. Type of Applicator. Required if Applicator Sequence (300A,0107) is sent. Defined Terms: ELECTRON_SQUARE = square electron applicator ELECTRON_RECT = rectangular electron applicator ELECTRON_CIRC = circular electron applicator ELECTRON_SHORT = short electron applicator ELECTRON_OPEN = open (dummy) electron applicator INTRAOPERATIVE = intraoperative (custom) applicator STEREOTACTIC = stereotactic applicator User-defined description for Applicator. Introduces a Sequence of General Accessories associated with this Beam. One or more items may be included in this sequence. Identification Number of the General Accessory. The value shall be unique within the sequence. User or machine supplied identifier for General Accessory. User supplied description of General Accessory. Specifies the type of accessory. Defined Terms: GRATICULE = Accessory tray with a radio-opaque grid IMAGE_DETECTOR = Image acquisition device positioned in the beam line RETICLE = Accessory tray with radio-transparent markers or grid Machine-readable identifier for this accessory Fraction number for this beam administration. Delivery Type of treatment. Defined Terms: TREATMENT = normal patient treatment OPEN_PORTFILM = portal image acquisition with open field TRMT_PORTFILM = portal image acquisition with treatment port CONTINUATION = continuation of interrupted treatment SETUP = no treatment beam is applied for this RT Beam. To be used for specifying the gantry, couch, and other machine positions where X-Ray set-up images or measurements are to be taken Conditions under which treatment was terminated. Enumerated Values: NORMAL = treatment terminated normally OPERATOR = operator terminated treatment MACHINE = machine terminated treatment UNKNOWN = status at termination unknown Treatment machine termination code. This code is dependent upon the particular application and equipment. Conditions under which treatment was verified by a verification system. Enumerated Values: VERIFIED = treatment verified VERIFIED_OVR = treatment verified with at least one out-of-range value overridden NOT_VERIFIED = treatment verified manually Desired machine setting of primary meterset. Desired machine setting of secondary meterset. Machine setting actually delivered as recorded by primary meterset. Machine setting actually delivered as recorded by secondary meterset. Treatment Time set (sec). Treatment Time actually delivered (sec). Number of control points delivered. Introduces sequence of beam control points for current treatment beam. The sequence may contain one or more items. See C.8.8.21.1.

All treatment machine delivery parameters (including table angles and positions) in the RT Treatment Session Record Module shall be specified as absolute, not relative, values at the Control Point.

Uniquely identifies Control Point specified by Control Point Index (300A,0112) within Beam referenced by Referenced Beam Number (300C,0006). Date administration of treatment beam began. Time administration of treatment beam began. Desired machine setting for current control point. See C.8.8.21.2.

Specified Meterset (3008,0042) contains the MU as specified in the corresponding RT Plan at a given control point. Delivered Meterset (3008,0044) shall contain one of the following three values:

Machine setting actually delivered at current control point. See C.8.8.21.2.

Specified Meterset (3008,0042) contains the MU as specified in the corresponding RT Plan at a given control point. Delivered Meterset (3008,0044) shall contain one of the following three values:

Dose Rate set on treatment machine for segment beginning at current control point (meterset/min). Dose Rate actually delivered for segment beginning at current control point (meterset/min). Nominal Beam Energy at control point. Units used for Nominal Beam Energy (300A,0114). Required if Nominal Beam Energy (300A,0114) is sent. Defined Terms: MV = Megavolt MEV = Mega electron-Volt If Radiation Type (300A,00C6) is PHOTON, Nominal Beam Energy Unit (300A,0015) shall be MV. If Radiation Type (300A,00C6) is ELECTRON, Nominal Beam Energy Unit (300A,0015) shall be MEV. Introduces sequence of Wedge positions for current control point. The sequence may contain one or more items. Uniquely identifies wedge specified by Wedge Number (300A,00D2) within Beam referenced by Referenced Beam Number (300C,0006). Required if Wedge Position Sequence (300A,0116) is sent. Position of Wedge at current control point. Required if Wedge Position Sequence (300A,0116) is sent. Enumerated Values: IN, OUT. Introduces sequence of beam limiting device (collimator) jaw or leaf (element) positions. Required for Control Point 0 of Control Point Delivery Sequence (3008,0040) or if beam limiting device (collimator) changes during beam administration. The sequence may contain one or more items. Type of beam limiting device. The value of this attribute shall correspond to RT Beam Limiting Device Type (300A,00B8) defined in an element of Beam Limiting Device Leaf Pairs Sequence (3008,00A0). Required if Beam Limiting Device Position Sequence (300A,011A) is sent. Enumerated Values: X = symmetric jaw pair in IEC X direction Y = symmetric jaw pair in IEC Y direction ASYMX = asymmetric jaw pair in IEC X direction ASYMY = asymmetric pair in IEC Y direction MLCX = multileaf (multi-element) jaw pair in IEC X direction MLCY = multileaf (multi-element) jaw pair in IEC Y direction Positions of beam limiting device (collimator) leaf (element) or jaw pairs (mm) in IEC BEAM LIMITING DEVICE coordinate axis appropriate to RT Beam Limiting Device Type (300A,00B8), e.g. X-axis for MLCX, Y-axis for MLCY. Contains 2N values, where N is the Number of Leaf/Jaw Pairs (300A,00BC) defined in element of Beam Limiting Device Leaf Pairs Sequence (3008,00A0). Values shall be in IEC leaf subscript order 101, 102, … 1N, 201, 202 … 2N. Required if Beam Limiting Device Position Sequence (300A,011A) is sent. Treatment machine gantry angle, i.e. orientation of IEC GANTRY coordinate system with respect to IEC FIXED REFERENCE coordinate system (degrees). Required for Control Point 0 of Control Point Delivery Sequence (3008,0040) or if Gantry Angle changes during beam administration. Direction of Gantry Rotation when viewing gantry from isocenter, for segment beginning at current Control Point. Required for Control Point 0 of Control Point Delivery Sequence (3008,0040), or if Gantry Rotation Direction changes during beam administration. Enumerated Values: CW = clockwise CC = counter-clockwise NONE = no rotation Gantry Pitch Angle. i.e. the rotation of the IEC GANTRY coordinate system about the X-axis of the IEC GANTRY coordinate system (degrees). If used, must be present for first item of Control Point Sequence, or if used and Gantry Pitch Rotation Angle changes during Beam, must be present. See C.8.8.25.6.5.

Position of Beam Stopper during beam administration. Enumerated Values: EXTENDED = Beam Stopper extended RETRACTED = Beam Stopper retracted UNKNOWN = Position unknown Beam Limiting Device (collimator) angle, i.e. orientation of IEC BEAM LIMITING DEVICE coordinate system with respect to IEC GANTRY coordinate system (degrees). Required for Control Point 0 of Control Point Delivery Sequence (3008,0040) or if beam limiting device (collimator) angle changes during beam delivery. Direction of Beam Limiting Device Rotation when viewing beam limiting device (collimator) from radiation source, for segment beginning at current Control Point. Required for Control Point 0 of Control Point Delivery Sequence (3008,0040) or if Beam Limiting Device Rotation Direction changes during beam administration. Enumerated Values: CW = clockwise CC = counter-clockwise NONE = no rotation Patient Support angle, i.e. orientation of IEC PATIENT SUPPORT (turntable) coordinate system with respect to IEC FIXED REFERENCE coordinate system (degrees). Required for Control Point 0 of Control Point Delivery Sequence (3008,0040) or if Patient Support Angle changes during beam administration. Direction of Patient Support Rotation when viewing table from above, for segment beginning at current Control Point. Required for Control Point 0 of Control Point Delivery Sequence (3008,0040), or if Patient Support Rotation Direction changes during beam administration. Enumerated Values: CW = clockwise CC = counter-clockwise NONE = no rotation Distance (positive) from the IEC PATIENT SUPPORT vertical axis to the IEC TABLE TOP ECCENTRIC vertical axis (mm). Table Top (non-isocentric) angle, i.e. orientation of IEC TABLE TOP ECCENTRIC coordinate system with respect to IEC PATIENT SUPPORT coordinate system (degrees). Required for Control Point 0 of Control Point Delivery Sequence (3008,0040) or if Table Top Eccentric Angle changes during beam administration. Direction of Table Top Eccentric Rotation when viewing table from above, for segment beginning at current Control Point. Required for Control Point 0 of Control Point Delivery Sequence (3008,0040) or if Table Top Eccentric Rotation Direction changes during beam administration. Enumerated Values: CW = clockwise CC = counter-clockwise NONE = no rotation Table Top Pitch Angle, i.e. the rotation of the IEC TABLE TOP coordinate system about the X-axis of the IEC TABLE TOP coordinate system (degrees). If required by treatment delivery device, shall be present for first item of Control Point Sequence. If required by treatment delivery device and if Table Top Pitch Angle changes during Beam, shall be present in all subsequent items of Control Point Sequence. See C.8.8.25.6.2.

Table Top Vertical position in IEC TABLE TOP coordinate system (mm). This value is interpreted as an absolute, rather than relative, Table setting. Required for Control Point 0 of Control Point Delivery Sequence (3008,0040) or if Table Top Vertical Position changes during beam administration. Table Top Longitudinal position in IEC TABLE TOP coordinate system (mm). This value is interpreted as an absolute, rather than relative, Table setting. Required for Control Point 0 of Control Point Delivery Sequence (3008,0040) or if Table Top Longitudinal Position changes during beam administration. Table Top Lateral position in IEC TABLE TOP coordinate system (mm). This value is interpreted as an absolute, rather than relative, Table setting. Required for Control Point 0 of Control Point Delivery Sequence (3008,0040) or if Table Top Lateral Position changes during beam administration. Introduces a sequence of items describing any corrections made to any attributes prior to delivery of the next control point. The sequence may contain one or more items. Contains the Data Element Tag of the parent sequence containing the attribute that was corrected. The value is limited in scope to the Treatment Session Beam Sequence (3008,0020) and all nested sequences therein. Contains the sequence item index (starting at 1) of the corrected attribute within its parent sequence. Contains the Data Element Tag of the attribute that was corrected. The value applied to the attribute that was referenced by the Parameter Sequence Pointer (3008,0061), Parameter Item Index (3008,0063) and Parameter Pointer (3008,0065). Introduces sequence of parameters that were overridden during the administration of the beam segment immediately prior to the current control point. The sequence may contain one or more items. Contains the Data Element Tag of the attribute that was overridden. Required if Override Sequence (3008,0060) is sent. Contains the Data Element Tag of the parent sequence containing the attribute that was overridden. The value is limited in scope to the Treatment Session Beam Sequence (3008,0020) and all nested sequences therein. Contains the sequence item index (monotonically increasing from 1) of the overridden attributes within its parent sequence. The value is limited in scope to the Treatment Session Beam Sequence (3008,0020) and all nested sequences therein. Name of operator who authorized override. Required if Override Sequence (3008,0060) is sent. User-defined description of reason for override of parameter specified by Override Parameter Pointer (3008,0062). Name of operator administering treatment session. Identifier of Fraction Group within referenced RT Plan. Total number of treatments (Fractions) planned for current Fraction Group. Type of brachytherapy treatment technique. Enumerated Values: INTRALUMENARY, INTRACAVITARY, INTERSTITIAL, CONTACT, INTRAVASCULAR, PERMANENT. See RT Plan IOD. Type of brachytherapy treatment. Defined Terms: MANUAL = manually positioned HDR = High dose rate MDR = Medium dose rate LDR = Low dose rate PDR = Pulsed dose rate Introduces sequence of Sources to be used within Application Setups. The sequence may contain one or more items. Identification number of the Source. The value of Source Number (300A,0212) shall be unique within the Recorded Source Sequence (3008,0100) in which it is created. Type of Source. Defined Terms: POINT, LINE, CYLINDER, SPHERE. Manufacturer of source. Serial Number of source. User-defined name of Isotope. Half-life of Isotope (days). Measurement unit of Source Strength. Required if the source is not a gamma-emitting (photon) source. May be present otherwise. Enumerated Values: AIR_KERMA_RATE = Air Kerma Rate if Source is Gamma emitting Isotope. DOSE_RATE_WATER = Dose Rate in Water if Source is Beta emitting Isotope. Air Kerma Rate in air of Isotope specified at Air Kerma Rate Reference Date (300A,022C) and Air Kerma Rate Reference Time (300A,022E) (in µGy h-1 at 1 m). Value shall be zero for non-gamma sources. Source Strength of Isotope at Source Strength Reference Date (300A,022C) and Source Strength Reference Time (300A,022E), in units specified in Source Strength Units (300A,0229). Required if the source is not a gamma-emitting (photon) source. See C.8.8.15.13.

Reference date for Reference Air Kerma Rate (300A,022A) or Source Strength (300A,022B) of Isotope. Reference time for Air Kerma Rate (300A,022A) or Source Strength (300A,022B) of Isotope. Introduces sequence of Application Setups for RT Treatment Record for current RT Plan. The sequence may contain one or more items. Type of Application Setup. Defined Terms: FLETCHER_SUIT, DELCLOS, BLOEDORN, JOSLIN_FLYNN, CHANDIGARH, MANCHESTER, HENSCHKE, NASOPHARYNGEAL, OESOPHAGEAL, ENDOBRONCHIAL, SYED_NEBLETT, ENDORECTAL, PERINEAL. References application setup specified by Application Setup Number (300A,0234) in Application Setup Sequence (300A,0230) in RT Brachy Applications Module within referenced RT Plan. User-defined name for Application Setup. Manufacturer of Application Setup. Identification number of the Template. User-defined type for Template Device. User-defined name for Template Device. Results of check-wire travel through all channels of current Application Setup. Enumerated Values: PASSED = Passed check FAILED = Failed check UNKNOWN = Unknown status Introduces sequence of verification images obtained during delivery of current beam. The sequence may contain one or more items. See Note. Total Reference Air Kerma for current Application Setup, i.e. the sum of the products of the Air Kerma Rates of each Source in each Channel with its respective Channel Time (µGy at 1 m). Value shall be zero for non-gamma sources. Introduces sequence of doses measured during treatment delivery, summed over entire session. The sequence may contain one or more items. Uniquely references Dose Reference specified by Dose Reference Number (300A,0012) in Dose Reference Sequence (300A,0010) in RT Prescription Module of referenced RT Plan. Required if Referenced Measured Dose Reference Sequence (3008,0080) is sent and Referenced Measured Dose Reference Number (3008,0082) is not sent. It shall not be present otherwise. Uniquely references Measured Dose Reference specified by Measured Dose Reference Number (3008,0064) in Measured Dose Reference Sequence (3008,0010). Required if Referenced Measured Dose Reference Sequence (3008,0080) is sent and Referenced Dose Reference Number (300C,0051) is not sent. It shall not be present otherwise. Measured Dose in units specified by Dose Units (3004,0002) in sequence referenced by Measured Dose Reference Sequence (3008,0010) or Dose Reference Sequence (300A,0010) in RT Prescription Module of referenced RT Plan as defined above. Required if Referenced Measured Dose Reference Sequence (3008,0080) is sent. Introduces sequence of doses estimated for each treatment delivery. The sequence may contain one or more items. Uniquely identifies Dose Reference specified by Dose Reference Number (300A,0012) in Dose Reference Sequence (300A,0010) in RT Prescription Module of referenced RT Plan. Required if Referenced Calculated Dose Reference Sequence (3008,0090) is sent and Referenced Calculated Dose Reference Number (3008,0092) is not sent. It shall not be present otherwise. Uniquely identifies Calculated Dose Reference specified by Calculated Dose Reference Number (3008,0072) within Calculated Dose Reference Sequence (3008,0070). Required if Referenced Calculated Dose Reference Sequence (3008,0090) is sent and Referenced Dose Reference Number (300C,0051) is not sent. It shall not be present otherwise. Calculated Dose (Gy). Required if Referenced Calculated Dose Reference Sequence (3008,0090) is sent. Fraction number for this application setup. Delivery Type of treatment. Defined Terms: TREATMENT = normal patient treatment CONTINUATION = continuation of interrupted treatment Conditions under which treatment was terminated. Enumerated Values: NORMAL = treatment terminated normally OPERATOR = operator terminated treatment MACHINE = machine terminated treatment for other than NORMAL condition UNKNOWN = status at termination unknown Treatment machine termination code. This code is dependent upon the particular application and equipment. Conditions under which treatment was verified by a verification system. Enumerated Values: VERIFIED = treatment verified VERIFIED_OVR = treatment verified with at least one out-of-range value overridden NOT_VERIFIED = treatment verified manually Introduces sequence of Brachy Accessory Devices associated with current Application Setup. The sequence may contain one or more items. Identification number of the Brachy Accessory Device. The value of Brachy Accessory Device Number (300A,0262) shall be unique within the Application Setup in which it is created. Required if Recorded Brachy Accessory Device Sequence (3008,0120) is sent. User or machine supplied identifier for Brachy Accessory Device. Required if Recorded Brachy Accessory Device Sequence (3008,0120) is sent. Type of Brachy Accessory Device. Required if Recorded Brachy Accessory Device Sequence (3008,0120) is sent. Defined Terms: SHIELD, DILATATION, MOLD, PLAQUE, FLAB. User-defined name for Brachy Accessory Device. Introduces sequence of Channels for current Application Setup. The sequence may contain one or more items. Identification number of the Channel. The value of Channel Number (300A,0282) shall be unique within the Application Setup in which it is created. Length of Channel (mm). See RT Plan IOD. Total amount of time specified between Control Point 0 and final Control Point of the Brachy Control Point Sequence (300A,02D0) for current Channel (sec). Total amount of time actually delivered between Control Point 0 and final Control Point of the Brachy Control Point Sequence (300A,02D0) for current Channel (sec). Type of Source movement. Defined Terms: STEPWISE, FIXED, OSCILLATING, UNIDIRECTIONAL. Number of Pulses specified per fraction for current Channel. Required if Brachy Treatment Type (300A,0202) is PDR. See C.8.8.22.1.

In Brachytherapy treatment techniques where Brachy Treatment Type (300A,0202) is PDR, the Brachy Control Point Sequence (300A,02D0) shall consist of 2N items, where N = Delivered Number of Pulses (3008,0138). Each control point pair shall specify the start and end of a single pulse.

Number of Pulses actually delivered per fraction for current Channel. Required if Brachy Treatment Type (300A,0202) is PDR. See C.8.8.22.1.

Pulse repetition interval (sec) specified for current Channel. Required if Brachy Treatment Type (300A,0202) is PDR. See C.8.8.22.1

Pulse repetition interval (sec) actually delivered for current Channel. Required if Brachy Treatment Type (300A,0202) is PDR. See C.8.8.22.1.

Introduces sequence of doses measured during treatment delivery, summed over entire session. The sequence may contain one or more items. Uniquely references Dose Reference specified by Dose Reference Number (300A,0012) in Dose Reference Sequence (300A,0010) in RT Prescription Module of referenced RT Plan. Required if Referenced Measured Dose Reference Sequence (3008,0080) is sent and Referenced Measured Dose Reference Number (3008,0082) is not sent. It shall not be present otherwise. References Measured Dose Reference specified by Measured Dose Reference Number (3008,0064) in Measured Dose Reference Sequence (3008,0010). Required if Referenced Measured Dose Reference Sequence (3008,0080) is sent and Referenced Dose Reference Number (300C,0051) is not sent. It shall not be present otherwise. Measured Dose. Required if Referenced Measured Dose Reference Sequence (3008,0080) is sent. Introduces sequence of doses estimated for each treatment delivery. The sequence may contain one or more items. Uniquely identifies Dose Reference specified by Dose Reference Number (300A,0012) in Dose Reference Sequence (300A,0010) in RT Prescription Module of referenced RT Plan. Required if Referenced Calculated Dose Reference Sequence (3008,0090) is sent and Referenced Calculated Dose Reference Number (3008,0092) is not sent. It shall not be present otherwise. Uniquely identifies Calculated Dose Reference specified by Calculated Dose Reference Number (3008,0072) within Calculated Dose Reference Sequence (3008,0070). Required if Referenced Calculated Dose Reference Sequence (3008,0090) is sent and Referenced Dose Reference Number (300C,0051) is not sent. It shall not be present otherwise. Calculated Dose (Gy). Required if Referenced Calculated Dose Reference Sequence (3008,0090) is sent. Introduces sequence of recorded Source Applicators. The sequence may contain one or more items. Identification number of the Source Applicator. The value of Source Applicator Number (300A,0290) shall be unique within the Channel in which it is created. User or machine supplied identifier for Source Applicator. Required if Recorded Source Applicator Sequence (3008,0140) is sent. Type of Source Applicator. Required if Recorded Source Applicator Sequence (3008,0140) is sent. Enumerated Values: FLEXIBLE, RIGID. User-defined name for Source Applicator. Length of Source Applicator (mm), defined as the distance between the connector of the applicator and the distal-most position of the source. Required if Recorded Source Applicator Sequence (3008,0140) is sent. Manufacturer of Source Applicator. Distance of path along channel (mm) between adjacent (potential) dwell positions. Required if Source Movement Type (300A,0288) is STEPWISE. Identification number of the Transfer Tube. The value of Transfer Tube Number (300A,02A2) shall be unique within the Channel in which it is created. Length of Transfer Tube of current afterloading Channel (mm). Required if value Transfer Tube Number (300A,02A2) is not zero length. Introduces sequence of Channel Shields associated with current Channel. The sequence may contain one or more items. See RT Plan IOD for description of Channel Shields. Identification number of the Channel Shield. The value of Channel Shield Number (300A,02B2) shall be unique within the Channel in which it is created. Required if Recorded Channel Shield Sequence (3008,0150) is sent. User or machine supplied identifier for Channel Shield. Required if Recorded Channel Shield Sequence (3008,0150) is sent. User-defined name for Channel Shield. Uniquely identifies the referenced Source within the Recorded Source Sequence (3008,0100) for current Application Setup. Date on which the source(s) exited the safe. Required if Recorded Channel Sequence (3008,0130) is sent and Brachy Treatment Type (300A,0202) is not MANUAL. Time on which the source(s) exited the safe. Required if Recorded Channel Sequence (3008,0130) is sent and Brachy Treatment Type (300A,0202) is not MANUAL. Date on which the source(s) returned to the safe. Required if Recorded Channel Sequence (3008,0130) is sent and Brachy Treatment Type (300A,0202) is not MANUAL. Time on which the source(s) returned to the safe. Required if Recorded Channel Sequence (3008,0130) is sent and Brachy Treatment Type (300A,0202) is not MANUAL. Number of control points in Channel. For an N-segment Channel there will be 2N (stepwise movement) or N+1 (continuous movement) control points. Introduces sequence of machine configurations describing this Channel. The sequence may contain two or more items. See RT Plan IOD and C.8.8.22.1 for description of Brachy Control Point Delivered Sequence. Index of current Control Point, starting at 0 for first Control Point. Date when current Control Point occurred. Time when current Control Point occurred. Distance between current Control Point Position and the distal-most possible Source position in current Channel (mm). See RT Plan IOD. Introduces sequence of parameters which were overridden during the administration of the treatment immediately prior to the current control point. The sequence may contain one or more items. Contains the Data Element Tag of the attribute which was overridden. Required if Override Sequence (3008,0060) is sent. Name of operator who authorized override. Required if Override Sequence (3008,0060) is sent. User-defined description of reason for override of parameter specified by Override Parameter Pointer (3008,0062). Status of the Treatment at the time the Treatment Summary was created. Enumerated Values: NOT_STARTED, ON_TREATMENT, ON_BREAK, SUSPENDED, STOPPED, COMPLETED. See C.8.8.23.1.

The definition of the enumerated values for Current Treatment Status (3008,0200) are defined as follows: NOT_STARTED Patient has not yet begun treatment. ON_TREATMENT Patient is currently undergoing treatment. ON_BREAK Patient is currently not undergoing treatment, but a resumption date is known. SUSPENDED Patient is currently not undergoing treatment, but resumption of treatment is planned at an unknown date. STOPPED Patient has stopped treatment without completing the planned course. COMPLETED Patient completed the planned course of treatment. A change in the Current Treatment Status (or any other field) in a RT Treatment Summary Record Object shall define a new instance of the RT Treatment Summary Record IOD.

Comment on current treatment status. Date of delivery of the first treatment. Date of delivery of the most recent administration. Introduces sequence describing current state of planned vs. delivered fraction groups. The sequence may contain one or more items. References Fraction Group Number (300A,0071) in Fraction Group Sequence (300A,0070) in the referenced RT Plan. Indicates type of fraction group. Required if Fraction Group Summary Sequence (3008,0220) is sent. Enumerated Values: EXTERNAL_BEAM, BRACHY. Number of fractions planned for this fraction group. Required if Fraction Group Summary Sequence (3008,0220) is sent. Number of fractions delivered as of Treatment Summary Report. Required if Fraction Group Summary Sequence (3008,0220) is sent. Introduces sequence describing status of fractions in Fraction Group. The sequence may contain one or more items. Identifies fraction. Required if Fraction Status Summary Sequence (3008,0240) is sent. Date when fraction was delivered. Required if Fraction Status Summary Sequence (3008,0240) is sent. Time when fraction was delivered. Required if Fraction Status Summary Sequence (3008,0240) is sent. Conditions under which treatment was terminated. Required if Fraction Status Summary Sequence (3008,0240) is sent. Enumerated Values: NORMAL = treatment terminated normally OPERATOR = operator terminated treatment MACHINE = machine terminated treatment for other than NORMAL condition UNKNOWN = status at termination unknown Introduces sequence of references to Measured Dose References. The sequence may contain one or more items. Uniquely identifies Dose Reference specified by Dose Reference Number (300A,0012) in Dose Reference Sequence (300A,0010) in RT Prescription Module of referenced RT Plan referenced in Referenced RT Plan Sequence (300C,0002) of RT General Treatment Record Module. User-defined description of Dose Reference. Cumulative Dose delivered to Dose Reference (Gy). Required if Treatment Summary Dose Reference Sequence (3008,00E0) is sent. Introduces sequence of references to Calculated Dose References. The sequence may contain one or more items. Uniquely identifies Dose Reference specified by Dose Reference Number (300A,0012) in Dose Reference Sequence (300A,0010) in RT Prescription Module of referenced RT Plan referenced in Referenced RT Plan Sequence (300C,0002) of RT General Treatment Record Module. User-defined description of Dose Reference. Cumulative Dose delivered to Dose Reference (Gy). Required if Treatment Summary Dose Reference Sequence (3008,0050) is sent. Introduces sequence of ion tolerance tables to be used for delivery of treatment plan. One or more items shall be included in this sequence. See Note 1. Identification number of the Tolerance Table. The value of Tolerance Table Number (300A,0042) shall be unique within the RT Ion Plan in which it is created. User-defined label for Tolerance Table. Maximum permitted difference (in degrees) between planned and delivered Gantry Angle. Maximum permitted difference (in degrees) between planned and delivered Beam Limiting Device Angle. Introduces sequence of beam limiting device (collimator) tolerances. One or more items may be included in this sequence. Type of beam limiting device (collimator). Enumerated Values: X = symmetric jaw pair in IEC X direction Y = symmetric jaw pair in IEC Y direction ASYMX = asymmetric jaw pair in IEC X direction ASYMY = asymmetric pair in IEC Y direction MLCX = multileaf (multi-element) jaw pair in IEC X direction MLCY = multileaf (multi-element) jaw pair in IEC Y direction Maximum permitted difference (in mm) between planned and delivered leaf (element) or jaw positions for current beam limiting device (collimator). Maximum permitted difference (in degrees) between planned and delivered Patient Support Angle. Maximum permitted difference (in mm) between planned and delivered Table Top Vertical Position. Maximum permitted difference (in mm) between planned and delivered Table Top Longitudinal Position. Maximum permitted difference (in mm) between planned and delivered Table Top Lateral Position. Maximum permitted difference (in degrees) between planned and delivered Table Top Pitch Angle. Maximum permitted difference (in degrees) between planned and delivered Table Top Roll Angle. Maximum permitted difference (in mm) between planned and delivered Snout Position. Introduces sequence of setup and/or treatment beams for current RT Ion Plan. One or more items shall be included in this sequence. Identification number of the Beam. The value of Beam Number (300A,00C0) shall be unique within the RT Ion Plan in which it is created. See section C.8.8.25.1. User-defined name for Beam. See section C.8.8.25.1. User-defined description for Beam. See section C.8.8.25.1. Motion characteristic of Beam. Enumerated Values: STATIC = all beam parameters remain unchanged during delivery DYNAMIC = one or more beam parameters changes during delivery Particle type of Beam. Defined Terms: PHOTON PROTON ION Mass number of radiation. Required if Radiation Type (300A,00C6) is ION Atomic number of radiation. Required if Radiation Type (300A,00C6) is ION Charge state of radiation. Required if Radiation Type (300A,00C6) is ION The method of beam scanning to be used during treatment. Defined Terms: NONE = No beam scanning is performed. UNIFORM = The beam is scanned between control points to create a uniform lateral fluence distribution across the field. MODULATED = The beam is scanned between control points to create a modulated lateral fluence distribution across the field. User-defined name identifying treatment machine to be used for beam delivery. See section C.8.8.25.2. Manufacturer of the equipment to be used for beam delivery. Institution where the equipment is located that is to be used for beam delivery. Mailing address of the institution where the equipment is located that is to be used for beam delivery. Department in the institution where the equipment is located that is to be used for beam delivery. Manufacturer's model name of the equipment that is to be used for beam delivery. Manufacturer's serial number of the equipment that is to be used for beam delivery. Measurement unit of machine dosimeter. Enumerated Values: MU = Monitor Unit NP = number of particles Uniquely identifies Tolerance Table specified by Tolerance Table Number (300A,0042) within Tolerance Table Sequence in RT Ion Tolerance Tables Module. These tolerances are to be used for verification of treatment machine settings. Distance (in mm) from virtual source position to gantry rotation axis or nominal isocenter position (fixed beam-lines) of the equipment to be used for beam delivery. Specified by a numeric pair - the VSAD in the IEC Gantry X direction followed by the VSAD in the IEC Gantry Y direction. The VSAD is commonly used for designing apertures in contrast to the effective source-axis-distance (ESAD) that is commonly used with the inverse square law for calculating the dose decrease with distance. See section C.8.8.25.4. Introduces sequence of beam limiting device (collimator) jaw or leaf (element) sets. One or more items may be included in this sequence. Type of beam limiting device (collimator). Enumerated Values: X = symmetric jaw pair in IEC X direction Y = symmetric jaw pair in IEC Y direction ASYMX = asymmetric jaw pair in IEC X direction ASYMY = asymmetric pair in IEC Y direction MLCX = multileaf (multi-element) jaw pair in IEC X direction MLCY = multileaf (multi-element) jaw pair in IEC Y direction Isocenter to beam limiting device (collimator) distance (in mm) of the equipment that is to be used for beam delivery. See section C.8.8.25.4. Number of leaf (element) or jaw pairs (equal to 1 for standard beam limiting device jaws). Boundaries of beam limiting device (collimator) leaves (in mm) in IEC BEAM LIMITING DEVICE coordinate axis appropriate to RT Beam Limiting Device Type (300A,00B8), i.e. X-axis for MLCY, Y-axis for MLCX. Contains N+1 values, where N is the Number of Leaf/Jaw Pairs (300A,00BC), starting from Leaf (Element) Pair 1. Required if RT Beam Limiting Device Type (300A,00B8) is MLCX or MLCY. See section C.8.8.25.3. Uniquely identifies Patient Setup to be used for current beam, specified by Patient Setup Number (300A,0182) within Patient Setup Sequence of RT Patient Setup Module. Introduces sequence of reference images used for validation of current beam. One or more items may be included in this sequence. Uniquely identifies Reference Image within Referenced Reference Image Sequence (300C,0042). Delivery Type of treatment. Defined Terms: TREATMENT = normal patient treatment OPEN_PORTFILM = portal image acquisition with open field (the source of radiation is specified by Radiation Type (300A,00C6)) TRMT_PORTFILM = portal image acquisition with treatment port (the source of radiation is specified by Radiation Type (300A,00C6)) CONTINUATION = continuation of interrupted treatment SETUP = no treatment beam is applied for this RT Beam. To be used for specifying the gantry, couch, and other machine positions where X-Ray set-up images or measurements shall be taken. Introduces sequence of related SOP Class/Instance pairs describing related instances of RT Dose (for grids, isodose curves, and named/unnamed point doses). One or more items may be included in this sequence. Number of wedges associated with current beam. Shift of the wedge tray induced on the range of the ion beam as measured in water (in mm). Introduces sequence of treatment wedges. Required if Number of Wedges (300A,00D0) is non-zero. The number of items shall be identical to the value of Number of Wedges (300A,00D0). Identification number of the Wedges. The value of Wedge Number (300A,00D2) shall be unique within the Beam in which it was created. Typer of wedge (if any) defined for Beam. Defined Terms: STANDARD = standard (static) wedge MOTORIZED = single wedge that can be removed from beam remotely. PARTIAL_STANDARD = wedge does not extend across the whole field and is operated manually. PARTIAL_MOTORIZ = wedge does not extend across the whole field and can be removed from beam remotely. User-supplied identifier for Wedge. An accessory identifier to be read by a device such as a bar code reader. Nominal wedge angle (degrees). Orientation of wedge, i.e. orientation of IEC WEDGE FILTER coordinate system with respect to the IEC BEAM LIMITING DEVICE coordinate systems (degrees). Isocenter to downstream edge of wedge tray (mm). See section C.8.8.25.4 Number of compensators associated with current Beam. Water-Equivalent thickness of the compensator tray (in mm) parallel to radiation beam axis. Introduces sequence of compensators. Required if Number of Compensators (300A,00E0) is non-zero. The number of items shall be identical to the value of Number of Compensators (300A,00E0). User defined description for the compensator. Identification number of the Compensator. The value of Compensator Number (300A,00E4) shall be unique within the Beam in which it is created. User-supplied identifier for material used to manufacture Compensator. User-supplied identifier for the compensator. An accessory identifier to be read by a device such as a bar code reader. Isocenter to compensator tray attachment edge distance (in mm) for current range compensator. Required if Compensator Mounting Position (300A,02E1) is not DOUBLE_SIDED. See section C.8.8.25.4 Indicates presence or absence of geometrical divergence of the range compensator. Enumerated Values: PRESENT = the range compensator is shaped according to the beam geometrical divergence. ABSENT = the range compensator is not shaped according to the beam geometrical divergence. Indicates on which side of the Compensator Tray the compensator is mounted. Enumerated Values: PATIENT_SIDE = the Compensator is mounted on the side of the Compensator Tray that is towards the patient. SOURCE_SIDE = the Compensator is mounted on the side of the Compensator Tray that is towards the radiation source. DOUBLE_SIDED = the Compensator has a shaped (i.e. non-flat) surface on both sides of the Compensator Tray. Number of rows in the range compensator. A row is defined to be in the X direction of the IEC Beam Limiting Device Coordinate system. Number of columns in the range compensator. A column is defined to be in the Y direction of the IEC Beam Limiting Device Coordinate system. Physical distance (in mm) between the center of each pixel projected onto machine isocentric plane. Specified by a numeric pair - adjacent row spacing followed by adjacent column spacing. See 10.7.1.3 for further explanation of the value order. The x and y coordinates of the upper left hand corner (first pixel transmitted) of the range compensator, projected onto the machine isocentric plane in the IEC BEAM LIMITING DEVICE coordinate system (mm). The offset distance (in mm) applied to the x coordinate of the Compensator Position (300A,00EA) for even numbered rows. Required if the compensator pattern is hexogonal. A data stream of the pixel samples that comprise the range compensator, expressed as physical thickness (in mm), either parallel to radiation beam axis if Compensator Divergence (300A,02E0) equals ABSENT, or divergent according to the beam geometrical divergence if Compensator Divergence (300A,02E0) equals PRESENT. The order of pixels sent is left to right, top to bottom (upper left pixel, followed by the remainder of row 1, followed by the remainder of the rows). A data stream of the pixel samples that comprise the distance from the isocenter to the compensator surface closest to the radiation source (in mm). The order of pixels sent is left to right, top to bottom (upper left pixel, followed by the remainder of row 1, followed by the remainder of the rows). Required if Material ID (300A,00E1) is non-zero length, and Compensator Mounting Position (300A,02E1) is DOUBLE_SIDED. See sections C.8.8.14.9 and C.8.8.25.4 Compensator Linear Stopping Power Ratio, relative to water, at the beam energy specified by the Nominal Beam Energy (300A,0114) of the first Control Point of the Ion Control Point Sequence (300A,03A8). The diameter (in mm) of the milling tool to be used to create the compensator. The diameter is expressed as the actual physical size and not a projected size at isocenter. Number of boli associated with current Beam. Introduces sequence of boli associated with Beam. Required if Number of Boli (300A,00ED) is non-zero. The number of items shall be identical to the value of Number of Boli (300A,00ED). Uniquely identifies ROI representing the Bolus specified by ROI Number (3006,0022) in Structure Set ROI Sequence (3006,0020) in Structure Set Module within RT Structure Set in Referenced Structure Set Sequence (300C,0060) in RT General Plan Module. An accessory identifier to be read by a device such as a bar code reader. Number of shielding blocks associated with Beam. Water-Equivalent thickness of the block tray (in mm) parallel to radiation beam axis. Introduces sequence of blocks associated with Beam. Required if Number of Blocks (300A,00F0) is non-zero. The number of items shall be identical to the value of Number of Blocks (300A,00F0). User-supplied identifier for block tray. An accessory identifier to be read by a device such as a bar code reader. Isocenter to downstream edge of block tray (mm). See section C.8.8.25.4 Type of block. See section C.8.8.14.4. Enumerated Values: SHIELDING = blocking material is inside contour APERTURE = blocking material is outside contour Indicates presence or otherwise of geometrical divergence. Enumerated Values: PRESENT = block edges are shaped for beam divergence ABSENT = block edges are not shaped for beam divergence Indicates on which side of the Block Tray the block is mounted. Enumerated Values; PATIENT_SIDE = the block is mounted on the side of the Block Tray that is towards the patient. SOURCE_SIDE = the block is mounted on the side of the Block Tray that is towards the radiation source. Identification number of the Block. The value of Block Number (300A,00FC) shall be unique within the Beam in which it is created. User-defined name for block. User-supplied identifier for material used to manufacture Block. Physical thickness of block (in mm) parallel to radiation beam axis. See section C.8.8.14.4. Number of (x,y) pairs defining the block edge. A data stream of (x,y) pairs that comprise the block edge. The number of pairs shall be equal to Block Number of Points (300A,0104), and the vertices shall be interpreted as a closed polygon. Coordinates are projected onto the machine isocentric plane in the IEC BEAM LIMITING DEVICE coordinate system (mm). Introduces sequence of Snouts associated with Beam. Only a single item shall be permitted in this sequence. User or machine supplied identifier for Snout. An accessory identifier to be read by a device such as a bar code reader. Introduces sequence of Applicators associated with Beam. Only a single item shall be permitted in this sequence. User or machine supplied identifier for Applicator. See section C.8.8.14.12 An accessory identifier to be read by a device such as a bar code reader. Type of applicator. Defined Terms: ION_SQUARE = square ion applicator ION_RECT = rectangluar ion applicator ION_CIRC = circular ion applicator ION_SHORT = short ion applicator ION_OPEN = open (dummy) ion applicator INTEROPERATIVE = interoperative (custom) applicator STEREOTACTIC = stereotactic applicator User-defined description for Applicator. Introduces a Sequence of General Accessories associated with this Beam. One or more items may be included in this sequence. Identification Number of the General Accessory. The value shall be unique within the sequence. User or machine supplied identifier for General Accessory. User supplied description of General Accessory. Specifies the type of accessory. Defined Terms: GRATICULE = Accessory tray with a radio-opaque grid IMAGE_DETECTOR = Image acquisition device positioned in the beam line RETICLE = Accessory tray with radio-transparent markers or grid Machine-readable identifier for this accessory Number of range shifters associated with current beam. Introduces sequence of range shifters associated with Beam. Required if Number of Range Shifters (300A,0312) is non-zero. The number of items shall be identical to the value of Number of Range Shifters (300A,0312). Identification number of the Range Shifter. The value of Range Shifter Number (300A,0316) shall be unique within the Beam in which it is created. User or machine supplied identifier for Range Shifter. An accessory identifier to be read by a device such as a bar code reader. Type of Range Shifter. Defined Terms: ANALOG = Device is variable thickness and is composed of opposing sliding wedges, water column or similar mechanism. BINARY = Device is composed of different thickness materials that can be moved in or out of the beam in various stepped combinations. User defined description of Range Shifter. Number of lateral spreading devices associated with current beam. Introduces sequence of lateral spreading devices associated with Beam. Required if Number of Lateral Spreading Devices (300A,0330) is non-zero. The number of items shall be identical to the value of Number of Lateral Spreading Devices (300A,0330). Identification number of the Lateral Spreading Device. The value of Lateral Spreading Device Number (300A,0334) shall be unique within the Beam in which it is created. User or machine supplied identifier for Lateral Spreading Device. An accessory identifier to be read by a device such as a bar code reader. Type of Lateral Spreading Device. Defined Terms: SCATTERER = metal placed into the beam path to scatter charged particles laterally. MAGNET = nozzle configuration of magnet devices to expand beam laterally. User-defined description for lateral spreading device. Number of range modulators associated with current beam. Introduces sequence of range modulators associated with Beam. Required if Number of Range Modulators (300A,0340) is non-zero. The number of items shall be identical to the value of Number of Range Modulators (300A,0340). Identification number of the Range Modulator. The value of Range Modulator Number (300A,0344) shall be unique within the Beam in which it is created. User or machine supplied identifier for Range Modulator. An accessory identifier to be read by a device such as a bar code reader. Type of Range Modulator. Defined Terms: FIXED = fixed modulation width and weights using ridge filter or constant speed wheel with constant beam current WHL_FIXEDWEIGHTS = selected wheel/track (Range Modulator ID) is spinning at constant speed. Modulation width is adjusted by switching constant beam current on and off at wheel steps indicated by Range Modulator Gating Values. WHL_MODWEIGHTS = selected wheel/track (Range Modulator ID) is spinning at constant speed. Weight per wheel step is adjusted by modulating beam current according to selected Beam Current Modulation ID (300A,034C). Only one item in the Range Modulator Sequence (300A,0342) can have a Range Modulator Type (300A,0348) of WHL_MODWEIGHTS. User-defined description of Range Modulator. User-supplied identifier for the beam current modulation pattern. Required if Range Modulator Type (300A,0348) is WHL_MODWEIGHTS Azimuthal angle (degrees) of the fixation light coordinate around IEC BEAM LIMITING DEVICE Y-axis. Used for eye treatments. See section C.8.8.25.6.4. Polar angle (degrees) of the fixation light coordinate. Used for eye treatments. See section C.8.8.25.6.4. Value of Cumulative Meterset Weight (300A,0134) for final Control Point in Ion Control Point Sequence (300A,03A8). Required if Cumulative Meterset Weight is non-null in Control Points specified within Ion Control Point Sequence. See section C.8.8.14.1. Number of control points in Beam. Value shall be greater than or equal to 2. Introduces sequence of machine configurations describing Ion treatment beam. The number of items shall be identical to the value of Number of Control Points (300A,0110). See C.8.8.25.7.

The control point sequence for RT Ion Beams is defined using the same rule set as in the RT Beams module (see Section C.8.8.14.5 Control Point Sequence). Specifically, the following rules apply:

Index of current Control Point, starting at 0 for first Control Point. Cumulative weight to current control point. Cumulative Meterset Weight for the first item in Control Point Sequence shall always be zero. Cumulative Meterset Weight for the final item in Ion Control Point Sequence shall always be equal to Final Cumulative Meterset Weight. Introduces a sequence of Dose References for current Beam. One or more items may be included in this sequence. Uniquely identifies Dose Reference specified by Dose Reference Number (300A,0012) in Dose Reference Sequence (300A,0010) in RT Prescription Module. Coefficient used to calculate cumulative dose contribution from this Beam to the referenced Dose Reference at the current Control Point. Nominal Beam Energy at control point in MeV per nucleon. Defined at nozzle entrance before all Beam Modifiers. Required for first item of Control Point Sequence, or if Nominal Beam Energy changes during Beam, and KVp (0018,0060) is not present. Peak kilo voltage output of the setup X-Ray generator to be used. Required for first item of Control Point Sequence, or if KVp changes during setup, and Nominal Beam Energy (300A,0114) is not present. Specifies the speed of delivery of the specified dose in units specified by Primary Dosimeter Unit (300A,00B3) per minute. Introduces sequence of Wedge positions for current control point. Required for first item of Ion Control Point Sequence if Number of Wedges (300A,00D0) is non-zero, and in subsequent control points if Wedge Position (300A,0118) or Wedge Thin Edge Position (300A,00DB) changes during beam. The number of items shall be identical to the value of Number of Wedges (300A,00D0). Uniquely references Wedge described by Wedge Number (300A,00D2) in Wedge Sequence (300A,00D1). Position of Wedge at current Control Point. Enumerated Values: IN OUT Closest distance from the central axis of the beam along a wedge axis to the thin edge as projected to the machine isocentric plane (mm). Value is positive is the wedge does not cover the central axis, negative if it does. Required if Wedge Type (300A,00D3) of the wedge referenced by Referenced Wedge Number (300C,00C0) is PARTIAL_STANDARD or PARTIAL_MOTORIZ. See section C.8.8.25.6.4. Introduces sequence of Range Shifter settings for the current control point. One or more items shall be included in this sequence. Required for first item of Control Point Sequence if Number of Range Shifters (300A,0312) is non-zero, or if Range Shifter Setting (300A,0362) changes during Beam. Uniquely references Range Shifter described by Range Shifter Number (300A,0316) in Range Shifter Sequence (300A,0314). Machine specific setting attribute for the range shifter. The specific encoding of this value should be documented in a Conformance Statement. See section C.8.8.25.5. Isocenter to downstream edge of range shifter (mm) at current control point. See section C.8.8.25.4 Water equivalent thickness (in mm) of the range shifter at the central axis for the beam energy incident upon the device. Introduces sequence of Lateral Spreading Device settings for the current control point. One or more items shall be included in this sequence. Required for first item of Control Point Sequence if Number of Lateral Spreading Devices (300A,0330) is non-zero, or if Lateral Spreading Device Setting (300A,0372) changes during Beam. Uniquely references Lateral Spreading Device described by Lateral Spreading Device Number (300A,0334) in Lateral Spreading Device Sequence (300A,0332). Machine specific setting attribute for the lateral spreading device. The specific encoding of this value should be documented in a Conformance Statement. See section C.8.8.25.5. Isocenter to downstream edge of Lateral Spreading Device (mm) at current control point. See section C.8.8.25.4 Water equivalent thickness (in mm) of the lateral spreading device at the central axis for the beam energy incident upon the device. Introduces sequence of Range Modulator Settings for current control point. One or more items shall be included in this sequence. Required for first item of Control Point Sequence if Number of Range Modulators (300A,0340) is non-zero, or if Range Modulator Setting changes during Beam. Uniquely references Range Modulator described by Range Modulator Number (300A,0344) in Range Modulator Sequence (300A,0342). Start position defines the range modulator position at which the beam is switched on. Required if Range Modulator Type (300A,0348) of the range modulator referenced by Referenced Range Modulator Number (300C,0104) is WHL_MODWEIGHTS or WHL_FIXEDWEIGHTS Stop position defines the range modulator position at which the beam is switched off. Required if Range Modulator Type (300A,0348) of the range modulator referenced by Referenced Range Modulator Number (300C,0104) is WHL_MODWEIGHTS or WHL_FIXEDWEIGHTS If Range Modulator Type (300A,0348) is WHL_MODWEIGHTS or WHL_FIXEDWEIGHTS: Water equivalent thickness (in mm) of the range modulator at the position specified by Range Modulator Gating Start Value (300A,0382). If Range Modulator Type (300A,0348) is FIXED: Minimum water equivalent thickness (in mm) of the range modulator. If Range Modulator Type (300A,0348) is WHL_MODWEIGHTS or WHL_FIXEDWEIGHTS: Water equivalent thickness (in mm) of the range modulator at the position specified by Range Modulator Gating Stop Value (300A,0384). If Range Modulator Type (300A,0348) is FIXED: Maximum water equivalent thickness (in mm) of the range modulator. Isocenter to downstream edge of range modulator (mm) at current control point. See section C.8.8.25.4 Gantry angle of radiation source, i.e. orientation of IEC GANTRY coordinate system with respect to IEC FIXED REFERENCE coordinate system (degrees). Required for first item of Control Point Sequence, or if Gantry Angle changes during Beam. Direction of Gantry Rotation when viewing gantry from isocenter, for segment following Control Point. Required for first item of Control Point Sequence, or if Gantry Rotation Direction changes during Beam. See section C.8.8.14.8. Enumerated Values: CW = clockwise CC = counter-clockwise NONE = no rotation Gantry Pitch Angle of the radiation source, i.e. the rotation of the IEC GANTRY coordinate system about the X-axis of the IEC GANTRY coordinate system (degrees). Required for first item of Control Point Sequence, or if Gantry Pitch Rotation Angle changes during Beam. See C.8.8.25.6.5.

Direction of Gantry Pitch Angle when viewing along the positive X-axis of the IEC GANTRY coordinate system, for segment following Control Point. Required for first item of Control Point Sequence, or if Gantry Pitch Rotation Direction changes during Beam. See C.8.8.14.8 and C.8.8.25.6.5. Enumerated Values: CW = clockwise CC = counter-clockwise NONE = no rotation

Beam Limiting Device angle, i.e. orientation of IEC BEAM LIMITING DEVICE coordinate system with respect to IEC GANTRY coordinate system (degrees). Required for first item of Control Point Sequence, or if Beam Limiting Device Angle changes during Beam. Direction of Beam Limiting Device Rotation when viewing beam limiting device (collimator) from radiation source, for segment following Control Point. Required for first item of Control Point Sequence, or if Beam Limiting Device Rotation Direction changes during Beam. See section C.8.8.14.8. Enumerated Values: CW = clockwise CC = counter-clockwise NONE = no rotation User-supplied or machine code identifier for machine configuration to produce beam spot. This may be the nominal spot size or some other machine specific value. Required if Scan Mode (300A,0308) is MODULATED. Number of spot positions used to specify scanning pattern for current segment beginning at control point. Required if Scan Mode (300A,0308) is MODULATED. The x and y coordinates of the scan spots are defined as projected onto the machine isocentric plane in the IEC GANTRY coordinate system (mm). Required if Scan Mode (300A,0308) is MODULATED. Contains 2N values where N is the Number of Scan Spot Positions (300A,0392). A data set of meterset weights corresponding to scan spot positions. The order of weights matches the positions in Scan Spot Positions (300A,0394). The sum contained in all meterset weights shall match the difference of the cumulative meterset weight of the current control point to the following control point. Required if Scan Mode (300A,0308) is MODULATED. The Scanning Spot Size as calculated using the Full Width Half Maximum (FWHM). Specified by a numeric pair - the size measured in air at isocenter in IEC GANTRY X direction followed by the size in the IEC GANTRY Y direction (mm). The number of times the scan pattern given by Scan Spot Position Map (300A,0394) and Scan Spot Meterset Weights (300A,0396) shall be applied at the current control point. To obtain the meterset weight per painting, the values in the Scan Spot Meterset Weights (300A,0396) should be divided by the value of this attribute. Required if Scan Mode (300A,0308) is MODULATED. Patient Support angle, i.e. orientation of IEC PATIENT SUPPORT (turntable) coordinate system with respect to IEC FIXED REFERENCE coordinate system (degrees). Required for first item of Control Point Sequence, or if Patient Support Angle changes during Beam. Direction of Patient Support Rotation when viewing table from above, for segment following Control Point. Required for first item of Control Point Sequence, or if Patient Support Rotation Direction changes during Beam. See section C.8.8.14.8. Enumerated Values: CW = clockwise CC = counter-clockwise NONE = no rotation Table Top Pitch Angle, i.e. the rotation of the IEC TABLE TOP coordinate system about the X-axis of the IEC TABLE TOP coordinate system (degrees). Required for first item of Control Point Sequence, or if Table Top Pitch Angle changes during Beam. See section C.8.8.25.6.2. Direction of Table Top Pitch Rotation when viewing the table along the positive X-axis of the IEC TABLE TOP coordinate system, for segment following Control Point. Required for first item of Control Point Sequence, or if Table Top Pitch Rotation Direction changes during Beam. See C.8.8.14.8 and C.8.8.25.6.2. Enumerated Values: CW = clockwise CC = counter-clockwise NONE = no rotation

Table Top Roll Angle, i.e. the rotation of the IEC TABLE TOP coordinate system about the Y-axis of the IEC TABLE TOP coordinate system (degrees). Required for first item of Control Point Sequence, or if Table Top Roll Angle changes during Beam. See section C.8.8.25.6.2. Direction of Table Top Roll Rotation when viewing the table along the positive Y-axis of the IEC TABLE TOP coordinate system, for segment following Control Point. Required for first item of Control Point Sequence, or if Table Top Roll Rotation Direction changes during Beam. See C.8.8.14.8 and C.8.8.25.6.2. Enumerated Values: CW = clockwise CC = counter-clockwise NONE = no rotation.

Angle (in degrees) of the head fixation for eye treatments with respect to the Table Top Pitch Angle (300A,0140) coordinate system. Positive head fixation angle is the same direction as positive Table Top pitch. See section C.8.8.25.6.4. Table Top Vertical position in IEC TABLE TOP coordinate system (mm). Required for first item of Control Point Sequence, or if Table Top Vertical Position changes during Beam. See section C.8.8.14.6. Table Top Longitudinal position in IEC TABLE TOP coordinate system (mm). Required for first item of Control Point Sequence, or if Table Top Longitudinal Position changes during Beam. See section C.8.8.14.6. Table Top Lateral position in IEC TABLE TOP coordinate system (mm). Required for first item of Control Point Sequence, or if Table Top Lateral Position changes during Beam. See section C.8.8.14.6. Axial position of the snout (in mm) measured from isocenter to the downstream side of the snout (without consideration of variable length elements such as blocks, MLC and/or compensators). Required for first item in Control Point Sequence, or if Snout Position changes during Beam. Isocenter coordinates (x,y,z) in the patient based coordinate system described in C.7.6.2.1.1 (mm). Required for first item of Segment Control Point Sequence, or if Segment Isocenter Position changes during Beam. Patient surface entry point coordinates (x,y,z), along the central axis of the beam, in the patient based coordinate system described in C.7.6.2.1.1 (mm). Name of operator administering treatment session. Identifier of fraction group within referenced RT Ion Plan. Total number of treatments (fractions) planned for current fraction group. Measurement unit of the machine dosimeter. Enumerated Values: MU = Monitor Units NP = Number of Particles Introduces sequence of setup and/or treatment beams administered during treatment session. One or more items shall be included in this sequence. References Beam specified by Beam Number (300A,00C0) in Ion Beam Sequence (300A,03A2) in RT Ion Beams Module within the referenced RT Ion Plan. User-defined name for Beam. See section C.8.8.25.1. User-defined description for Beam. See section C.8.8.25.1. Motion characteristic of Beam. Enumerated Values: STATIC = all beam parameters remain unchanged during delivery DYNAMIC = one or more beam parameters changes during delivery Particle type of Beam. Defined Terms: PHOTON PROTON ION Mass number of radiation. Required if Radiation Type (300A,00C6) is ION Atomic number of radiation. Required if Radiation Type (300A,00C6) is ION Charge state of radiation. Required if Radiation Type (300A,00C6) is ION The method of beam scanning used during treatment. Defined Terms: NONE = No beam scanning is performed. UNIFORM = The beam is scanned between control points to create a uniform lateral fluence distribution across the field. MODULATED = The beam is scanned between control points to create a modulated lateral fluence distribution across the field. Uniquely identifies Ion Tolerance Table specified by Tolerance Table Number (300A,0042) within Ion Tolerance Table Sequence in RT Ion Tolerance Tables Module. These tolerances are to be used for verification of treatment machine settings. Introduces sequence of beam limiting device (collimator) jaw or leaf (element) sets. One or more items may be included in this sequence. Type of beam limiting device (collimator). Enumerated Values: X = symmetric jaw pair in IEC X direction Y = symmetric jaw pair in IEC Y direction ASYMX = asymmetric jaw pair in IEC X direction ASYMY = asymmetric pair in IEC Y direction MLCX = multileaf (multi-element) jaw pair in IEC X direction MLCY = multileaf (multi-element) jaw pair in IEC Y direction Number of leaf (element) or jaw pairs (equal to 1 for standard beam limiting device jaws). Uniquely identifies Ion Patient Setup to be used for current beam, specified by Patient Setup Number (300A,0182) within Patient Setup Sequence of RT Patient Setup Module. Introduces sequence of verification images obtained during delivery of current beam. One or more items may be included in this sequence. See C.8.8.14.2.

Introduces sequence of doses measured during treatment delivery for current Beam. The sequence may contain one or more items. Uniquely references Dose Reference specified by Dose Reference Number (300A,0012) in Dose Reference Sequence (300A,0010) in RT Prescription Module of referenced RT Ion Plan. Required if Referenced Measured Dose Reference Number (3008,0082) is not sent. Uniquely references Measured Dose Reference specified by Measured Dose Reference Number (3008,0064) in Measured Dose Reference Sequence (3008,0010). Required if Referenced Dose Reference Number (300C,0051) is not sent. Measured Dose in units specified by Dose Units (3004,0002) in sequence referenced by Measured Dose Reference Sequence (3008,0010) or Dose Reference Sequence (300A,0010) in RT Prescription Module of Referenced RT Ion Plan as defined above. Introduces sequence of doses estimated for each treatment delivery. The sequence may contain one or more items. Uniquely identifies Dose Reference specified by Dose Reference Number (300A,0012) in Dose Reference Sequence (300A,0010) in RT Prescription Module of referenced RT Ion Plan. Required if Referenced Calculated Dose Reference Number (3008,0092) is not sent. Uniquely identifies Calculated Dose Reference specified by Calculated Dose Reference Number (3008,0072) within Calculated Dose Reference Sequence (3008,0070). Required if Referenced Dose Reference Number (300C,0051) is not sent. Calculated Dose (Gy). Number of wedges associated with current beam. Introduces sequence of treatment wedges. Required if Number of Wedges (300A,00D0) is non-zero. One or more items may be included in this sequence. The number of items shall be identical to the value of Number of Wedges (300A,00D0). Identification number of the Wedges. The value of Wedge Number (300A,00D2) shall be unique within the Beam in which it was created. Type of wedge (if any) defined for Beam. Defined Terms: STANDARD = standard (static) wedge MOTORIZED = single wedge that can be removed from beam remotely. PARTIAL_STANDARD = wedge does not extend across the whole field and is operated manually. PARTIAL_MOTORIZ = wedge does not extend across the whole field and can be removed from beam remotely. User-supplied identifier for Wedge. An accessory identifier to be read by a device such as a bar code reader. Nominal wedge angle (degrees). Orientation of wedge, i.e. orientation of IEC WEDGE FILTER coordinate system with respect to the IEC BEAM LIMITING DEVICE coordinate systems (degrees). Number of range compensators associated with current Beam. Introduces sequence of treatment compensators. Required if Number of Compensators (300A,00E0) is non-zero. One or more items may be included in this sequence. The number of items shall be identical to the value of Number of Compensators (300A,00E0). Uniquely identifies compensator specified by Compensator Number (300A,00E4) within Beam referenced by Referenced Beam Number (300C,0006). User-supplied identifier for compensator. An accessory identifier to be read by a device such as a bar code reader. Number of boli associated with current Beam. Introduces sequence of boli associated with Beam. Required if Number of Boli (300A,00ED) is non-zero. One or more items may be included in this sequence. The number of items shall be identical to the value of Number of Boli (300A,00ED). Uniquely identifies ROI representing the Bolus specified by ROI Number (3006,0022) in Structure Set ROI Sequence (3006,0020) in Structure Set Module within RT Structure Set in Referenced Structure Set Sequence (300C,0060) in RT General Plan Module. An accessory identifier to be read by a device such as a bar code reader. Number of shielding blocks associated with Beam. Introduces sequence of blocks associated with Beam. Required if Number of Blocks (300A,00F0) is non-zero. One or more items may be included in this sequence. The number of items shall be identical to the value of Number of Blocks (300A,00F0). User-supplied identifier for block tray. An accessory identifier to be read by a device such as a bar code reader. Uniquely identifies block specified by Block Number (300A,00FC) within Beam referenced by Referenced Beam Number (300C,0006). User-defined name for block. Introduces sequence of Snouts associated with Beam. Required if Snout Sequence (300A,030C) is included in the RT Ion Plan referenced within the Referenced RT Plan Sequence (300C,0002). Only a single item shall be permitted in this sequence. User or machine supplied identifier for Snout. An accessory identifier to be read by a device such as a bar code reader. Introduces sequence of Applicators associated with Beam. Required if Applicator Sequence (300A,0107) is included in the RT Ion Plan referenced within the Referenced RT Plan Sequence (300C,0002). Only a single item shall be permitted in this sequence. User or machine supplied identifier for Applicator. See C.8.8.14.12 An accessory identifier to be read by a device such as a bar code reader. Type of applicator. Defined Terms: ION_SQUARE = square ion applicator ION_RECT = rectangluar ion applicator ION_CIRC = circular ion applicator ION_SHORT = short ion applicator ION_OPEN = open (dummy) ion applicator INTEROPERATIVE = interoperative (custom) applicator STEREOTACTIC = stereotactic applicator User-defined description for Applicator. Introduces a Sequence of General Accessories associated with this Beam. One or more items may be included in this sequence. Identification Number of the General Accessory. The value shall be unique within the sequence. User or machine supplied identifier for General Accessory. User supplied description of General Accessory. Specifies the type of accessory. Defined Terms: GRATICULE = Accessory tray with a radio-opaque grid IMAGE_DETECTOR = Image acquisition device positioned in the beam line RETICLE = Accessory tray with radio-transparent markers or grid Machine-readable identifier for this accessory Number of range shifters associated with current beam. Introduces sequence of range shifters recorded with Beam. Required if Number of Range Shifters (300A,0312) is non-zero. One or more items may be included in this sequence. The number of items shall be identical to the value of Number of Range Shifters (300A,0312). Uniquely identifies range shifter specified by Range Shifter Number (300A,0316) within Beam referenced by Referenced Beam Number (300C,0006). User or machine supplied identifier for Range Modulator. An accessory identifier to be read by a device such as a bar code reader. Number of lateral spreading devices associated with current beam. Introduces sequence of lateral spreading devices associated with Beam. Required if Number of Lateral Spreading Devices (300A,0330) is non-zero. One or more items may be included in this sequence. The number of items shall be identical to the value of Number of Lateral Spreading Devices (300A,0330). Uniquely identifies lateral spreading device specified by Lateral Spreading Device Number (300A,0334) within Beam referenced by Referenced Beam Number (300C,0006). User or machine supplied identifier for Lateral Spreading Device. An accessory identifier to be read by a device such as a bar code reader. Number of range modulators associated with current beam. Introduces sequence of range modulators associated with Beam. Required if Number of Range Modulators (300A,0340) is non-zero. One or more items may be included in this sequence. The number of items shall be identical to the value of Number of Range Modulators (300A,0340). Uniquely identifies range modulator specified by Range Modulator Number (300A,0344) within Beam referenced by Referenced Beam Number (300C,0006). User or machine supplied identifier for Range Modulator. An accessory identifier to be read by a device such as a bar code reader. Type of Range Modulator. Defined Terms: FIXED = fixed modulation width and weights using ridge filter or constant speed wheel with constant beam current WHL_FIXEDWEIGHTS = selected wheel/track (Range Modulator ID) is spinning at constant speed. Modulation width is adjusted by switching constant beam current on and off at wheel steps indicated by Range Modulator Interrupt Values WHL_MODWEIGHTS = selected wheel/track (Range Modulator ID) is spinning at constant speed. Weight per wheel step is adjusted by modulating beam current according to selected Beam Current Modulation ID (300A,034C) Only one item in the Recorded Range Modulator Sequence (3008,00F6) can have a Range Modulator Type (300A,0348) of WHL_MODWEIGHTS. User-supplied identifier for the beam current modulation pattern. Required if Range Modulator Type (300A,0348) is WHL_MODWEIGHTS Azimuthal angle (degrees) of the fixation light coordinate around IEC PATIENT SUPPORT Y-axis. Used for eye treatments. See section C.8.8.25.6.4. Polar angle (degrees) of the fixation light coordinate. Used for eye treatments. See section C.8.8.25.6.4. Fraction number for this beam administration. Delivery Type of treatment. Defined Terms: TREATMENT = normal patient treatment OPEN_PORTFILM = portal image acquisition with open field (the source of radiation is specified by Radiation Type (300A,00C6)) TRMT_PORTFILM = portal image acquisition with treatment port (the source of radiation is specified by Radiation Type (300A,00C6)) CONTINUATION = continuation of interrupted treatment SETUP = no treatment beam was applied for this RT Beam. To be used for specifying the gantry, couch, and other machine positions where X-Ray set-up images or measurements were taken. Conditions under which treatment was terminated. Enumerated Values: NORMAL = treatment terminated normally OPERATOR = operator terminated treatment MACHINE = machine terminated treatment UNKNOWN = status at termination unknown Treatment machine termination code. This code is dependent upon the particular application and equipment. Conditions under which treatment was verified by a verification system. Enumerated Values: VERIFIED = treatment verified VERIFIED_OVR = treatment verified with at least one out-of-range value overridden NOT_VERIFIED = treatment verified manually Desired machine setting of primary meterset in units specified by Primary Dosimeter Unit (300A,00B3). Desired machine setting of secondary meterset. Machine setting actually delivered as recorded by primary meterset in units specified by Primary Dosimeter Unit (300A,00B3). Machine setting actually delivered as recorded by secondary meterset. Treatment Time set (sec). Treatment Time actually delivered (sec). Number of control points in Beam. Introduces sequence of beam control points for current ion treatment beam. One or more items may be included in this sequence. The number of items shall be identical to the value of Number of Control Points (300A,0110). See section C.8.8.21.1. Uniquely identifies Control Point specified by Control Point Index (300A,0112) within the Beam referenced by Referenced Beam Number (300C,0006). Date administration of treatment beam began. Time administration of treatment beam began. Desired machine setting for current control point in units specified by Primary Dosimeter Unit (300A,00B3). Machine setting actually delivered at current control point in units specified by Primary Dosimeter Unit (300A,00B3). The specified speed of delivery of the specified dose in units specified by Primary Dosimeter Unit (300A,00B3) per minute. The delivered speed of delivery of the specified dose in units specified by Primary Dosimeter Unit (300A,00B3) per minute. Nominal Beam Energy at control point in MeV per nucleon. Defined at nozzle entrance before all Beam Modifiers. Required for Control Point 0 of Ion Control Point Delivery Sequence (3008,0041) or if Nominal Beam Energy (300A,0114) changes during beam administration, and KVp (0018,0060) is not present. Peak kilo voltage output of the setup X-Ray generator used. Required for Control Point 0 of Ion Control Point Delivery Sequence (3008,0041), or if KVp changes during setup, and Nominal Beam Energy (300A,0114) is not present. Introduces sequence of Wedge positions for current control point. Required for first item of Ion Control Point Sequence if Number of Wedges (300A,00D0) is non-zero, and in subsequent control points if Wedge Position (300A,0118) or Wedge Thin Edge Position (300A,00DB) changes during beam. One or more items may be included in this sequence. The number of items shall be identical to the value of Number of Wedges (300A,00D0). Uniquely references Wedge described by Wedge Number (300A,00D2) in Wedge Sequence (300A,00D1). Position of Wedge at current control point. Enumerated Values: IN, OUT. Closest distance from the central axis of the beam along a wedge axis to the thin edge as projected to the machine isocentric plane (mm). Value is positive is the wedge does not cover the central axis, negative if it does. Required if Wedge Type (300A,00D3) of the wedge referenced by Referenced Wedge Number (300C,00C0) is PARTIAL_STANDARD or PARTIAL_MOTORIZ. See section C.8.8.25.6.4. Introduces sequence of Range Shifter settings for the current control point. One or more items may be included in this sequence. Required for Control Point 0 of Ion Control Point Delivery Sequence (3008,0041) or if Range Shifter Setting (300A,0362) changes during beam administration, and Number of Range Shifters (300A,0312) is non-zero. Uniquely references Range Shifter described by Range Shifter Number (300A,0316) in Range Shifter Sequence (300A,0314). Machine specific setting attribute for the range shifter. The specific encoding of this value should be documented in a Conformance Statement. See section C.8.8.25.5. Introduces sequence of Lateral Spreading Device settings for the current control point. One or more items may be included in this sequence. Required for Control Point 0 of Ion Control Point Delivery Sequence (3008,0041) or if Lateral Spreading Device Setting (300A,0372) changes during beam administration, and Number of Lateral Spreading Devices (300A,0330) is non-zero. Uniquely references Lateral Spreading Device described by Lateral Spreading Device Number (300A,0334) in Lateral Spreading Device Sequence (300A,0332). Machine specific setting attribute for the lateral spreading device. The specific encoding of this value should be documented in a Conformance Statement. See section C.8.8.25.5. Introduces sequence of Range Modulator Settings for current control point. One or more items may be included in this sequence.Required for Control Point 0 of Ion Control Point Delivery Sequence (3008,0041), or if Range Modulator Settings change during beam administration, and Number of Range Modulators (300A,0340) is non-zero. Uniquely references Range Modulator described by Range Modulator Number (300A,0344) in Range Modulator Sequence (300A,0342). Start position defines the range modulator position at which the beam is switched on. Required if Range Modulator Type (300A,0348) of the range modulator referenced by Referenced Range Modulator Number (300C,0104) is WHL_MODWEIGHTS or WHL_FIXEDWEIGHTS Stop position defines the range modulator position at which the beam is switched off. Required if Range Modulator Type (300A,0348) of the range modulator referenced by Referenced Range Modulator Number (300C,0104) is WHL_MODWEIGHTS or WHL_FIXEDWEIGHTS Treatment machine gantry angle, i.e. orientation of IEC GANTRY coordinate system with respect to IEC FIXED REFERENCE coordinate system (degrees). Required for Control Point 0 of Ion Control Point Delivery Sequence (3008,0041) or if Gantry Angle changes during beam administration. Direction of Gantry Rotation when viewing gantry from isocenter, for segment beginning at current Control Point. Required for Control Point 0 of Ion Control Point Delivery Sequence (3008,0041), or if Gantry Rotation Direction changes during beam administration. Enumerated Values: CW = clockwise CC = counter-clockwise NONE = no rotation Gantry Pitch Angle. i.e. the rotation of the IEC GANTRY coordinate system about the X-axis of the IEC GANTRY coordinate system (degrees). Required for first item of Control Point Sequence, or if Gantry PitchRotation Angle changes during Beam. See C.8.8.25.6.5.

Direction of Gantry PitchAngle when viewing along the positive X-axis of the IEC GANTRY coordinate system, for segment following Control Point. Required for first item of Control Point Sequence, or if Gantry PitchRotation Direction changes during Beam. See C.8.8.14.8 and C.8.8.25.6.5. Enumerated Values: CW = clockwise CC = counter-clockwise NONE = no rotation

Beam Limiting Device (collimator) angle, i.e. orientation of IEC BEAM LIMITING DEVICE coordinate system with respect to IEC GANTRY coordinate system (degrees). Required for Control Point 0 of Ion Control Point Delivery Sequence (3008,0041) or if beam limiting device (collimator) angle changes during beam administration. Direction of Beam Limiting Device Rotation when viewing beam limiting device (collimator) from radiation source, for segment beginning at current Control Point. Required for Control Point 0 of Ion Control Point Delivery Sequence (3008,0041) or if Beam Limiting Device Rotation Direction changes during beam administration. Enumerated Values: CW = clockwise CC = counter-clockwise NONE = no rotation User-supplied or machine code identifier for machine configuration to produce beam spot. This may be the nominal spot size or some other machine specific value. Required if Scan Mode (300A,0308) is MODULATED. Number of spot positions used to specify scanning pattern for current segment beginning at control point. Required if Scan Mode (300A,0308) is MODULATED. The x and y coordinates of the scan spots are defined as projected onto the machine isocentric plane in the IEC GANTRY coordinate system (mm). Required if Scan Mode (300A,0308) is MODULATED. Contains 2N values were N is the Number of Scan Spot Positions (300A,0392). A data set of metersets delivered to the scan spot positions. The order of metersets matches the positions in Scan Spot Position Map (300A,0394). The sum contained in all metersets shall match the difference of the Delivered Meterset of the current control point to the following control point. Required if Scan Mode (300A,0308) is MODULATED. The Scanning Spot Size as calculated using the Full Width Half Maximum (FWHM). Specified by a numeric pair - the size measured in air at isocenter in IEC GANTRY X direction followed by the size in the IEC GANTRY Y direction (mm). The intended number of times the scan pattern given by Scan Spot Position Map (300A,0394) and Scan Spot Meterset Weights (300A,0396) in the Referenced RT Plan was to be applied at the current control point. Note: The actual number of paintings is not known or recorded. The Scan Spot Metersets Delivered (3008,0047) contains the sum of all complete and partial repaints. Required if Scan Mode (300A,0308) is MODULATED. Patient Support angle, i.e. orientation of IEC PATIENT SUPPORT (turntable) coordinate system with respect to IEC FIXED REFERENCE coordinate system (degrees). Required for Control Point 0 of Ion Control Point Delivery Sequence (3008,0041) or if Patient Support Angle changes during beam administration. Direction of Patient Support Rotation when viewing table from above, for segment beginning at current Control Point. Required for Control Point 0 of Ion Control Point Delivery Sequence (3008,0041), or if Patient Support Rotation Direction changes during beam administration. Enumerated Values: CW = clockwise CC = counter-clockwise NONE = no rotation Table Top Pitch Angle, i.e. the rotation of the IEC TABLE TOP coordinate system about the X-axis of the IEC TABLE TOP coordinate system (degrees). Required for first item of Control Point Sequence, or if Table Top Pitch Angle changes during Beam. See section C.8.8.25.6.2. Direction of Table Top Pitch Rotation when viewing the table along the positive X-axis of the IEC TABLE TOP coordinate system, for segment following Control Point. Required for first item of Control Point Sequence, or if Table Top Pitch Rotation Direction changes during Beam. See C.8.8.14.8 and C.8.8.25.6.2. Enumerated Values: CW = clockwise CC = counter-clockwise NONE = no rotation

Angle (in degrees) of the head fixation for eye treatments with respect to the Table Top Pitch Angle (300A,0140) coordinate system. Positive head fixation angle is the same direction as positive Table Top Pitch. See section C.8.8.25.6.4. Table Top Vertical position in IEC TABLE TOP coordinate system (mm). This value is interpreted as an absolute, rather than relative, Table setting. Required for Control Point 0 of Ion Control Point Delivery Sequence (3008,0041) or if Table Top Vertical Position changes during beam administration. Table Top Longitudinal position in IEC TABLE TOP coordinate system (mm). This value is interpreted as an absolute, rather than relative, Table setting. Required for Control Point 0 of Ion Control Point Delivery Sequence (3008,0041) or if Table Top Longitudinal Position changes during beam administration. Table Top Lateral position in IEC TABLE TOP coordinate system (mm). This value is interpreted as an absolute, rather than relative, Table setting. Required for Control Point 0 of Ion Control Point Delivery Sequence (3008,0041) or if Table Top Lateral Position changes during beam administration. Axial position of the snout (in mm) measured from isocenter to the downstream side of the snout (without consideration of variable length elements such as blocks, MLC and/or compensators). Required for Control Point 0 of Ion Control Point Delivery Sequence (3008,0041) or if Snout Position changes during beam administration. Introduces a sequence of items describing corrections made to any attributes prior to delivery of the next control point. The sequence may contain one or more items. Contains the Data Element Tag of the parent sequence containing the attribute that was corrected. The value is limited in scope to the Treatment Session Ion Beam Sequence (3008,0021) and all nested sequences therein. Contains the ones-based sequence item index of the corrected attribute within its parent sequence as indicated by Parameter Sequence Pointer (3008,0061). Contains the Data Element Tag of the attribute that was corrected. The value that was added the value referenced by the Parameter Sequence Pointer (3008,0061), Parameter Item Index (3008,0063) and Parameter Pointer (3008,0065). Introduces sequence of parameters that were overridden during the administration of the beam segment immediately prior to the current control point. The sequence may contain one or more items. Contains the Data Element Tag of the parent sequence containing the attribute that was overridden. The value is limited in scope to the Treatment Session Ion Beam Sequence (3008,0021) and all nested sequences therein. Contains the Data Element Tag of the attribute that was overridden. Contains the ones-based sequence item index of the overridden attributes within it's parent sequence. The value is limited in scope to the Treatment Session Ion Beam Sequence (3008,0021) and all nested sequences therein. Name of operator who authorized override. User-defined description of reason for override of parameter specified by Override Parameter Pointer (3008,0062). Introduces sequence of beam limiting device (collimator) jaw or leaf (element) positions. Required if Ion Beam Limiting Device Sequence (300A,03A4) is included and for first item of Control Point Sequence, or if Beam Limiting Device changes during Beam. One or more items shall be included in this sequence. Type of beam limiting device (collimator). The value of this attribute shall correspond to RT Beam Limiting Device Type (300A,00B8) defined in an item of Ion Beam Limiting Device Sequence (300A,03A4). Enumerated Values: X = symmetric jaw pair in IEC X direction Y = symmetric jaw pair in IEC Y direction ASYMX = asymmetric jaw pair in IEC X direction ASYMY = asymmetric pair in IEC Y direction MLCX = multileaf (multi-element) jaw pair in IEC X direction MLCY = multileaf (multi-element) jaw pair in IEC Y direction Positions of beam limiting device (collimator) leaf (element) or jaw pairs (in mm) in IEC BEAM LIMITING DEVICE coordinate axis appropriate to RT Beam Limiting Device Type (300A,00B8), e.g. X-axis for MLCX, Y-axis for MLCY. Contains 2N values, where N is the Number of Leaf/Jaw Pairs (300A,00BC) in Ion Beam Limiting Device Sequence (300A,03A4). Values shall be listed in IEC leaf (element) subscript order 101, 102, ... 1N, 201, 202, ... 2N. See section C.8.8.25.3. Defined terms: TABLE = Treatment delivery system table CHAIR = Treatment delivery system chair See section C.8.8.25.6.3. User-specified identifier for manufacturer specific patient support devices. A Patient Support accessory identifier to be read by a device such as a bar code reader. Date the Series started. See C.8.9.1.1.2 for specialization.

For PET Series, Series Date (0008,0021) and Series Time (0008,0031) are specified to be Type 1. The Series Date (0008,0021) and Series Time (0008,0031) are used as the reference time for all PET Image attributes that are temporally related, including activity measurements. The Series Date (0008,0021) and Series Time (0008,0031) are not tied to any real-world event (e.g. acquisition start, radiopharmaceutical administration) and their real-world meaning are implementation dependent.

Time the Series started. See C.8.9.1.1.2 for specialization.

Pixel value units. See C.8.9.1.1.3 for explanation. Defined terms: CNTS, NONE, CM2, PCNT, CPS, BQML, MGMINML, UMOLMINML, MLMING, MLG, 1CM, UMOLML, PROPCNTS, PROPCPS, MLMINML, MLML, GML, STDDEV

The units of the pixel values obtained after conversion from the stored pixel values (SV) (Pixel Data (7FE0,0010)) to pixel value units (U), as defined by Rescale Intercept (0028,1052) and Rescale Slope (0028,1053). Defined Terms: CNTS = counts NONE = unitless CM2 = centimeter**2 PCNT = percent CPS = counts/second BQML = Becquerels/milliliter MGMINML = milligram/minute/milliliter UMOLMINML = micromole/minute/milliliter MLMING = milliliter/minute/gram MLG = milliliter/gram 1CM = 1/centimeter UMOLML = micromole/milliliter PROPCNTS = proportional to counts PROPCPS = proportional to counts/sec MLMINML = milliliter/minute/milliliter MLML = milliliter/milliliter GML = grams/milliliter STDDEV = standard deviations

The primary source of counts. The primary source leads to the underlying image Units (0054,1001), as opposed to secondary sources which are used during reconstruction correction. Enumerated Values: EMISSION TRANSMISSION A multi-valued indicator of the type of Series. See C.8.9.1.1.4 for explanation. Value 1 Enumerated Values: STATIC DYNAMIC GATED WHOLE BODY Value 2 Enumerated Values: IMAGE REPROJECTION

The Series Type (0054,1000), Value 1 is used to identify the spatial location and temporal nature of the images within a PET Series. The Enumerated Values and their definitions are: STATIC = a group of images at varying spatial locations at the same time DYNAMIC = a group of images at a set of spatial locations (e.g. slices) at varying time slices, with all spatial locations acquired at all time slices GATED = a group of images at the same spatial location, same starting and ending time, but acquired in different time slots of (possibly) different R-R intervals WHOLE BODY = same as STATIC, except covering multiple transverse fields of view (and therefore acquired at a different time). Notes: 1. Using this definition and the comments in C.8.9.1.1.1, here are some examples of PET series and the encoding of Series Type (0054,1000) Value 1. Static acquisition: a group of n transverse images at varying superior<->inferior locations, all acquired between the same starting and ending time. Series Type = STATIC. Dynamic acquisition: a group of n*m transverse images at n superior<->inferior locations, acquired with m different starting and ending times. Series Type = DYNAMIC. Gated acquisition: a group of n*m*p transverse images at n superior<->inferior locations, all acquired between the same starting and ending time, acquired in m different R-R Intervals (as determined by Low R-R Value (0018,1081) and High R-R Value (0018,1082)), and acquired in p time slots of a given R-R Interval (as determined by Trigger Time (0054,1000) ). Series Type = GATED. Whole body acquisition: a group of n transverse images at varying superior<->inferior locations covering a significant fraction of the entire body. Series Type = WHOLE BODY. Multiple transverse fields of view: a group of n transverse images at varying superior<->inferior locations. Series Type = WHOLE BODY. Interleaved: group of 2*n transverse images acquired at overlapped AFOVs to increase transverse sampling. Series Type = WHOLE BODY. Sagittal (Coronal, Oblique): sagittal (coronal, oblique) re-sliced images derived by reformatting transverse images. The Series Type is STATIC, DYNAMIC, GATED, or WHOLE BODY depending on source Series Type. Arithmetic: images derived by an arithmetic operation on operand images. The Series Type is STATIC, DYNAMIC, GATED, or WHOLE BODY depending on source Series Type. Metabolic: images derived by a metabolic model. The Series Type is STATIC, DYNAMIC, GATED, or WHOLE BODY depending on source Series Type. 2. Using this definition, here are some images that are not stored in the same PET Series: Two images from the same scan that were reconstructed differently. Emission and transmission images for the same Patient and Study, even if acquired simultaneously (because emission and transmission images have different reconstruction processing). Two images of same patient, one after NH3 injection and one after FDG injection. Two images: an original image created from reconstructed scan data and its derived image based on a metabolic model. The Series Type (0054,1000), Value 2 is used to identify the volumetric meaning of the images within a PET Series. The Enumerated Values and their definitions are: IMAGE = a tomographic image slice REPROJECTION = a projection image derived from forward projection through slices of tomographic images, using the algorithm defined in Reprojection Method (0054,1004).

Method for projecting volumetric data onto planar projection. Required if Series Type (0054,1000), Value 2 is REPROJECTION. Defined terms: SUM MAX PIXEL The maximum number of R-R Intervals that may exist in this Series. Required if Series Type (0054,1000), Value 1 is GATED. The maximum number of Time Slots that may exist in this Series. Required if Series Type (0054,1000), Value 1 is GATED. The maximum number of Time Slices that may exist in this Series. Required if Series Type (0054,1000), Value 1 is DYNAMIC. The maximum number of Slices that may exist in this Series. A value that indicates which, if any, corrections have been applied to the images in this series. Defined terms: DECY=decay corrected ATTN=attenuation corrected SCAT=scatter corrected DTIM=dead time corrected MOTN=gantry motion corrected (e.g. wobble, clamshell) PMOT=patient motion corrected CLN=count loss normalization (correction for count loss in gated Time Slots). RAN=randoms corrected RADL=non-uniform radial sampling corrected DCAL=sensitivity calibrated using dose calibrator NORM=detector normalization Type of randoms correction processing. Defined terms: NONE = no randoms correction DLYD = delayed event subtraction SING = singles estimation A textual description of the attenuation correction processing. e.g. measured vs. calculated, transmission source type (ring, line, point), assumed patient geometry (polygon, ellipse, segmented, attenuation coefficient, skull thickness), post-injection transmission, smoothing. A textual description of the scatter correction processing. e.g. convolution-subtraction, dual energy window, model-based, use of attenuation data. The real-world event to which images in this Series were decay corrected. See C.8.9.1.1.5 for explanation. Defined terms: NONE = no decay correction START= acquisition start time ADMIN = radiopharmaceutical administration time

The Decay Correction (0054,1102) is the real-world event to which images in this Series were decay corrected. If decay correction is applied, all images in the Series shall be decay corrected to the same time. The Defined Terms and definitions are: NONE = no decay correction START= acquisition start time, Acquisition Time (0008,0032) ADMIN = radiopharmaceutical administration time, Radiopharmaceutical Start Time (0018,1072) The time to which images have been decay corrected can be derived from Decay Factor (0054,1321), Frame Reference Time (0054,1300), Radionuclide Half Life (0018,1075), Series Date (0008,0021), and Series Time (0008,0031).

Diameter, in mm, of the region within which the data was used in creating the reconstruction of the image. Data may exist outside this region and portions of the patient may exist outside this region. Textual description of the convolution kernel(s) used to reconstruct the data (e.g. name, cutoff, radial/axial/angular, mathematical form, DC handling) Textual description of reconstruction processing, e.g. 2D filtered backprojection, 2D iterative, 3D PROMIS, 3D FAVOR, 3D iterative. Textual description of which detector lines of response were used, mashed, or otherwise processed during tomographic reconstruction. Description of how the data collection was started. Defined terms: DENS = density (counts/sec) RDD = relative density difference (change in counts/sec) MANU = manual TIME = time AUTO = automatic, when ready TRIG = physiological trigger See C.8.9.1.1.6 for explanation.

Acquisition Start Condition (0018,0073) is the method of starting acquisition data collection. The Defined Terms and definitions are: DENS = preset count density (counts/sec) was reached RDD = preset relative count density difference (change in counts/sec) was reached MANU = acquisition was started manually TIME = preset time limit was reached AUTO = start automatically, when ready TRIG = preset number of physiological triggers was reached

Count density, change in count density, or physiological triggers causing data collection to start. Description of how the data collection for the series was stopped. Defined terms: CNTS = counts DENS = density (counts/sec) RDD = relative density difference (change in counts/sec) MANU = manual OVFL = data overflow TIME = time TRIG = physiological trigger See C.8.4.9.1.3 for explanation.

Number of counts, count density, change in count density, or physiological triggers causing the termination. Shape of the field of view of the PET camera. Defined Terms: CYLINDRICAL RING HEXAGONAL MULTIPLE PLANAR Dimensions of the field of view, in mm. Transverse detector diameter followed by axial width. Angle of tilt in degrees of the gantry. See C.8.9.1.1.7 for explanation.

Gantry/Detector Tilt (0018,1120) for PET Image data is the angle in degrees of the gantry relative to the patient’s major (Head to Feet) axis (or the table supporting the patient). Positive tilt is moving the top of the gantry towards the patient’s feet.

Angle of slew in degrees of the gantry. Positive slew is moving the gantry on the patient's left toward the patient's superior, when the patient is supine. Describes the detector motion during acquisition. Defined Terms: NONE = stationary gantry STEP AND SHOOT = Interrupted motion, acquire only while stationary CONTINUOUS = Gantry motion and acquisition are simultaneous and continuous WOBBLE = wobble motion CLAMSHELL = clamshell motion Collimator Type. Defined Terms: NONE = no collimator RING = transverse septa Label describing the collimator used. Maximum axial angle accepted, in degrees. Number of adjacent axial lines of response mashed together. See C.8.9.1.1.8 for explanation.

Axial Mash (0054,1201) is multi-valued and is defined as the number of unique axial Lines of Response (LOR) that were mashed together (center of the axial field of view only). Value 1 is the number of LORs mashed for an odd slice. Value 2 is the number of LORs mashed for an even slice. For discrete crystal scanners, each unique LOR corresponds to a pair of crystals. For continuous detectors whose bin size is variable, the number of LORs mashed is determined by the actual bin size divided by the Detector Element Size (0054,1203), Value 2. The value of Axial Mash (0054,1201) is the same regardless of whether the mashing was done during acquisition or reconstruction. Note: As an example on a discrete crystal scanner, if a ring difference of -2,0,+2 are binned as an odd slice and a ring difference of -1,+1 are binned as an even slice, then the Axial Mash (0054,1201) is equal to 3\2 .

Number of adjacent transverse lines of response mashed together. See C.8.9.1.1.9 for explanation.

Transverse Mash (0054,1202) is defined as the number of unique transverse Lines of Response (LOR) that were mashed together. For discrete crystal scanners, each unique LOR corresponds to a pair of crystals. For continuous detectors whose bin size is variable, the number of LORs mashed is determined by the actual bin size divided by the Detector Element Size (0054,1203), Value 1. The value of Transverse Mash (0054,1202) is the same regardless of whether the mashing was done during acquisition or reconstruction.

Size of an individual detector element, in mm. Transverse dimension followed by axial dimension. For a discrete crystal, this is the crystal size. For a continuous detector, this is the pixel bin size. The width of the coincidence timing window, in nsec. The maximum time difference accepted between two single events. Sequence of Items that describes the energy windows used for this Series. This sequence may contain zero or more items. See C.8.9.1.1.10 for explanation.

Multiple energy windows are allowed in order to allow coincidence events based on additional Energy Windows (e.g. Compton events scattered in the detector). All energy windows are assumed to contribute to all images in the PET Series.

The lower limit of the energy window, in KeV. The upper limit of the energy window, in KeV. Array defining the type of additional counts accumulated during acquisition. Defined terms: DLYD=delayed events SCAT=scattered events in secondary window SING=singles DTIM=events lost due to deadtime Sequence of Items that describe isotope information. Zero or more Items may be included in this sequence. Sequence that identifies the radionuclide. Zero or one item shall be present in the sequence. Route of administration. Sequence that identifies the administration route of the radiopharmaceutical. This sequence shall contain exactly one item. Volume of administered radiopharmaceutical in cubic cm. Time of start of administration. The actual time of radiopharmaceutical administration to the patient for imaging purposes, using the same time base as Series Time (0008,0031). The use of this Attribute is deprecated in favor of Radiopharmaceutical Start DateTime (0018,1078). Note: The use of a time alone can cause confusion when the procedure spans midnight. Date and time of start of administration. The actual date and time of radiopharmaceutical administration to the patient for imaging purposes, using the same time base as Series Time (0008,0031). Time of end of administration. The actual ending time of radiopharmaceutical administration to the patient for imaging purposes, using the same time base as Series Time (0008,0031). The use of this Attribute is deprecated in favor of Radiopharmaceutical Stop DateTime (0018,1079). Note: The use of a time alone can cause confusion when the procedure spans midnight. Date and time of end of administration. The actual ending date and time of radiopharmaceutical administration to the patient for imaging purposes, using the same time base as Series Time (0008,0031). The radiopharmaceutical dose administered to the patient measured in Becquerels (Bq) at the Radiopharmaceutical Start Time (0018,1072). Note: In other IODs, such as the NM IOD, this same attribute is specified in MegaBecquerels (MBq). The radionuclide half life, in seconds, that was used in the correction of this image. The radionuclide positron fraction (fraction of decays that are by positron emission) that was used in the correction of this image. The activity per unit mass of the radiopharmaceutical, in Bq/micromole, at the Radiopharmaceutical Start Time (0018,1072). Name of the radiopharmaceutical. Sequence that identifies the radiopharmaceutical. This sequence shall contain exactly one item. Sequence of Items that describes the intervention drugs used. One or more items may be included in this sequence. Name of the intervention drug. Sequence that identifies the intervention drug name. Only a single Item shall be permitted in this Sequence. Time of administration of the intervention drug, using the same time base as for the Series Time (0008,0031). Time of completion of administration of the intervention drug, using the same time base as for the Series Time (0008,0031). Intervention drug dose, in mg. Heart beat duration sorting has been applied. Enumerated values: Y = yes N = no Text indicating trigger source. Defined terms: EKG Description of the type of PVC rejection criteria used. Number of beats skipped after a detected arrhythmia. Average number of heart beats per minute for the collection period for this image. This shall include all accepted beats as well as rejected beats. Description of type of framing performed. Defined Terms: FORW = forward BACK = backward PCNT = forward/backward by percentage See C.7.6.18.1.1.1.

Image identification characteristics. See C.8.9.4.1.1 for specialization.

For PET Images, Image Type (0008,0008) is specified to be Type 1. Note: For PET images, Image Type (0008,0008) Value 1 will be ORIGINAL for reconstructed images. DERIVED may be appropriate for some other results images. For PET images, Image Type (0008,0008) Value 2 will be PRIMARY.

Number of samples (planes) in this image. This value shall be 1. Specifies the intended interpretation of the pixel data. See C.8.9.4.1.2 for specialization.

For PET images, Photometric Interpretation (0028,0004) shall have one of the following Enumerated Values: MONOCHROME2 See C.7.6.3.1.2 for definition of this term.

Number of bits allocated for each pixel sample. Each sample shall have the same number of bits allocated. Enumerated values: 16. Number of bits stored for each pixel sample. Each sample shall have the same number of bits stored. The value shall be the same as the value in Bits Allocated (0028,0100). Most significant bit for pixel sample data. Each sample shall have the same high bit. Shall be one less than the value in Bits Stored (0028,0101). The value b in relationship between stored values (SV) and pixel value units (U) defined in Units (0054,1001): U = m*SV+b. The Rescale Intercept is always zero for PET images. m in the equation specified in Rescale Intercept (0028,1052). The time that the pixel values in the image occurred. Frame Reference Time is the offset, in msec, from the Series reference time. See explanation in C.8.9.4.1.5. Time interval, in msec, from the start of the trigger to the beginning of data acquisition for this image. Required if Series Type (0054,1000), Value 1 is GATED. Nominal duration per individual frame, in msec. Required if Series Type (0054,1000), Value 1 is GATED. See C.8.9.4.1.3 for explanation.

The Frame Time (0018,1063) is the explicit duration of the gated frame when Cardiac Framing Type (0018,1064) is equal to FORW or BACK. Frame Time (0018,1063) is the nominal duration of the gated frame when Cardiac Framing Type (0018,1064) is equal to PCNT.

R-R interval lower limit for beat rejection, in msec. Required if Series Type (0054,1000), Value 1 is GATED and Beat Rejection Flag (0018,1080) is Y. R-R interval upper limit for beat rejection, in msec. Required if Series Type (0054,1000), Value 1 is GATED and Beat Rejection Flag (0018,1080) is Y. Specifies whether an Image has undergone lossy compression. Enumerated values: 00 = Image has NOT been subjected to lossy compression. 01 = Image has been subjected to lossy compression. See C.7.6.1.1.5. Required if Lossy Compression has been performed on the image.

An index identifying the position of this image within a PET Series. See C.8.9.4.1.9 for explanation.

Image Index (0054,1330) is an index identifying the position of this image within a PET Series. Note: The scheme for encoding Image Index (0054,1330) is as follows. Images within a PET Series can be viewed as a multi-dimensional array whose possible dimensions include R-R Intervals, Time Slots, Time Slices, and Slices. The dimensions of the array are defined by the Series Type (0054,1000) Value 1. Each dimension of the array has an index that identifies the position of this image in the array. The indices are: R-R Interval Index, Time Slot Index, Time Slice Index, Slice Index. The indices are calculated as follows: Using these index values the position of this image within the multi-dimensional array (the Image Index (0054,1330)) is calculated as follows:

The date the acquisition of data that resulted in this image started. See C.8.9.4.1.4 for specialization.

For PET Images, Acquisition Date (0008,0022) and Acquisition Time (0008,0032) are specified to be Type 2. The Acquisition Date (0008,0022) and Acquisition Time (0008,0032) use the same time base as Series Time (0008,0031). For Series Type (0054,1000) Value 1 equal to STATIC, WHOLE BODY, or DYNAMIC, the Acquisition Time (0008,0032) is the real-world beginning of the accumulation of events into this Image. For STATIC, WHOLE BODY, or DYNAMIC Series, the Acquisition Time (0008,0032) may vary from Image to Image within a PET Series. For Series Type (0054,1000) Value 1 equal to GATED, the Acquisition Time (0008,0032) is the real-world beginning of the capability of accumulating events into this Image. (The actual accumulation of events has only occurred during an R-R Interval.) For GATED Series, the Acquisition Time (0008,0032) shall not vary from Image to Image within a PET Series.

The time the acquisition of data that resulted in this image started. See C.8.9.4.1.4 for specialization.

Elapsed time of the data acquisition for this image, in msec. See C.8.9.4.1.6 for explanation.

The accumulation of counts for a PET Image shall occur entirely between: (1) the acquisition starting time (as specified by Acquisition Date (0008,0022) and Acquisition Time (0008,0032)), and (2) the acquisition ending time, which is equal to the acquisition starting time in (1) plus the Actual Frame Duration (0018,1242). If the Series Type (0054,1000), Value 1 is GATED, then the actual accumulation of counts has only occurred during an R-R Interval.

Average duration of accepted beats, in msec, of the R-R interval. Number of heartbeats that fall within Low R-R Value (0018,1081) and High R-R Value (0018,1082), and were therefore accepted and contribute coincidence events to this R-R Interval. Number of heartbeats that fall outside Low R-R Value (0018,1081) and High R-R Value (0018,1082), and do not contribute coincidence events to this R-R Interval. However, they may contribute coincidence events to other R-R Intervals. The sum of events that occur in the primary event channel. The counts include Trues +Scatter+ Randoms if Randoms Correction Method (0054,1100) is NONE; otherwise the counts are Trues +Scatter. Sum of counts accumulated in secondary channels. See C.8.9.4.1.7 for explanation.

Secondary Counts Accumulated (0054,1311) is multi-valued and, if supplied, has Values corresponding to the Secondary Counts Type (0054,1220). The number and order of the Values in Secondary Counts Accumulated (0054,1311) shall be the same as Secondary Counts Type (0054,1220).

The slice-to-slice sensitivity correction factor that was used to correct this image. The value shall be one if no slice sensitivity correction was applied. The decay factor that was used to scale this image. Required if Decay Correction (0054,1102) is other than NONE. If decay correction is applied, all images in the Series shall be decay corrected to the same time. Factor that was used to scale this image from counts/sec to Bq/ml using a dose calibrator. The value shall be one if no dose calibration was applied. See C.8.9.4.1.8 for explanation.

The Dose Calibration Factor (0054,1322) is the factor that was used to scale this image from counts/sec to Bq/ml using an external dose calibrator. The value shall be one if no dose calibration was applied. The application of a dose calibration correction is specified by Corrected Image (0028,0051) equal to DCAL. Note: Dose Calibration Factor (0054,1322) is not equal to the inverse of the sensitivity (kcps/Bq/ml) of the scanner, which is usually measured for a given radiopharmaceutical distribution and excluding the effects of attenuation.

An estimate of the fraction of acquired counts that were due to scatter and were corrected in this image. The value shall be zero if no scatter correction was applied. The average dead time correction factor that was applied to this image. The value shall be one if no dead time correction was applied. Describes the anatomical direction that slices are progressing as the slices are considered in order (as defined by the Slice Index. See section C.8.9.4.1.9 for a definition of Slice Index). Meaningful only for cardiac images. When View Code Sequence (0054,0220) indicates a short axis view, then Enumerated Values are: APEX_TO_BASE BASE_TO_APEX Sequence that describes the projection of the anatomic region of interest. Only a single Item shall be permitted in this sequence. View Modifier. Required if needed to fully specify the View. Only a single Item shall be permitted in this sequence. Type of equipment that originally acquired the data used to create the images in this Series. Enumerated Values: DX PX IO MG See section C.7.3.1.1.1 for further explanation. Uniquely identifies the Performed Procedure Step SOP Instance to which the Series is related (e.g. a Modality or General-Purpose Performed Procedure Step SOP Instance). The Sequence shall have one Item. Required if the Modality Performed Procedure Step SOP Class, General Purpose Performed Procedure Step SOP Class is supported. Identifies the intent of the images that are contained within this Series. Enumerated Values: FOR PRESENTATION FOR PROCESSING See C.8.11.1.1.1 for further explanation.

Presentation Intent Type (0008,0068) shall identify the intent for the purposes of display or other presentation of all Images within this Series. Notes: 1. Since this is a Series level attribute, all Images within a Series have the same value for this Attribute. 2. The intent of this restriction is to ensure that FOR PRESENTATION and FOR PROCESSING images are placed in separate Series, so that no confusion can arise as to which images are suitable for diagnostic reading as determined by local policy. A Series of Images intended for viewing by an observer, after application of any grayscale transformations specified in the image object such as VOI LUT, shall have an Enumerated Value of FOR PRESENTATION. Notes: 1. These images may still be of Image Type (0008,0008) ORIGINAL rather than DERIVED despite the possibility that they may have undergone some processing, such as unsharp masking. In this case a DERIVED image would have undergone yet further processing to make it substantially different from the original. See Figure C.8-13. 2. These images may still be subjected to processing or further processing, if appropriate, depending on the application. 3. These images are intended for display on a device, without (further) processing, since that device may not be capable of image processing. The quality of the displayed image or its suitability for any purpose is beyond the scope of the DICOM Standard. Images that have been corrected to account for characteristics of the detector but which are intended to be further processed before being displayed, shall have an Enumerated Value of FOR PROCESSING. Note: This type is provided to allow the functions of image acquisition and image processing for presentation to be separated and yet have images conveyed between the two processes using a DICOM object. Individual sites or users may choose to substitute their own specialized processing in place of that supplied by the implementor. Images available at this stage of processing may be useful for quality control and problem solving purposes, as well as academic research. Images of this type may also be archived, retrieved and processed with different algorithms or parameters in order to alter the appearance of specific features for clinical purposes. The nature of the detector correction that may have been applied before sending an image of type FOR PROCESSING is not specified. In particular, acquisitions that acquire several sets of matrices of pixel values (such as image data, gain offset and a defect map) must perform some processing (detector correction) before a DX Image object can be instantiated. The nature of the processing that may have been applied before sending an image of type FOR PRESENTATION is also not specified. It is expected that individual implementors will use Private Attributes to convey specifics of the processing applied that may be of use for further processing by those aware of the parameters and algorithms. The diversity of detector types and processing algorithms make it undesirable to standardize such parameters. Whether or not the spatial locations of all pixels are preserved during the processing of the source image that resulted in the current image can be indicated by Spatial Locations Preserved (0028,135A) in a Source Image Sequence (0008,2112) reference from the FOR PRESENTATION image to a FOR PROCESSING predecessor. If images from the same exposure exist with different Values of Presentation Intent Type (0008,0068), then they shall have different SOP Instance UIDs. Notes: 1. Source Image Sequence (0008,2112) may be used to relate these images. 2. The SOP Class UIDs of the two images will also be different.

Laterality of (possibly paired) body part (as described in Anatomic Region Sequence (0008,2218)) examined. Enumerated Values: R = right L = left U = unpaired B = both left and right Note: This Attribute is mandatory, in order to ensure that images may be positioned correctly relative to one another for display. Shall be consistent with any laterality information contained in Primary Anatomic Structure Modifier Sequence (0008,2230), if present. Note: Laterality (0020,0060) is a Series level Attribute and must be the same for all Images in the Series, hence it must be absent. Image identification characteristics. See C.8.11.3.1.1 for specialization.

Value 1 shall identify the Pixel Data Characteristics in accordance with Section C.7.6.1.1.2 where the Enumerated Values are defined to be ORIGINAL or DERIVED. Note: DX images may still be of type ORIGINAL rather than DERIVED despite the possibility that they may have undergone some processing. In this case a DERIVED image would have undergone yet further processing to make it substantially different from the original. Value 2 shall identify the Patient Examination Characteristics in accordance with Section C.7.6.1.1.2 where the Enumerated Values are defined to be PRIMARY or SECONDARY. Note: DX images generally use PRIMARY value for images captured from patient exposure. If images from the same exposure exist with different Values of Image Type, then they shall have different SOP Instance UIDs. Note: Source Image Sequence (0008,2112) may be used to relate these images. Value 3 (which is specific to the IOD) shall be present and have zero length (null value). Other Values (4 and beyond) are optional and implementation specific.

Number of samples in this image. Shall have an Enumerated Value of 1. Specifies the intended interpretation of the pixel data. Enumerated Values: MONOCHROME1 MONOCHROME2 Number of bits allocated for each pixel sample. Enumerated Values: 8, 16 Number of bits stored for each pixel sample. Enumerated Values: 6 to 16 Most significant bit for pixel sample data. Shall have an Enumerated Value of one less than the value in Bit Stored (0028,0101). Data representation of the pixel samples. Shall have the Enumerated Value: 0000H = Unsigned Integer. The relationship between the Pixel sample values and the X-Ray beam intensity. Enumerated Values: LIN = Linearly proportional to X-Ray beam intensity LOG = Logarithmically proportional to X-Ray beam intensity See C.8.11.3.1.2 for further explanation.

The sign of the relationship between the Pixel sample values stored in Pixel Data (7FE0,0010) and the X-Ray beam intensity. Enumerated Values; 1 = Lower pixel values correspond to less X-Ray beam intensity -1 = Higher pixel values correspond to less X-Ray beam intensity See C.8.11.3.1.2 for further explanation.

m in the equation specified by Rescale Intercept (0028,1052). Enumerated Value: 1 See C.8.11.3.1.2 for further explanation.

Specifies the output units of Rescale Slope (0028,1053) and Rescale Intercept (0028,1052). Enumerated Value: US = Unspecified See C.8.11.3.1.2 for further explanation.

Specifies an identity transformation for the Presentation LUT, other than to account for the value of Photometric Interpretation (0028,0004), such that the output of all grayscale transformations defined in the IOD containing this Module are defined to be P-Values. Enumerated Values: IDENTITY - output is in P-Values - shall be used if Photometric Interpretation (0028,0004) is MONOCHROME2. INVERSE - output after inversion is in P-Values - shall be used if Photometric Interpretation (0028,0004) is MONOCHROME1. See C.8.11.3.1.2 for further explanation.

See C.7.6.1.1.5 for further explanation. Required if Lossy Compression has been performed on the Image.

A text description of how this image was derived. See C.8.11.3.1.4 for further explanation.

If an Image is identified to be a Derived image in Image Type (0008,0008), Derivation Description (0008,2111) is an optional and implementation specific text description of the way the image was derived from an original image. As applied to DX images, it may be used to describe derivation operations such as edge enhancement, temporal filtering, digital subtraction, or other linear and non-linear transformations.

Indicates any visual processing performed on the images prior to exchange. See C.8.11.3.1.3 for further explanation.

Code representing the device-specific processing associated with the image (e.g. Organ Filtering code) Note: This Code is manufacturer specific but provides useful annotation information to the knowledgeable observer. Patient direction of the rows and columns of the image. See C.7.6.1.1.1 for further explanation.

Table C.7-18 describes the Attributes of devices or calibration objects (e.g., catheters, markers, baskets) that are associated with a study and/or image. Table C.7-18 DEVICE MODULE ATTRIBUTES

Indicates whether or not image contains sufficient burned in annotation to identify the patient and date the image was acquired. Enumerated Values: YES NO Defines a sequence of VOI LUTs. See C.8.11.3.1.5 for further explanation. One or more Items may be included in this Sequence. Required if Presentation Intent Type (0008,0068) is FOR PRESENTATION and Window Center (0028,1050) is not present. May also be present if Window Center (0028,1050) is present.

The Attributes of the VOI LUT Module (C.11.2) are specialized in the DX Image Module. Window Center (0028,1050) and Window Width (0028,1051) specify a linear conversion (unless otherwise specified by the value of VOI LUT Function (0028,1056); see C.11.2.1.3) from the output of the (conceptual) Modality LUT values to the input to the (conceptual) Presentation LUT. Window Center contains the value that is the center of the window. Window Width contains the width of the window. The application of the Window Center (0028,1050) and Window Width (0028,1051) shall not produce a signed result. Note: If the Presentation LUT Shape (2050,0020) is IDENTITY, then the result of applying the Window Center (0028,1050) and Window Width (0028,1051) is P-Values. If multiple values are present, both Attributes shall have the same number of values and shall be considered as pairs. Multiple values indicate that multiple alternative views should be presented. The VOI LUT Sequence specifes a (potentially non-linear) conversion from the output of the (conceptual) Modality LUT values to the input to the (conceptual) Presentation LUT. If multiple items are present in VOI LUT Sequence (0028,3010), only one shall be applied. Multiple items indicate that multiple alternative views should be presented. If any VOI LUT Attributes are included by an Image, a Window Width and Window Center or the VOI LUT Table, but not both, shall be applied to the Image for display. Inclusion of both indicates that multiple alternative views should be presented. The three values of the LUT Descriptor (0028,3002) describe the format of the LUT Data (0028,3006). The first value is the number of entries in the lookup table. The second value is the first stored pixel value mapped. This pixel value is mapped to the first entry in the LUT. All image pixel values less than the first value mapped are also mapped to the first entry in the LUT Data. An image pixel value one greater than the first value mapped is mapped to the second entry in the LUT Data. Subsequent image pixel values are mapped to the subsequent entries in the LUT Data up to an image pixel value equal to number of entries + first value mapped - 1 which is mapped to the last entry in the LUT Data. Image pixel values greater than number of entries + first value mapped are also mapped to the last entry in the LUT Data. The third value specifies the number of bits for each entry in the LUT Data (analogous to “bits stored”). It shall be between 10-16. The LUT Data shall be stored in a format equivalent to 16 “bits allocated” and “high bit” equal to “bits stored” - 1. The third value conveys the range of LUT entry values. These unsigned LUT entry values shall range between 0 and 2 n -1, where n is the third value of the LUT Descriptor. Notes: 1. The third value is restricted in the VOI LUT Module to 8 or 16 but is specialized here. 2. The first and second values are not specialized and are the same as in the VOI LUT Module. The LUT Data (0028,3006) contains the LUT entry values.

Specifies the format of the LUT Data in this Sequence. See C.8.11.3.1.5 for further explanation. Required if the VOI LUT Sequence (0028,3010) is sent.

Free form text explanation of the meaning of the LUT. LUT Data in this Sequence. Required if the VOI LUT Sequence (0028,3010) is sent. Defines a Window Center for display. See C.8.11.3.1.5 for further explanation. Required if Presentation Intent Type (0008,0068) is FOR PRESENTATION and VOI LUT Sequence (0028,3010) is not present. May also be present if VOI LUT Sequence (0028,3010) is present.

Window Width for display. See C.8.11.3.1.5 for further explanation. Required if Window Center (0028,1050) is sent.

Free form explanation of the meaning of the Window Center and Width. Multiple values correspond to multiple Window Center and Width values. Time in mSec that the detector is active during acquisition of this image. Note: This activation window overlaps the time of the X-Ray exposure as defined by Exposure Time (0018,1150) and Detector Activation Offset From Exposure (0018,7016). Offset time in mSec that the detector becomes active after the X-Ray beam is turned on during acquisition of this image. May be negative. Shape of the Field of View, that is the image pixels stored in Pixel Data (7FE0,0010). Enumerated Values: RECTANGLE ROUND HEXAGONAL Dimensions in mm of the Field of View, that is the image pixels stored in Pixel Data (7FE0,0010). If Field of View Shape (0018,1147) is: RECTANGLE: row dimension followed by column. ROUND: diameter. HEXAGONAL: diameter of a circumscribed circle. Offset of the TLHC of a rectangle circumscribing the Field of View, that is the image pixels stored in Pixel Data (7FE0,0010), before rotation or flipping, from the TLHC of the physical detector area measured in physical detector pixels as a row offset followed by a column offset. Required if Field of View Rotation (0018,7032) or Field of View Horizontal Flip (0018,7034) is present. See C.8.11.4.1.1 for further explanation.

The relationship between the Physical Detector Area, the Active Detector Area, the Field of View (what is stored in the Pixel Data (7FE0,0010)), the Exposed Area (after X-Ray Collimation) and the Displayed Area is illustrated in the following diagrams. Note: Some of these Attributes relate the image data to manufacturer specific characteristics of the detector that may be used for quality control purposes, e.g. correlation of image artifacts with a detector defect map, analysis of noise performance, etc. The Displayed Area is defined in pixel coordinates relative to the stored image pixel values by the Attributes of the Display Shutter Module (see section C.7.6.11). If this Module is not present or supported, then the Displayed Area is equal to the Field of View. The Exposed Area is defined in pixel coordinates relative to the stored image pixel values by the Attributes of the X-Ray Collimator Module (see section C.8.7.3). For the Digital X-Ray IODs, the Field of View is usually rectangular in shape and the same size as the stored Pixel Data (7FE0,0010). The shape and size of the Field of View and the spacing of the pixels are defined by the following Attributes: - Field of View Shape (0018,1147), - Field of View Dimensions (0018,1149), - Imager Pixel Spacing (0018,1164), - Rows (0028,0010), - Columns (0028,0011) The following Attributes define the relationship of the Field of View to the Physical Detector Area: - Field of View Origin (0018,7030), - Field of View Rotation (0018,7032), - Field of View Horizontal Flip (0018,7034). For the Digital X-Ray IODs, the Active Area, i.e. that part of the detector matrix that was activated for this exposure, is usually rectangular in shape. The shape and size of the Active Area and the size and spacing of the detectors are defined by the following Attributes: - Detector Active Shape (0018,7024), - Detector Active Dimensions (0018,7026), - Detector Element Physical Size (0018,7020), - Detector Element Spacing (0018,7022). Notes: 1. The Detector Element Physical Size (0018,7020) and Detector Element Spacing (0018,7022) may be different if there are insensitive regions between each detector. 2. This model of description is not able to accurately describe multiple matrices of detectors that are “tiled” to produce a single image. The following optional Attribute defines the relationship of the Active Area to the Physical Detector Area: - Detector Active Origin (0018,7028). The relationship between detectors and stored image pixels is defined by Detector Binning (0018,701A) which specifies how many detectors, in each of the row and column directions, contribute to (are pooled or averaged to form) a single stored image pixel. Note: Detector Binning (0018,701A) may have values less than one if sub-sampling is used to derive an image with higher spatial resolution than the detector matrix. Figure C.8-14 Explanation of DX Detector Attributes Figure C.8-15 Explanation of DX Detector Attributes

Clockwise rotation in degrees of Field of View, that is the image pixels stored in Pixel Data (7FE0,0010), relative to the physical detector. Enumerated Values: 0, 90, 180, 270 Required if Field of View Horizontal Flip (0018,7034) is present. See C.8.11.4.1.1 for further explanation.

Whether or not a horizontal flip has been applied to the Field of View, that is the image pixels stored in Pixel Data (7FE0,0010), after rotation relative to the physical detector as described in Field of View Rotation (0018,7032). Enumerated Values: NO YES Required if Field of View Rotation (0018,7032) is present. See C.8.11.4.1.1 for further explanation.

Physical distance measured at the front plane of the detector housing between the center of each image pixel specified by a numeric pair - row spacing value(delimiter) column spacing value in mm. See 10.7.1.3 for further explanation of the value order. The value of this attribute shall never be adjusted to account for correction for the effect of geometric magnification or calibration against an object of known size; Pixel Spacing (0028,0030) is specified for that purpose. Identifier of the cassette that contains the photostimulable phosphor plate, for CR acquisitions. Identifier of the photostimulable phosphor plate, for CR acquisitions. The type of detector used to acquire this image. Defined Terms: DIRECT = X-Ray photoconductor SCINTILLATOR = Phosphor used STORAGE = Storage phosphor FILM = Scanned film/screen The physical configuration of the detector. Defined Terms: AREA = single or tiled detector SLOT = scanned slot, slit or spot Free text description of detector. Text description of operating mode of detector (implementation specific). The ID or serial number of the detector used to acquire this image. The date on which the detector used to acquire this image as identified in Detector ID (0018,700A) was last calibrated. The time at which the detector used to acquire this image as identified in Detector ID (0018,700A) was last calibrated. Total number of X-Ray exposures that have been made on the detector used to acquire this image as identified in Detector ID (0018,700A) since it was calibrated. Total number of X-Ray exposures that have been made on the detector used to acquire this image as identified in Detector ID (0018,700A) since it was manufactured. Time in Seconds since an exposure was last made on this detector prior to the acquisition of this image. Number of active detectors used to generate a single pixel. Specified as number of row detectors per pixel then column. Name of the manufacturer of the detector component of the acquisition system Model name of the detector component of the acquisition system Whether or not the detector is operating within normal tolerances during this image acquisition. Enumerated Values: YES NO Note: This flag is intended to indicate whether or not there may have been some compromise of the diagnostic quality of the image due to some condition such as over-temperature, etc. Detector temperature during exposure in degrees Celsius. Detector sensitivity in manufacturer specific units. Note: This value is intended to provide a single location where manufacturer specific information can be found for annotation on a display or film, that has meaning to a knowledgeable observer. Physical dimensions of each detector element that comprises the detector matrix, in mm. Expressed as row dimension followed by column. Note: This may not be the same as Detector Element Spacing (0018,7022) due to the presence of spacing material between detector elements. Physical distance between the center of each detector element, specified by a numeric pair - row spacing value(delimiter) column spacing value in mm. See 10.7.1.3 for further explanation of the value order. Note: This may not be the same as the Imager Pixel Spacing (0018,1164), and should not be assumed to describe the stored image. Shape of the active area. Enumerated Value: RECTANGLE ROUND HEXAGONAL Note: This may be different from the Field of View Shape (0018,1147), and should not be assumed to describe the stored image. Dimensions in mm of the active area. If Detector Active Shape(0018,7024) is: RECTANGLE: row dimension followed by column. ROUND: diameter. HEXAGONAL: diameter of a circumscribed circle. Note: This may be different from the Field of View Dimensions (0018,1149), and should not be assumed to describe the stored image. Offset of the TLHC of a rectangle circumscribing the active detector area from the TLHC of a rectangle circumscribing the physical detector area, measured in physical detector pixels as a row offset followed by a column offset. See C.8.11.4.1.1 for further explanation.

A Sequence that describes the radiographic method of patient, tube and detector positioning to achieve a well described projection or view. Only a single Item shall be permitted in this Sequence. Shall be consistent with the other Attributes in this Module, if present, but may more specifically describe the image acquisition. Description of imaging subject's position relative to the equipment. See C.7.3.1.1.2 for Defined Terms and further explanation. If present, shall be consistent with Patient Gantry Relationship Code Sequence (0054,0414) and Patient Orientation Modifier Code Sequence (0054,0412).

Patient Position (0018,5100) specifies the position of the patient relative to the imaging equipment space. This attribute is intended for annotation purposes only. It does not provide an exact mathematical relationship of the patient to the imaging equipment. When facing the front of the imaging equipment, Head First is defined as the patient’s head being positioned toward the front of the imaging equipment. Feet First is defined as the patient’s feet being positioned toward the front of the imaging equipment. Prone is defined as the patient’s face being positioned in a downward (gravity) direction. Supine is defined as the patient’s face being in an upward direction. Decubitus Right is defined as the patient’s right side being in a downward direction. Decubitus Left is defined as the patient’s left side being in a downward direction. The Defined Terms are:

Radiographic view of the image relative to the imaging subject's orientation. Shall be consistent with View Code Sequence (0054,0220). See C.8.11.5.1.1 for further explanation.

View Code Sequence (0054,0220) replaces the function of View Position (0018,5101), and describes the radiographic view of the image relative to the real-world patient orientation as described in PS 3.17 annex on Explanation of Patient Orientation.

Sequence that describes the projection of the anatomic region of interest on the image receptor. Note: It is strongly recommended that this Attribute be present, in order to ensure that images may be positioned correctly relative to one another for display. Shall be consistent with View Position (0018,5101). See C.8.11.5.1.1 for further explanation. Only a single Item shall be permitted in this Sequence.

View modifier. Zero or more Items may be included in this Sequence. Sequence that describes the orientation of the patient with respect to gravity. See C.8.11.5.1.2 for further explanation. Only a single Item shall be permitted in this Sequence.

This Attribute is not related to Patient Orientation (0020,0020) and conveys a different concept entirely.

Patient Orientation Modifier. Required if needed to fully specify the orientation of the patient with respect to gravity. Only a single Item shall be permitted in this Sequence. Sequence which describes the orientation of the patient with respect to the gantry. Only a single Item shall be permitted in this Sequence. Distance in mm from source to the table, support or bucky side that is closest to the Imaging Subject, as measured along the central ray of the X-Ray beam. Note: 1. This definition is less useful in terms of estimating geometric magnification than a measurement to a defined point within the Imaging Subject, but accounts for what is realistically measurable in an automated fashion in a clinical setting. 2. This measurement does not take into account any air gap between the Imaging Subject and the "front" of the table or bucky. 3. If the detector is not mounted in a table or bucky, then the actual position relative to the patient is implementation or operator defined. 4. This value is traditionally referred to as Source Object Distance (SOD). See C.8.11.7 Mammography Image Module for explanation if Positioner Type (0018,1508) is MAMMOGRAPHIC.

Table C.8-74 contains IOD Attributes that describe a Digital Mammography X-Ray Image including its acquisition and positioning. Table C.8-74 MAMMOGRAPHY IMAGE MODULE ATTRIBUTES

Distance in mm from source to detector center. Note: This value is traditionally referred to as Source Image Receptor Distance (SID). See C.8.11.7 Mammography Image Module for explanation if Positioner Type (0018,1508) is MAMMOGRAPHIC.

Table C.8-74 contains IOD Attributes that describe a Digital Mammography X-Ray Image including its acquisition and positioning. Table C.8-74 MAMMOGRAPHY IMAGE MODULE ATTRIBUTES

Ratio of Source Image Receptor Distance (SID) over Source Object Distance (SOD). Defined Terms: CARM COLUMN MAMMOGRAPHIC PANORAMIC CEPHALOSTAT RIGID NONE Notes: 1. The term CARM can apply to any positioner with 2 degrees of freedom of rotation of the X-Ray beam about the Imaging Subject. 2. The term COLUMN can apply to any positioner with 1 degree of freedom of rotation of the X-Ray beam about the Imaging Subject. Position of the X-Ray beam about the patient from the RAO to LAO direction where movement from RAO to vertical is positive, if Positioner Type (0018,1508) is CARM. See C.8.7.5 XA Positioner Module for further explanation if Positioner Type (0018,1508) is CARM. See C.8.11.7 Mammography Image Module for explanation if Positioner Type (0018,1508) is MAMMOGRAPHIC. Position of the X-Ray beam about the patient from the CAU to CRA direction where movement from CAU to vertical is positive, if Positioner Type (0018,1508) is CARM. See C.8.7.5 XA Positioner Module for further explanation if Positioner Type (0018,1508) is CARM. See C.8.11.7 Mammography Image Module for explanation if Positioner Type (0018,1508) is MAMMOGRAPHIC. Angle of the X-Ray beam in the row direction in degrees relative to the normal to the detector plane. Positive values indicate that the X-Ray beam is tilted toward higher numbered columns. Negative values indicate that the X-Ray beam is tilted toward lower numbered columns. See C.8.7.5 XA Positioner Module for further explanation. See C.8.11.7 Mammography Image Module for explanation if Positioner Type (0018,1508) is MAMMOGRAPHIC. Angle of the X-Ray beam in the column direction in degrees relative to the normal to the detector plane. Positive values indicate that the X-Ray beam is tilted toward lower numbered rows. Negative values indicate that the X-Ray beam is tilted toward higher numbered rows. See C.8.7.5 XA Positioner Module for further explanation. See C.8.11.7 Mammography Image Module for explanation if Positioner Type (0018,1508) is MAMMOGRAPHIC. Angle of the X-Ray beam in degree relative to an orthogonal axis to the detector plane. Positive values indicate that the tilt is toward the head of the table. Note: The detector plane is assumed to be parallel to the table plane. Only meaningful if Positioner Type (0018,1508) is COLUMN. Defined Terms: FIXED TILTING NONE Angle of table plane in degrees relative to horizontal plane [Gravity plane]. Positive values indicate that the head of the table is upward. Only meaningful if Table Type (0018,113A) is TILTING. The average thickness in mm of the body part examined when compressed, if compression has been applied during exposure. The compression force applied to the body part during exposure, measured in Newtons. Type of equipment that originally acquired the data used to create the images in this Series. Enumerated Value: MG See section C.7.3.1.1.1 for further explanation. Sequence that contains attributes from the Imaging Service Request. The sequence may have one or more Items. Enumerated Values: MAMMOGRAPHIC NONE Distance in mm from source to detector center on the chest wall line Notes: 1. This value is traditionally referred to as Source Image Distance (SID). 2. See C.8.11.7.1.1.

Figure C.8-8 shows the X-Ray beam for a digital mammography system. The X-Ray beam vector is defined from the Focal Spot to the center of the chest wall line of the Image Detection device. Figure C.8-8

Distance in mm from source to the bucky side that is closest to the Imaging Subject, as measured along the X-Ray beam vector. Notes: 1. This value is traditionally referred to as Source Object Distance (SOD). 2. See notes for this attribute in C.8.11.5 DX Positioning Module. 3. See C.8.11.7.1.1 for description of X-Ray beam vector.

Position in degrees of the X-Ray beam vector in the coronal anatomical plane as if the patient were standing where movement of the X-Ray source from right to vertical is positive, and vertical is zero. Position in degrees of the X-Ray beam vector in the sagittal anatomical plane as if the patient were standing where movement of the X-Ray source from anterior to posterior is positive, and vertical is zero. Laterality of the region examined. Enumerated Values: R = right L = left B = both (e.g. cleavage) Organ to which Organ Dose (0040,0316) applies. Enumerated Value: BREAST Note: In the Mammography IOD, Organ Dose (0040,0316) refers to the mean glandular dose. Whether or not an implant is present. Enumerated Values: YES NO Indicates whether this image is a partial view, that is a subset of a single view of the breast. Enumerated Values: YES, NO If this Attribute is absent, then the image may or may not be a partial view. Note: This may occur when a breast is larger than the active area of the detector. If this Attribute is present, its value shall be NO if there is a View Modifier Code Sequence (0054,0222) Item of value (R-102D6, SNM3, "Magnification") or (R-102D7, SNM3, "Spot Compression"). Free text description of the portion of the breast captured in a partial view image. This Attribute shall not be present if there is a View Modifier Code Sequence (0054,0222) Item of value (R-102D6, SNM3, "Magnification") or (R-102D7, SNM3, "Spot Compression"). Sequence that describes the portion or section of the breast captured in a partial view image. One or two Items may be present. See C.8.11.7.1.3. If this Attribute is absent, then the image may or may not be a partial view. This Attribute shall not be present if there is a View Modifier Code Sequence (0054,0222) Item of value (R-102D6, SNM3, "Magnification") or (R-102D7, SNM3, "Spot Compression").

The following combinations of coded terms may be used to express the breast sections, for example, for the left cranio-caudal (L CC) view. These terms would also apply to the R CC, and the right and left FB, XCC, XCCL and XCCM views: Note: If six images are required, then the “Central, Anterior” combination would be added. The following combinations of coded terms may be used to express the breast sections, for example, for the left medio-lateral oblique (L MLO) view. These terms would also apply to the R MLO, and to the right and left LM, ML, LMO, and SIO views: Note: If six images are required, then the “Central, Anterior” combination would be added.

Sequence that describes the projection of the anatomic region of interest on the image receptor. Only a single Item shall be permitted in this Sequence. View modifier. Zero or more Items may be included in this Sequence. Type of equipment that originally acquired the data used to create the images in this Series. Enumerated Values: IO See section C.7.3.1.1.1 for further explanation. Enumerated Values: NONE CEPHALOSTAT RIGID Laterality of the region examined. Enumerated Values: R = right L = left B = both (i.e. midline) Sequence that identifies the anatomic region of interest in this image. Only a single Item shall be permitted in this Sequence. Sequence that refines the anatomic region of interest in this image. Required if Primary Anatomic Structure Sequence (0008,2228) is not sent. Only a single Item shall be permitted in this Sequence. Sequence that describes the primary anatomic structures of interest in this image. See C.8.11.9.1.1 for further explanation. Required if Anatomic Region Modifier Sequence (0008,2220) is not sent. One or more Items may be included in this Sequence.

The Code Value (0008,0100) shall be drawn from the DICOM Content Mapping Resource, Context ID 4018, for permanent dentition, or Context ID 4019 for deciduous dentition. These Context Groups correspond to ISO 3950-1984 that describes a designation of permanent and deciduous dentition using a two digit code, the first digit of which designates a quadrant, and the second digit a tooth. The teeth imaged shall be listed as multiple Items in the Primary Anatomic Structure Sequence (0008,2228).

Image identification characteristics. See C.8.12.1.1.6 for specialization.

The Image Type attribute identifies important image characteristics in a multiple valued data element. For Visible Light, Image Type is specialized as follows: a. Value 1 shall identify the Pixel Data Characteristics in accordance with Section C.7.6.1.1.2; Enumerated Values are: ORIGINAL and DERIVED; b. Value 2 shall identify the Patient Examination Characteristics in accordance with Section C.7.6.1.1.2; Enumerated Values are: PRIMARY and SECONDARY. c. Value 3 may be absent, but if present shall identify the members of a stereo pair, in which case Referenced Image Sequence (0008,1140) is used to identify the other member of the pair. If present, the Enumerated Values are: d. Other Values are implementation specific (optional).

Specifies the intended interpretation of the pixel data. See C.8.12.1.1.1 for specialization of this Attribute.

The Enumerated Values of Photometric Interpretation (0028,0004) shall be: MONOCHROME2 RGB YBR_FULL_422 YBR_PARTIAL_420 YBR_RCT YBR_ICT Note: There is no formal color space defined, hence “false” color applications that encode near-visible light images may be encoded, for example, as RGB.

Number of bits allocated for each pixel sample. Each sample shall have the same number of bits allocated. See C.8.12.1.1.2 for specialization of this Attribute. See PS 3.5 for further explanation.

The Enumerated Value of Bits Allocated (0028,0100) shall be 8; the Enumerated Value of Bits Stored (0028,0101) shall be 8; and the Enumerated Value of High Bit (0028,0102) shall be 7.

Number of bits stored for each pixel sample. Each sample shall have the same number of bits stored. See C.8.12.1.1.2 for specialization of this Attribute. See PS 3.5 for further explanation.

The Enumerated Value of Bits Allocated (0028,0100) shall be 8; the Enumerated Value of Bits Stored (0028,0101) shall be 8; and the Enumerated Value of High Bit (0028,0102) shall be 7.

Most significant bit for pixel sample data. Each sample shall have the same high bit. See C.8.12.1.1.2 for specialization of this Attribute. See PS 3.5 for further explanation.

The Enumerated Value of Bits Allocated (0028,0100) shall be 8; the Enumerated Value of Bits Stored (0028,0101) shall be 8; and the Enumerated Value of High Bit (0028,0102) shall be 7.

Data representation of the pixel samples. Each sample shall have the same pixel representation. See Section C.8.12.1.1.3 for specialization of this Attribute.

The Enumerated Value of Pixel Representation (0028,0103) shall be 0.

Number of samples (planes) per image. See C.8.12.1.1.4 for specialization of this Attribute.

The Enumerated Values of Samples per Pixel (0028,0002) shall be as follows: If the value of Photometric Interpretation (0028,0004) is MONOCHROME2, then the Enumerated Value of Samples per Pixel (0028,0002) shall be one (1). If the value of Photometric Interpretation (0028,0004) is RGB or YBR_FULL_422 or YBR_PARTIAL_420 or YBR_RCT or YBR_ICT, then the Enumerated Value of Samples per Pixel (0028,0002) shall be three (3).

Indicates whether the pixel data are sent color-by-plane or color-by-pixel. Required if Samples per Pixel (0028,0002) has a value greater than 1. See C.8.12.1.1.5 for specialization of this Attribute.

If present, the Enumerated Value of Planar Configuration (0028,0006) shall be 0. This value shall be present if Samples per Pixel (0028,0002) has a value greater than 1.

The time the image pixel data creation started. Required if the Image is part of a series in which the images are temporally related. Note: This Attribute was formerly known as Image Time. Specifies whether an Image has undergone lossy compression. Enumerated Values: 00 = Image has NOT been subjected to lossy compression. 01 = Image has been subjected to lossy compression. See C.7.6.1.1.5

A Sequence that references other images significantly related to this image. One or more items may be included in this sequence. Required if Image Type (0008,0008) Value 3 is present and has a value of "STEREO L" or "STEREO R". May also be present otherwise. See Section C.8.12.1.1.7.

When Image Type (0008,0008) Value 3 is STEREO L or STEREO R, Referenced Image Sequence (0008,1140) shall be used to identify the corresponding SOP Instance of the Stereoscopic acquisition. In this case, either:

Describes the purpose for which the reference is made. Zero or one item shall be present in the sequence. Window Center for display. See C.11.2.1.2 for further explanation. Meaningful only if Photometric Interpretation (0028,0004) is MONOCHROME2.

Window Width for display. See C.11.2.1.2 for further explanation. Required if Window Center (0028,1050) is present.

Sequence that identifies the anatomic region of interest in this image (i.e. external anatomy, surface anatomy, or general region of the body). Only a single Item shall be permitted in this sequence. Required if Number of Frames (0028,0008) is present and Specimen Accession Number (0040,050A) is absent. May be present otherwise. Sequence of Items that modifies the anatomic region of interest of this image One or more Items may be included in this Sequence. Describes the light color used for each channel to generate the image. If Photometric Interpretation (0028,0004) has one of the YBR values, the meaning is for pixel data in an equivalent RGB encoding. Note: Interpretation and representation of RGB images rely on the assumption that the red channel really contains the red wavelength range of illumination light, the blue channel the blue wavelength range, etc. Some modalities use the RGB Photometric Interpretation as a container representing 3 channels of any illumination wavelength. Shall have the same number of items as the value of Samples per Pixel (0028,0002). The channels shall be described in the order in which the channels are encoded. The coordinates of the center point of the Image in the Slide Coordinate System Frame of Reference. Zero or one item shall be present in the sequence. See Section C.8.12.2.1.1 for further explanation.

This Section defines the Slide Coordinate System and specifies the Attributes that shall be used to describe the location of the center point of the Image pixel plane (as captured through a microscope) in the Slide Coordinate System Frame of Reference. Note: In Slide Microscopy (SM), the Microscope is equipped with a moveable Stage and position sensors that enable storage of the location of the center point of the displayed image with respect to the examined Specimen. The Stage is the part of the Microscope to which the Slide is attached for viewing. The Objective Lens is the lens that is closest to the Specimen. The Top Surface of the Slide is the surface of the Slide on which the Specimen in Mounted. The Bottom Surface of the Slide is the opposite surface. This Specification presumes that: 1) the Slide is rectangular; 2) the Top Surface of the Slide is oriented toward the Objective Lens of the Microscope; and 3) the Bottom Surface of the Slide is in perfect contact with the Microscope Stage when the Slide is attached to the Stage for viewing. Notes: 1. The Label of the Slide is presumed to be mounted-on or written-on the Top Surface of the Slide. 2. Specification of the mechanical form, function, or tolerances of the Microscope are outside the scope of this Standard. Figure C.8-16 depicts the Top Surface of the Slide on the Microscope Stage from the perspective of the Objective Lens. This is Reference Slide Orientation. The X, Y, and Z axes of the Slide Coordinate System in Reference Slide Orientation are defined as follows. The Y-axis is a line that includes the Left Edge of the Slide. The X-axis is a line that is orthogonal to the Y-axis and includes at least one point of the Specimen Edge of the Slide. The Z-axis is a line that passes through the intersection of the X-axis and Y-axis and is orthogonal to the Microscope Stage. The Origin (0,0,0) of the Slide Coordinate System is the point of intersection of the X, Y, and Z axes. Figure C.8-16 REFERENCE SLIDE ORIENTATION Notes: 1. An improperly-placed coverslip or Specimen that overlaps an Edge of a Slide is not considered part of the Edge a Slide for purposes of defining the Slide Coordinate System. However, such objects may cause inaccurate positioning of the Slide on the Stage. 2. If the Left Edge and Specimen Edge of the Slide are not orthogonal (e.g. the Slide is damaged or defective or the Specimen Edge is curvilinear), then the lower left-hand corner of the Slide may not be located at the Origin. 3. The definitions of X, Y, and Z axes are the same for inverted microscopes, with the Top Surface of the slide (i.e. Specimen side of the Slide) still being closest to the Objective Lens. Figure C.8-17 depicts the Z-axis center point location. The X-axis value of Image Center Point Location (0040,073A) shall increase from the Origin toward the Right Edge in Reference Slide Orientation. The Y-axis value of Image Center Point Location (0040,073A) shall increase from the Origin toward the Label Edge in Reference Slide Orientation. The Z-axis value of Image Center Point Location (0040,073A) shall be referenced as zero at the image substrate reference plane (i.e. utilized surface of a glass slide) and shall increase in a positive fashion coincident with increased distance from the substrate surface. Figure C.8-17 Z-AXIS CENTER POINT LOCATION, VIEW FROM RIGHT EDGE OF SLIDE

The X offset in millimeters from the Origin of the Slide Coordinate System. See Figure C.8-16. The Y offset in millimeters from the Origin of the Slide Coordinate System. See Figure C.8-16. The Z offset in microns from the image substrate reference plane (i.e. utilized surface of a glass slide). Physical distance in the Imaging Subject, i.e. Patient or Specimen, between the center of each pixel along specified axes. One or more items may be present. Axis of a coordinate system. This sequence shall contain exactly one item. The distance between the center-points of adjacent pixels along the axis specified by Coordinate System Axis Code Sequence (0040,08DA). Units of the measurement. This sequence shall contain exactly one item. Image characteristics. See C.8.16.1 and C.8.13.3.1.1.

The Image Type (0008,0008) and associated Image Type related attributes provide a high level description of a multi-frame SOP Instance. These attributes describe properties that provide key summary information to users of the SOP Instance. Image Type (0008,0008) contains the highest level summary of what is in the SOP Instance. The Frame Type (0008,9007) attribute mirrors the corresponding Image Type attribute and applies to the frame level rather than to the image level. If more than one value is used by the set of frames for a given Frame Type (0008,9007) attribute value or associated attribute value then the corresponding value of the Image Type (0008,0008) or associated attribute shall contain a value of MIXED. This indicates that a mixed set of values exists within the multi-frame SOP Instance. The value MIXED shall only be used in the Image Type (0008,0008) when the corresponding values for the individual frames are not equal. When a value of an attribute is equal for all frames, the same value shall be used for the corresponding value of the Image Type (0008,0008). Values 2 and 3 of Image Type (0008,0008) are an exception to the rule for MIXED: Values 2 and 3 may never have the value of MIXED as described in sections C.8.16.1.2 and C.8.16.1.3. Image Type (0008,0008) and Frame Type (0008,9007) shall consist of four non-zero length values.

Number of samples (planes) in this image. This value shall be 1. Specifies the intended interpretation of the pixel data. Enumerated Value: MONOCHROME2. See C.7.6.3.1.2 for definition of this term.

The value of Photometric Interpretation (0028,0004) specifies the intended interpretation of the image pixel data. See PS 3.5 for restrictions imposed by compressed Transfer Syntaxes. The following values are defined. Other values are permitted but the meaning is not defined by this Standard. MONOCHROME1 = Pixel data represent a single monochrome image plane. The minimum sample value is intended to be displayed as white after any VOI gray scale transformations have been performed. See PS 3.4. This value may be used only when Samples per Pixel (0028,0002) has a value of 1. MONOCHROME2 = Pixel data represent a single monochrome image plane. The minimum sample value is intended to be displayed as black after any VOI gray scale transformations have been performed. See PS 3.4. This value may be used only when Samples per Pixel (0028,0002) has a value of 1. PALETTE COLOR = Pixel data describe a color image with a single sample per pixel (single image plane). The pixel value is used as an index into each of the Red, Blue, and Green Palette Color Lookup Tables (0028,1101-1103&1201-1203). This value may be used only when Samples per Pixel (0028,0002) has a value of 1. When the Photometric Interpretation is Palette Color; Red, Blue, and Green Palette Color Lookup Tables shall be present. RGB = Pixel data represent a color image described by red, green, and blue image planes. The minimum sample value for each color plane represents minimum intensity of the color. This value may be used only when Samples per Pixel (0028,0002) has a value of 3. HSV = Retired. ARGB = Retired. CMYK = Retired. YBR_FULL = Pixel data represent a color image described by one luminance (Y) and two chrominance planes (CB and CR). This photometric interpretation may be used only when Samples per Pixel (0028,0002) has a value of 3. Black is represented by Y equal to zero. The absence of color is represented by both CB and CR values equal to half full scale. Note: In the case where the Bits Allocated (0028,0100) has value of 8 half full scale is 128. In the case where Bits Allocated (0028,0100) has a value of 8 then the following equations convert between RGB and YCBCR Photometric Interpretation. Y = + .2990R + .5870G + .1140B CB = - .1687R - .3313G + .5000B + 128 CR = + .5000R - .4187G - .0813B + 128 Note: The above is based on CCIR Recommendation 601-2 dated 1990. YBR_FULL_422 = The same as YBR_FULL except that the CB and CR values are sampled horizontally at half the Y rate and as a result there are half as many CB and CR values as Y values. This Photometric Interpretation is only allowed with Planar Configuration (0028,0006) equal to 0. Two Y values shall be stored followed by one CB and one CR value. The CB and CR values shall be sampled at the location of the first of the two Y values. For each Row of Pixels, the first CB and CR samples shall be at the location of the first Y sample. The next CB and CR samples shall be at the location of the third Y sample etc. Note: This subsampling is often referred to as cosited sampling. YBR_PARTIAL_422 = The same as YBR_FULL_422 except that: 1. black corresponds to Y = 16; 2. Y is restricted to 220 levels (i.e. the maximum value is 235); 3. CB and CR each has a minimum value of 16; 4. CB and CR are restricted to 225 levels (i.e. the maximum value is 240); 5. lack of color is represented by CB and CR equal to 128. In the case where Bits Allocated (0028,0100) has value of 8 then the following equations convert between RGB and YBR_PARTIAL_422 Photometric Interpretation Y = + .2568R + .5041G + .0979B + 16 CB = - .1482R - .2910G + .4392B + 128 CR = + .4392R - .3678G - .0714B + 128 Note: The above is based on CCIR Recommendation 601-2 dated 1990. YBR_PARTIAL_420 = The same as YBR_PARTIAL_422 except that the CB and CR values are sampled horizontally and vertically at half the Y rate and as a result there are four times less CB and CR values than Y values, versus twice less for YBR_PARTIAL_422. This Photometric Interpretation is only allowed with Planar Configuration (0028,0006) equal to 0. The CB and CR values shall be sampled at the location of the first of the two Y values. For the first Row of Pixels (etc.), the first CB and CR samples shall be at the location of the first Y sample. The next CB and CR samples shall be at the location of the third Y sample etc. The next Rows of Pixels containing CB and CR samples (at the same locations than for the first Row) will be the third etc. YBR_ICT = Irreversible Color Transformation: Pixel data represent a color image described by one luminance (Y) and two chrominance planes (CB and CR). This photometric interpretation may be used only when Samples per Pixel (0028,0002) has a value of 3. Black is represented by Y equal to zero. The absence of color is represented by both CB and CR values equal to zero. Regardless of the value of Bits Allocated (0028,0100), the following equations convert between RGB and YCBCR Photometric Interpretation. Y = + .29900R + .58700G + .11400B CB = - .16875R - .33126G + .50000B CR = + .50000R - .41869G - .08131B Notes: 1. The above is based on ISO/IEC 15444-1 (JPEG 2000). 2. In a JPEG 2000 bitstream, DC level shifting (used if the untransformed components are unsigned) is applied before forward color transformation, and the transformed components may be signed (unlike in JPEG ISO/IEC 10918-1). 3. In JPEG 2000, spatial down-sampling of the chrominance components, if performed, is signaled in the JPEG 2000 bitstream. YBR_RCT = Reversible Color Transformation: Pixel data represent a color image described by one luminance (Y) and two chrominance planes (CB and CR). This photometric interpretation may be used only when Samples per Pixel (0028,0002) has a value of 3. Black is represented by Y equal to zero. The absence of color is represented by both CB and CR values equal to zero. Regardless of the value of Bits Allocated (0028,0100), the following equations convert between RGB and YBR_RCT Photometric Interpretation. Y = R + 2G +B) / 4 (Note:  mean floor) CB = B - G CR = R - G The following equations convert between YBR_RCT and RGB Photometric Interpretation. G = Y –  (CR + CB) / 4 R = CR + G B = CB + G Notes: 1. The above is based on ISO/IEC 15444-1 (JPEG 2000). 2. In a JPEG 2000 bitstream, DC level shifting (used if the untransformed components are unsigned) is applied before forward color transformation, and the transformed components may be signed (unlike in JPEG ISO/IEC 10918-1). 3. This photometric interpretation is a reversible approximation to the YUV transformation used in PAL and SECAM.

Number of bits allocated for each pixel sample. Each sample shall have the same number of bits allocated. Enumerated Values: 8 and 16. Number of bits stored for each pixel sample. Each sample shall have the same number of bits stored. Enumerated Values: 8, 12 and 16. See C.8.13.1.1.1 for specialization.

Table C.8-80 specifies the allowed combinations of Bits Allocated (0028,0100) and Bits Stored (0028,0101). Table C.8-80 ALLOWED COMBINATIONS OF ATTRIBUTE VALUES FOR BITS ALLOCATED AND BITS STORED

Most significant bit for pixel sample data. Each sample shall have the same high bit. Shall be one less than the value in Bits Stored (0028,0101). Value of the prescribed spacing to be applied between the slices in a volume that is to be acquired. The spacing in mm is defined as the center-to-center distance of adjacent slices. Indicates whether or not the image contains sufficient burned in annotation to identify the patient and date the image was acquired. Enumerated Values: NO This means that images that contain this Module shall not contain such burned in annotations. Specifies whether an Image has undergone lossy compression. Enumerated Values: 00 = Image has NOT been subjected to lossy compression. 01 = Image has been subjected to lossy compression. See C.7.6.1.1.5 for further explanation.

Describes the approximate lossy compression ratio(s) that have been applied to this image. See C.7.6.1.1.5 for further explanation. May be multivalued if successive lossy compression steps have been applied. Note: For example, a compression ratio of 30:1 would be described in this Attribute with a single value of 30. Required if Lossy Images Compression (0028,2110) is "01".

Specifies an identity transformation for the Presentation LUT, such that the output of all grayscale transformations defined in the IOD containing this Module are defined to be P-Values. Enumerated Values: IDENTITY - output is in P-Values. This icon image is representative of the Image. Only a single Item shall be permitted in this Sequence. A number identifying the single continuous gathering of data over a period of time that resulted in this image. Note: This number is not required to be unique across SOP Instances in a series. See also the description of the Referenced Raw Data Sequence (0008,9121). The date and time that the acquisition of data started. Note: The synchronization of this time with an external clock is specified in the synchronization Module in Acquisition Time synchronized (0018,1800). Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise. The time in seconds needed to run the prescribed pulse sequence. See C.7.6.16.2.2.1 for further explanation. Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise.

Figure C.7.6.16-2 shows the relationships among the various timing parameters used.

A sequence that identifies the set of Raw Data SOP Class/Instance pairs of the Raw data which were used to derive this Image. One or more Items may be included 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. 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 may be included in this Sequence. Full set of Composite SOP Instances referred to inside the Referenced Image Sequences of this Enhanced MR Image SOP Instance. See C.8.13.2.1.2 for further explanation. One or more Items may be included in this sequence. Required if the Referenced Image Sequence (0008,1140) is present.

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) attributes respectively.

Full set of Composite SOP Instances referred to inside the Source Image Sequences of this Enhanced MR Image SOP Instance. See C.8.13.2.1.2 for further explanation. One or more Items may be included in this sequence. Required if the Source Image Sequence (0008,2112) is present.

References to Grayscale Presentation State instances acquired in conjunction with this instance. Note: May only be used to reference Presentation States belonging to the acquired data and not to reference Presentation States generated subsequently such as during interpretation. One or more Items may be included in this sequence. Required if Presentation State is generated during acquisition, shall not be present otherwise. Content Qualification Indicator Enumerated Values: PRODUCT RESEARCH SERVICE See C.8.13.2.1.1 for further explanation.

Content Qualification (0018,9004) shall have the value PRODUCT if the content (image or Spectroscopy data) was produced with approved hardware and software. It shall have the value RESEARCH or SERVICE if there is any doubt as to whether the content was produced with approved hardware and software. If data with Content Qualification (0018,9004) of RESEARCH or SERVICE is used to derive other content then it is expected that this derived content will also have Content Qualification (0018,9004) set to RESEARCH or SERVICE. The intent of this element is to allow annotation of an advisory message that indicates that this content may not be suitable for clinical interpretation.

Nucleus that is resonant at the transmitter frequency. Defined Terms: 1H 3HE 7LI 13C 19F 23NA 31P 129XE Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise. Describes k-space filtering applied. Shall be NONE if no k-space filter. Defined Terms: COSINE COSINE_SQUARED FERMI GAUSSIAN HAMMING HANNING LORENTZIAN LRNTZ_GSS_TRNSFM RIESZ TUKEY NONE Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise. Nominal field strength of the MR Magnet, in Tesla. Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise. Agency that established MR safety standard applicable to the acquisition of this Instance. Defined Terms: IEC FDA MHW Name and Version of the applicable standard. User-defined comments about the image. Representation of complex data of frames in the SOP Instance. See C.8.13.3.1.5 for a description and Defined Terms.

The value of the Complex Image Component attribute (0008,9208) shall be used to indicate which component of the complex representation of the signal is represented in the pixel data. Table C.8-85 specifies the Defined Terms for Complex Image Component attribute (0008,9208). Table C.8-85 COMPLEX IMAGE COMPONENT ATTRIBUTE VALUES

Indication of acquisition contrast used with frames in the SOP Instance. See C.8.13.3.1.6 for a description and Defined Terms.

Table C.8-86 specifies the Defined Terms for Acquisition Contrast attribute (0008,9209). Table C.8-86 ACQUISITION CONTRAST VALUES

Name of the pulse sequence for annotation purposes. Potentially vendor-specific name. Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise. Identification of spatial data encoding scheme. Defined Terms: 1D 2D 3D Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise. Echo category of pulse sequences. Enumerated Values: SPIN GRADIENT BOTH Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise. Multiple Spin Echo category of pulse sequence used to collect different lines in k-space for a single frame. Enumerated Values: YES NO Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED and Echo Pulse sequence (0018,9008) equals SPIN or BOTH. Otherwise may be present if Image Type (0008,0008) Value 1 is DERIVED and Echo Pulse sequence (0018,9008) equals SPIN or BOTH. Technique that simultaneously excites several volumes. Enumerated Values: YES NO Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise. Phase Contrast Pulse sequence is a pulse sequence in which the flowing spins are velocity encoded in phase. Enumerated Values: YES NO Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise. Time of Flight contrast is created by the inflow of blood in the saturated plane. Enumerated Values: YES NO Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise. Steady State Sequence. Defined Terms: FREE_PRECESSION TRANSVERSE TIME_REVERSED LONGITUDINAL NONE Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise. Echo Planar category of Pulse Sequences. Enumerated Values: YES NO Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise. Saturation recovery pulse sequence. Enumerated Values: YES NO Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise. Spectrally Selected Suppression. Defined Terms: FAT WATER FAT_AND_WATER SILICON_GEL NONE Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise. Oversampling Phase. Enumerated Values: 2D = phase direction 3D = out of plane direction 2D_3D = both NONE Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise. Geometry category of k-Space traversal. Defined Terms: RECTILINEAR RADIAL SPIRAL Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise. Rectilinear phase encode reordering. Defined Terms: LINEAR CENTRIC SEGMENTED REVERSE_LINEAR REVERSE_CENTRIC Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED and Geometry of k-Space Traversal (0018,9032) equals RECTILINEAR. Otherwise may be present if Image Type (0008,0008) Value 1 is DERIVED and Geometry of k-Space Traversal (0018,9032) equals RECTILINEAR. Segmented k-Space traversal. If Geometry of k-Space Traversal is rectilinear, multiple lines can be acquired at one time. If Geometry of k-Space Traversal is spiral or radial, paths can be interleaved and acquired at one time. Enumerated Values: SINGLE = successive single echo coverage PARTIAL = segmented coverage FULL = single shot full coverage Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise. Coverage of k-Space in the ky-kz plane. Defined Terms: FULL CYLINDRICAL ELLIPSOIDAL WEIGHTED Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED and MR Acquisition Type (0018,0023) equals 3D. Otherwise may be present if Image Type (0008,0008) Value 1 is DERIVED and MR Acquisition Type (0018,0023) equals 3D. Number of interleaves or shots. Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise. Identifies the characteristics of this frame. Only a single Item shall be permitted in this sequence. Type of Frame. A multi-valued attribute analogous to the Image Type (0008,0008). Enumerated Values and Defined Terms are the same as those for the four values of the Image Type (0008,0008) attribute, except that the value MIXED is not allowed. See C.8.16.1 and C.8.13.3.1.1.

Identifies the timing and safety information of this frame. Only a single Item shall be permitted in this sequence. The time in ms between two successive excitations of the same volume. Shall be 0 (zero) if there is a single excitation per volume. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise. Steady state angle in degrees to which the magnetic vector is flipped from the magnetic vector of the primary field. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise. Number of lines in k-space acquired per excitation of the same volume regardless of the type of echo or the number of frames derived from them. See section C.8.12.5.2.1. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise. Number of RF echoes collected per RF shot (or excitation) per frame. A value of zero shall correspond to a pure gradient echo frame. Note that this value corresponds to the current frame. Several frames may be derived from the same shot. See section C.8.13.5.2.1. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise. Number of gradient echoes collected per RF echo per shot (or excitation) per frame. A value of zero shall correspond to a pure RF echo frame. If RF Echo Train Length (0018,9240) is non zero and Gradient Echo Train Length is as well then only the central echo will be an RF Spin Echo, all others will be gradient echoes. See section C.8.13.5.2.1. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise. Sequence containing the methods of SAR calculation and the corresponding values. One or more items may be present. Required if the system is capable of calculating Specific Absorption Rate (0018,9181). Specification of the method of SAR calculation as defined in Applicable Safety Standard Description (0018,9174). Defined Terms: IEC_WHOLE_BODY IEC_PARTIAL_BODY IEC_HEAD IEC_LOCAL Specific Absorption Rate in W/kg. Definition of gradient output unit, for which the value is stored in Gradient Output (0018,9182). Defined Terms: DB_DT = in T/s ELECTRIC_FIELD = in V/m PER_NERVE_STIM = percentage of peripheral nerve stimulation Required if the system is capable of calculating Gradient Output (0018,9182). Unit is defined by Gradient Output Type (0018,9180). Required if the system is capable of calculating Gradient Output (0018,9182). Sequence of operating mode information relating to the frame/SOP instance as required to adhere to the Applicable Safety Standard Agency (0018,9174) regulations. One or more Items may be included in this sequence. Required if required by law or regulations. May be present otherwise. Defined Terms: STATIC FIELD RF GRADIENT Operating mode applicable for the defined by the applicable standard. Defined Terms: IEC_NORMAL IEC_FIRST_LEVEL IEC_SECOND_LEVEL Identifies the geometry parameters of this frame. Only a single Item shall be permitted in this sequence. The axes of the in-plane phase encoding with respect to the frame. Enumerated Values: COLUMN ROW OTHER Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise. Number of Frequency Encoding steps (kx) acquired Required if Frame Type (0008,9007) Value 1 is ORIGINAL. May be present otherwise. Number of In-Plane Phase Encoding steps (ky) acquired Required if Frame Type (0008,9007) Value 1 is ORIGINAL. May be present otherwise. Number of Out-of-Plane Phase Encoding steps (kz) acquired Required if MR Acquisition Type (0018,0023) equals 3D and Frame Type (0008,9007) Value 1 is ORIGINAL. May be present otherwise. Fraction of acquisition matrix lines acquired, expressed as a percent. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise. Ratio of field of view dimension in phase direction to field of view dimension in frequency direction, expressed as a percent. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise. Identifies echo timing of this frame. Only a single Item shall be permitted in this sequence. The time in ms between the middle of the excitation pulse and the peak of the echo produced for kx=0. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise. Identifies general acquisition parameters of this frame. Only a single Item shall be permitted in this sequence. Inversion Recovery preparatory sequence. Enumerated Values: YES NO Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise. Times in ms after the middle of inverting RF pulse to middle of excitation pulse to detect the amount of longitudinal magnetization. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL and Inversion Recovery (0018,9009) equals YES. Otherwise may be present if Frame Type (0008,9007) Value 1 is DERIVED and Inversion Recovery (0018,9009) equals YES. Flow Compensation. Defined Terms: ACCELERATION VELOCITY OTHER NONE Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise. Flow Compensation Direction. Enumerated Values: PHASE FREQUENCY SLICE_SELECT SLICE_AND_FREQ SLICE_FREQ_PHASE PHASE_AND_FREQ SLICE_AND_PHASE OTHER Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL and Flow Compensation (0018,9010) equals other than NONE. Otherwise may be present if Frame Type (0008,9007) Value 1 is DERIVED and Flow Compensation (0018,9010) equals other than NONE. Spoiling. Enumerated Values: RF = RF spoiled GRADIENT = gradient spoiled RF_AND_GRADIENT NONE Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL and Echo Pulse Sequence (0018,9008) equals GRADIENT or BOTH. Otherwise may be present if Frame Type (0008,9007) Value 1 is DERIVED and Echo Pulse Sequence (0018,9008) equals GRADIENT or BOTH. T2 prepared Pulse Sequence. Enumerated Values: YES NO Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise. Spectrally Selected Excitation. Enumerated Values: WATER = water excitation FAT = fat excitation NONE Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise. Spatial Pre-saturation. Defined Terms: SLAB NONE Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise. Partial Fourier. Enumerated Values: YES NO Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise. Direction of Partial Fourier. Enumerated Values: PHASE FREQUENCY SLICE_SELECT COMBINATION Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL and Partial Fourier (0018,9081) equals YES. Otherwise may be present if Frame Type (0008,9007) Value 1 is DERIVED and Partial Fourier (0018,9081) equals YES. Parallel acquisition has been used to reduce measurement time. Enumerated Values: YES NO Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise. Parallel acquisition characteristics. Defined Terms: PILS SENSE SMASH OTHER Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL and Parallel Acquisition (0018,9077) equals YES. Otherwise may be present if Frame Type (0008,9007) Value 1 is DERIVED and Parallel Acquisition (0018,9077) equals YES. Measurement time reduction factor expressed as ratio of original and reduced measurement time for the in-plane direction. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL and Parallel Acquisition (0018,9077) equals YES. Otherwise may be present if Frame Type (0008,9007) Value 1 is DERIVED and Parallel Acquisition (0018,9077) equals YES. Measurement time reduction factor expressed as ratio of original and reduced measurement time for the out-of-plane direction Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL and Parallel Acquisition (0018,9077) equals YES. Otherwise may be present if Frame Type (0008,9007) Value 1 is DERIVED and Parallel Acquisition (0018,9077) equals YES. Measurement time reduction factor expressed as ratio of original and reduced measurement time for the second in-plane direction. Only required for MR Spectroscopy SOP Instances. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL and Parallel Acquisition (0018,9077) equals YES. Otherwise may be present if Frame Type (0008,9007) Value 1 is DERIVED and Parallel Acquisition (0018,9077) equals YES. Identifies sequence containing MR modifier Sequence Attributes. Only one item may be included in this sequence. Magnetization Transfer pulse sequence. Enumerated Values: ON_RESONANCE OFF_RESONANCE NONE Required if Frame Type (0008,9007) Value 1 is ORIGINAL. May be present otherwise. Blood Signal Nulling ("Black Blood") preparatory pulse sequence. Enumerated Values: YES NO Required if Frame Type (0008,9007) Value 1 is ORIGINAL. May be present otherwise. Tagging. Defined Terms: GRID LINE NONE Required if Frame Type (0008,9007) Value 1 is ORIGINAL. May be present otherwise. Space between lines in mm. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL and Tagging (0018,9028) is GRID or LINE. Otherwise may be present if Frame Type (0008,9007) Value 1 is DERIVED and Tagging (0018,9028) is GRID or LINE. Space between the lines in mm in the other direction. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL and Tagging (0018,9028) is GRID. Otherwise may be present if Frame Type (0008,9007) Value 1 is DERIVED and Tagging (0018,9028) is GRID. Angle of the tag lines relative to the rows axis (left to right) of the image, with a range of 0-180 degrees. The angle is increasing in clockwise direction. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL and Tagging (0018,9028) is GRID or LINE. Otherwise may be present if Frame Type (0008,9007) Value 1 is DERIVED and Tagging (0018,9028) is GRID or LINE. Angle of the tag lines relative to the rows axis (left to right) of the image, with a range of 0-180 degrees. The angle is increasing in clockwise direction. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL and Tagging (0018,9028) is GRID. Otherwise may be present if Frame Type (0008,9007) Value 1 is DERIVED and Tagging (0018,9028) is GRID. Thickness of the line in mm. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL and Tagging (0018,9028) is GRID or LINE. Otherwise may be present if Frame Type (0008,9007) Value 1 is DERIVED and Tagging (0018,9028) is GRID or LINE. Delay time in ms of the beginning of the application of the tagging pattern relative to the last R-peak. Center transmitter frequency in MHz. Required if Frame Type (0008,9007) Value 1 is ORIGINAL. May be present otherwise. Reciprocal of the effective sampling period, in hertz per pixel. Required if Frame Type (0008,9007) Value 1 is ORIGINAL. May be present otherwise. A sequence that provides information about each receive coil used. Only a single Item shall be permitted in this sequence. Name of receive coil used. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise. Name of manufacturer of receive coil. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise. Type of receive coil used. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise. Defined Terms: BODY VOLUME = head, extremity, etc. SURFACE MULTICOIL Indicates whether the receive coil is quadrature. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise. Enumerated Values: YES = quadrature or circularly polarized NO = linear A sequence that provides information regarding each element of a multi-coil. It should include attributes for all elements, whether used in the current acquisition or not. One or more Items shall be present. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL and Receive Coil Type (0018,9043) equals MULTICOIL. May be present otherwise only if Receive Coil Type (0018,9043) equals MULTICOIL. Name of element of multi-coil. Indicates whether the multi-coil element was used in the current acquisition. Enumerated Values: YES NO A textual description of the configuration of multi-coil elements which was used in the current acquisition. A sequence that provides information about the transmit coil used. Only a single Item shall be permitted in this sequence. Name of transmit coil used. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise. Name of manufacturer of transmit coil. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise. Type of transmit coil used. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise. Defined Terms: BODY VOLUME = head, extremity, etc. SURFACE Identifies the diffusion parameters of this frame. One Item shall be included in this sequence. Diffusion sensitization factor in sec/mm2. This is the actual b-value for original frames and those derived from frames with the same b-value, or the most representative b-value when derived from images with different b-values. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL and Diffusion b-matrix Sequence (0018,9601) is not present. May be present otherwise. Specifies whether diffusion conditions for the frame are directional, or isotropic with respect to direction. Defined Terms: DIRECTIONAL BMATRIX ISOTROPIC NONE = to be used when Frame Type (0008,9007) value 4 equals DIFFUSION_ANISO or Diffusion b-value (0018,9087) is 0 (zero). Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise. Sequence containing orientations of all diffusion sensitization gradients that were applied during the preparation phase for this frame. One or more Items may be present. Required if Diffusion Directionality (0018,9075) equals DIRECTIONAL The direction cosines of the diffusion gradient vector with respect to the patient Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise. The directional diffusion sensitization expressed as a 3x3 matrix with diagonal symmetry (with six unique elements from which the other elements can be derived). The rows and columns of the matrix are the X (right to left), Y (anterior to posterior) and Z (foot to head) patient-relative orthogonal axes as defined in C.7.6.2.1.1. The values are in units of ms/mm2. Exactly one Item shall be present. Required if Diffusion Directionality (0018,9075) equals BMATRIX. The value of b[X,X]. The value of b[X,Y]. The value of b[X,Z]. The value of b[Y,Y]. The value of b[Y,Z]. The value of b[Z,Z]. Class of diffusion anisotropy calculation. Defined Terms: FRACTIONAL RELATIVE VOLUME_RATIO Required if Frame Type (0008,9007) value 4 equals DIFFUSION_ANISO. Identifies the averaging parameters of this frame. Only a single Item shall be permitted in this sequence. Maximum number of times any point in k-space is acquired. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise. A sequence that provides the position of spatial saturation bands deposited as part of the pulse sequence. Zero or more Items may be included in this sequence. Thickness of slab in mm. The direction cosines of a normal vector perpendicular to the saturation plane with respect to the patient. See C.7.6.2.1.1 for further explanation.

The x, y, and z coordinates of the midpoint of the slab plane in mm with respect to the patient. See C.7.6.2.1.1 for further explanation.

Describes the chemical shift parameters used to measure the resonant peaks from which the MR metabolite map represented by this frame was derived. Only a single Item shall be permitted in this sequence. Text describing the Metabolite Map. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise. When the measured peaks or their ratios can be related to metabolite substances, this sequence may be used to describe the metabolite substance whose resonant peaks are mapped in the Metabolite Map, or the ratio of substance resonant peaks that is mapped. Only one item shall be present in this Sequence. The list of frequencies that were used to create the Metabolite Map. One or more Items may be included in this sequence. Minimal value of Chemical Shift Frequency in ppm. Maximum value of Chemical Shift Frequency in ppm. Identifies the velocity encoding of this frame. Only a single Item shall be permitted in this sequence. The direction cosines of the velocity encoding vector with respect to the patient. See C.7.6.2.1.1 for further explanation. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise.

Minimum velocity in cm/s. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise. Maximum velocity in cm/s. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise. Type of equipment that originally acquired the data used to create the images in this Series. Enumerated Values: MR See section C.7.3.1.1.1 for further explanation. Uniquely identifies the Performed Procedure Step SOP Instance to which the Series is related (e.g. a Modality or General-Purpose Performed Procedure Step SOP Instance). The Sequence shall have one Item. Required if the Modality Performed Procedure Step SOP Class , General Purpose Performed Procedure Step SOP Class is supported. Spectroscopy data characteristics. See C.8.14.5.1.1.

The Image Type (0008,0008) and Frame Type (0008,9007) are not included in this Macro but one or the other is always included in the Module or Macro that invokes this Macro, and they are therefore described here. In addition to the requirements specified in C.8.16.1 Image Type and Frame Type, the following additional requirements and Defined Terms are specified.

Precession frequency in MHz of the nucleus being addressed for each spectral axis. See section C.8.14.1.1 for further explanation of the ordering. Required if Image Type (0008,0008) Value 1 is ORIGINAL. May be present otherwise. Spectral width in Hz. See section C.8.14.1.1 for further explanation of the ordering. Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise. The chemical shift at the transmitter frequency in ppm. See section C.8.14.1.1 for further explanation of the ordering. Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise. Name of volume localization technique used. Shall be "NONE" if no spatial localization was performed. Defined Terms: ILOPS ISIS PRIME PRESS SLIM SLOOP STEAM NONE Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise. A sequence of one or more Items that provide the position of RF excitations used to select a volume of tissue. The selected volume is described by the intersection of the sequence Items. Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED and Volume Localization Technique (0018,9054) is other than NONE. May be present if Volume Localization Technique (0018,9054) is other than NONE. Thickness of slab in mm. The direction cosines of a normal vector perpendicular to the selection plane with respect to the patient. See C.7.6.2.1.1 for further explanation.

The x, y, and z coordinates of the mid-point of the slab in mm. See C.7.6.2.1.1 for further explanation.

Indicates whether de-coupling was active. Enumerated Values: YES NO Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise. Nucleus being de-coupled. Defined Terms: 1H 3HE 7LI 13C 19F 23NA 31P 129XE See section C.8.14.1.1 for further explanation of the ordering. Required if De-coupling (0018,9059) equals YES. The center frequency (Hz) for the de-coupling. See section C.8.14.1.1 for further explanation of the ordering. Required if De-coupling (0018,9059) equals YES. The de-coupling modulation scheme used. Defined Terms: MLEV WALTZ NARROWBAND Required if De-coupling (0018,9059) equals YES. The chemical shift in ppm at the de-coupling frequency. See section C.8.14.1.1 for further explanation of the ordering. Required if De-coupling (0018,9059) equals YES. Describes time domain filtering or apodization applied. Shall be NONE if no filtering operations were applied to the time domain data. Defined Terms: COSINE COSINE_SQUARED EXPONENTIAL GAUSSIAN HAMMING HANNING LORENTZIAN LRNTZ_GSS_TRNSFM NONE See section C.8.14.1.1 for further explanation of the ordering. Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise. Number of zero fills added to the time domain data before FT. Shall be 0 (zero) if no zero filling performed. See section C.8.14.1.1 for further explanation of the ordering. Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise. Describes baseline correction techniques. Shall be NONE if no baseline correction was performed. Defined Terms: LINEAR_TILT LOCAL_LINEAR_FIT POLYNOMIAL_FIT SINC_DECONVOLUTN TIME_DOMAIN_FIT SPLINE NONE Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise. Specifies whether operations were performed to correct resonant frequency of metabolite peaks due to B0 field inhomogeneities. Enumerated Values: YES NO Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise. Describes whether a first order (frequency dependent) phase correction was applied to the spectral data. Enumerated Values: YES NO Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise. Enumerated Values: YES NO Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise. Name of the pulse sequence for annotation purposes. Potentially vendor-specific name. Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise. Identification of data encoding scheme. Defined Terms: SINGLE_VOXEL ROW PLANE VOLUME Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise. Echo category of pulse sequences. Enumerated Values: SPIN GRADIENT BOTH Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise. Multiple Spin Echo category of pulse sequence used to collect different lines in k-space for a single frame. Enumerated Values: YES NO Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED and Echo Pulse Sequence (0018,9008) equals SPIN or BOTH. Otherwise may be present if Image Type (0008,0008) Value 1 is DERIVED and Echo Pulse Sequence (0018,9008) equals SPIN or BOTH. Technique that simultaneously excites several volumes. Enumerated Values: YES NO Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise. Steady State Sequence. Defined Terms: FREE_PRECESSION TRANSVERSE TIME_REVERSED LONGITUDINAL NONE Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise. Echo Planar category of pulse-sequences. Enumerated Values: YES NO Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise. Spectrally Selected Suppression. Defined Terms: WATER FAT FAT_AND_WATER SILICON_GEL NONE Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise. Geometry category of k-Space traversal. Defined Terms: RECTILINEAR RADIAL SPIRAL Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise. Rectilinear phase encode reordering. Defined Terms: LINEAR CENTRIC SEGMENTED REVERSE_LINEAR REVERSE_CENTRIC Required if Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED and Geometry of k-Space Traversal (0018,9032) equals RECTILINEAR. Otherwise may be present if Image Type (0008,0008) Value 1 is DERIVED and Geometry of k-Space Traversal (0018,9032) equals RECTILINEAR. Segmented k-Space traversal. If Geometry of k-Space Traversal is rectilinear, multiple lines can be acquired at one time. If Geometry of k-Space Traversal is spiral or radial, paths can be interleaved and acquired at one time. Enumerated Values: SINGLE = successive single echo coverage PARTIAL = segmented coverage FULL = single shot full coverage Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise. Coverage of k-Space. Defined Terms: FULL CYLINDRICAL ELLIPSOIDAL WEIGHTED Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED and MR Spectroscopy Acquisition Type (0018,9200) equals VOLUME. Otherwise may be present if Image Type (0008,0008) Value 1 is DERIVED and MR Spectroscopy Acquisition Type (0018,9200) equals VOLUME. Number of interleaves or shots. Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise. Identifies sequence containing Frame Type Attributes. Only a single Item shall be permitted in this sequence. Spectroscopy data characteristics. See C.8.14.5.1.1.

Identifies the geometry parameters of this frame. Only a single Item shall be permitted in this sequence. Number of data points in the columns direction. Required if Frame Type (0008,9007) Value 1 is ORIGINAL. May be present otherwise. Number of Phase Encoding Rows. Required if Frame Type (0008,9007) Value 1 is ORIGINAL. May be present otherwise. Number of Phase Encoding Columns. Required if Frame Type (0008,9007) Value 1 is ORIGINAL. May be present otherwise. Number of out-of-plane Phase Encoding steps. Required if MR Spectroscopy Acquisition Type (0018,9200) equals PLANE and Frame Type (0008,9007) Value 1 is ORIGINAL. May be present otherwise. Fraction of acquisition matrix lines acquired, expressed as a percent. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise. Ratio of field of view dimension in phase direction to field of view dimension in frequency direction, expressed as a percent. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise. Number of voxels in the vertical direction in the frame. Number of voxels in the horizontal direction in the frame. Number of rows of data points in spectroscopic data. Number of columns of data points in spectroscopic data. Data representation of the data points. Each data point shall have the same representation. Enumerated Values: COMPLEX = Data is complex pair REAL = Data contains only real component IMAGINARY = Data contains only imaginary component MAGNITUDE = Magnitude data Domain of represented signal in column direction. Enumerated Values: FREQUENCY TIME Domain of represented signal in row direction. Enumerated Values: FREQUENCY TIME Required if Data Point Rows (0028,9001) has a value of more than 1. First Order Phase Correction Angle. Number of values is determined by Row  Column  Number of Frames. Required if First Order Phase Correction (0018,9198) equals YES A data stream of the signal intensities that comprise the spectroscopic data. See C.8.14.4.1 for further explanation.

The Spectroscopy Data attribute (5600,0020) contains the Signal intensities for the spectra. The order of voxels sent for each spectral plane is left to right, top to bottom, i.e., the upper left voxel (labeled 1,1) is sent first followed by the remainder of row 1, followed by the first voxel of row 2 (labeled 2,1) then the remainder of row 2 and so on. Each "voxel" represents an entire spectrum. The complete spectral data from each voxel is sent, followed by the spectral data from the next voxel position. The number of voxels on each frame are described by Rows (0028,0010) and Columns (0028,0011). The number of frames is described by Number of Frames (0028,0008). The frames may represent different locations in a 3D acquisition, or the same position at a different point of time, or a difference of some other combination of attributes. Note: Either Rows or Columns or both may have a value of 1 (e.g., for single voxel spectroscopy). A value of zero for the corresponding value of Pixel Spacing in the Pixel Measures Macro is permitted under these circumstances. See 10.7.1.3. The spectral data points are ordered from lower effective magnetic field strength (down-field) to higher effective magnetic field strength (up-field) when the Signal Domain Columns (0028,9003) or Signal Domain Rows (0028,9235) attributes contain the value FREQUENCY and from first sample acquired to last sample acquired when the Signal Domain Columns (0028,9003) or Signal Domain Rows (0028,9235) attributes contain the value TIME. For two-dimensional spectral acquisitions, the ordering is such that all data points from a row (corresponding to all data points acquired in an individual sampling period), are followed by all data points from the successive sampling period. Following all data of the rows from a given voxel position, the data from the subsequent voxel position are sent. The axis parallel to the row direction corresponds to the sampling time axis. The axis parallel to the column direction corresponds to the evolution time axis. The dimensions of each spectrum that make up a voxel are described by Data Point Rows (0028,9001) and Data Point Columns (0028,9002). In the case of 1D spectra, the number of Data Point Rows shall be 1. For a Data Representation (0028,9108) value of COMPLEX, the order of data points is real channel followed by imaginary channel for each spectral data point. For the other Data Representation values (REAL, IMAGINARY and MAGNITUDE), each spectral data point contains only a single value. The Figure C.8-18 depicts 6 frames each made up of 4 rows and 4 columns of voxels. Specific values for Data Point Rows (0028,9001) and Data Point Columns (0028,9002) of these voxels are not depicted.

Indication if geometric manipulations are possible with frames in the SOP Instance. See C.8.14.5.1.2 for a description and Enumerated Values.

See C.8.16.2.1.2. No additional requirements or Defined Terms.

Method used for volume calculations with frames in the SOP Instance. See C.8.14.5.1.3 for a description and Defined Terms.

See C.8.16.2.1.3 for requirements, but not Defined Terms. Table C.8-110 specifies the Defined Terms for the Volume Based Calculation Technique (0008,9207) attribute. Table C.8-110 VOLUME BASED CALCULATION TECHNIQUE ATTRIBUTE VALUES

Representation of complex data of frames in the SOP Instance. See C.8.14.5.1.4 for a description and Defined Terms.

The value of the Complex Image Component attribute (0008,9208) shall be used to indicate which component of the complex representation of the signal is represented in the spectroscopy data. Table C.8-111 specifies the Defined Terms for Complex Image Component attribute (0008,9208). Table C.8-111 COMPLEX IMAGE COMPONENT ATTRIBUTE VALUES

Indication of acquisition contrast used with frames in the SOP Instance. See C.8.14.5.1.5 for a description and Defined Terms.

Table C.8-112 specifies the Defined Terms for Acquisition Contrast attribute (0008,9209). Table C.8-112 ACQUISITION CONTRAST VALUES

Type of equipment that originally acquired the data used to create the images in this Series. Enumerated Values: CT See section C.7.3.1.1.1 for further explanation. Uniquely identifies the Performed Procedure Step SOP Instance to which the Series is related (e.g. a Modality or General-Purpose Performed Procedure Step SOP Instance). The Sequence shall have one Item. Required if the Modality Performed Procedure Step SOP Class , General Purpose Performed Procedure Step SOP Class is supported. Image characteristics. See sections C.8.16.1 and C.8.15.2.1.1. A number identifying the single continuous gathering of data over a period of time that resulted in this image. Note: This number is not required to be unique across SOP Instances in a series. See also the description of the Referenced Raw Data Sequence (0008,9121). The date and time that the acquisition of data started. Notes: 1. The synchronization of this time with an external clock is specified in the synchronization Module in Acquisition Time synchronized (0018,1800) . 2. See C.7.6.16.2.2.1 for an overview of all acquisition related timing attributes. Required if Image Type (0008,0008) Value 1 of this frame is ORIGINAL or MIXED, may be present otherwise.

Figure C.7.6.16-2 shows the relationships among the various timing parameters used.

The time in seconds needed to complete the acquisition of data. See C.7.6.16.2.2.1 for further explanation. Required if Image Type (0008,0008) Value 1 of this frame is ORIGINAL or MIXED, may be present otherwise.

Figure C.7.6.16-2 shows the relationships among the various timing parameters used.

A sequence that identifies the set of Raw Data SOP Class/Instance pairs of the Raw data that were used to derive this Image. One or more Items may be included 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 in different instances have been reconstructed from the same raw data. 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 may be included in this sequence. Full set of Composite SOP Instances referring to image SOP Instances inside the frames of this Enhanced CT Image SOP Instance. See C.8.13.2.1.2 for further explanation. One or more Items may be included in this sequence. Required if the Referenced Image Sequence (0008,1140) is present.

Full set of Composite SOP Instances used as source image SOP Instances inside the frames of this Enhanced CT Image SOP Instance. See C.8.13.2.1.2 for further explanation. One or more Items may be included in this sequence. Required if the Source Image Sequence (0008,2112) is present.

References to Grayscale Presentation State instances acquired in conjunction with this instance. Note: May only be used to reference Presentation States belonging to the acquired data and not to reference Presentation States generated subsequently such as during interpretation. One or more Items may be included in this sequence. Required if Presentation State is generated during acquisition, shall not be present otherwise. Number of samples (planes) in this image. This value shall be 1. Specifies the intended interpretation of the pixel data. Enumerated Value: MONOCHROME2. See C.7.6.3.1.2 for definition of this term.

Number of bits allocated for each pixel sample. Each sample shall have the same number of bits allocated. This value shall be 16. Number of bits stored for each pixel sample. Each sample shall have the same number of bits stored. This value shall be 12 or16. Most significant bit for pixel sample data. Each sample shall have the same high bit. Shall be one less than the value in Bits Stored (0028,0101). Content Qualification Indicator Enumerated Values: PRODUCT RESEARCH SERVICE See C.8.13.2.1.1 for further explanation.

User-defined comments about the image Indicates whether or not the image contains sufficient burned in annotation to identify the patient and date the image was acquired. Enumerated Values: NO This means that images that contain this Module shall not contain such burned in annotations. Specifies whether an Image has undergone lossy compression. Enumerated Values: 00 = Image has NOT been subjected to lossy compression. 01 = Image has been subjected to lossy compression. See C.7.6.1.1.5 for further explanation.

Specifies an identity transformation for the Presentation LUT, such that the output of all grayscale transformations defined in the IOD containing this Module are defined to be P-Values. Enumerated Values: IDENTITY - output is in P-Values. This icon image is representative of the Image. Only a single Item shall be permitted in this Sequence. Identifies the characteristics of this frame. Only a single Item shall be permitted in this sequence. Type of Frame. A multi-valued attribute analogous to the Image Type (0008,0008). Enumerated Values and Defined Terms are the same as those for the four values of the Image Type (0008,0008) attribute, except that the value MIXED is not allowed. See sections C.8.16.1 and C.8.15.2.1.1.1. Contains the attributes defining the CT acquisition mode. Only a single Item shall be permitted in this sequence. Description of the method used during acquisition of this frame. See C.8.15.3.2.1 for Defined Terms. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise.

Acquisition Type (0018,9302) has the following Defined Terms: SEQUENCED identifies that the acquisition was performed by acquiring single or multi detector data while rotating the source about the gantry while the table is not moving. Additional slices are acquired by incrementing the table position and again rotating the source about the gantry while the table is not moving. SPIRAL identifies that the acquisition was performed by acquiring data while rotating the source about the gantry while continuously moving the table. CONSTANT_ANGLE identifies that the acquisition was performed by holding the source at a constant angle and moving the table to obtain a projection image (e.g., a localizer image). STATIONARY identifies that the acquisition was performed by holding the table at a constant position and acquiring multiple slices over time at the same location. FREE identifies that the acquisition was performed while rotating the source about the gantry while the table movement is under direct control of a human operator or under the control of an analysis application (e.g., fluoroscopic image).

The constant angle at which the x-ray source is located during acquisition. 0 degrees means that the source is located at the highest point of the gantry orbit. Degrees increase from 0 to positive 360 in a clockwise direction as viewed when facing the gantry where the table enters the gantry. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL and Acquisition Type (0018,9302) is CONSTANT_ANGLE. May be present otherwise if Frame Type (0008,9007) Value 1 of this frame is DERIVED and Acquisition Type (0018,9302) is CONSTANT_ANGLE. Identifies that the acquisition was performed by repetitively acquiring the same volume set over a period of time. Note: The Acquisition Type (0018,9302) value may be SEQUENCED, SPIRAL or STATIONARY depending on whether table movement is necessary to cover the volume. Enumerated Values YES NO Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise. Identifies that near real-time display of a block of continuously acquired data was performed, which may result in a lower than usual image quality. Enumerated Values YES NO Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise. Contains the attributes defining the details of the acquisition. Only a single Item shall be permitted in this sequence. Direction of rotation of the source about the gantry, as viewed while facing the gantry where the table enters the gantry. Enumerated Values: CW = clockwise CC = counter clockwise Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL and Acquisition Type (0018,9302) is other than CONSTANT_ANGLE. Otherwise may be present if Frame Type (0008,9007) Value 1 of this frame is DERIVED and Acquisition Type (0018,9302) is other than CONSTANT_ANGLE. The time in seconds of a complete revolution of the source around the gantry orbit. This value is independent of the Reconstruction Angle (0018,9319) of the frame. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL and Acquisition Type (0018,9302) is other than CONSTANT_ANGLE. Otherwise may be present if Frame Type (0008,9007) Value 1 of this frame is DERIVED and Acquisition Type (0018,9302) is other than CONSTANT_ANGLE. The width of a single row of acquired data (in mm). Note: Adjacent physical detector rows may have been combined to form a single effective acquisition row. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise. The width of the total collimation (in mm) over the area of active x-ray detection. Note: This will be equal to the number of effective detector rows multiplied by single collimation width. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise. The distance in mm from the top of the patient table to the center of rotation of the source (i.e. the data collection center or isocenter). The distance is positive when the table is below the data collection center. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise. Nominal angle of tilt in degrees of the scanning gantry. Not intended for mathematical computations. Zero degrees means the gantry is not tilted, negative degrees are when the top of the gantry is tilted away from where the table enters the gantry. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise. The diameter in mm of the region over which data were collected. See C.8.15.3.6.1. Note: In the case of an Acquisition Type (0018,9302) of CONSTANT_ANGLE, the diameter is that in a plane normal to the central ray of the diverging X-Ray beam as it passes through the data collection center. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise.

Contains the attributes defining the movement of the CT table. Only a single Item shall be permitted in this sequence. The distance in mm that the table moves in one second during the gathering of data that resulted in this frame. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL and Acquisition Type (0018,9302) is SPIRAL or CONSTANT_ANGLE. May be present otherwise if Frame Type (0008,9007) Value 1 of this frame is DERIVED and Acquisition Type (0018,9302) is SPIRAL or CONSTANT_ANGLE. Motion of the table (in mm) during a complete revolution of the source around the gantry orbit. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL and Acquisition Type (0018,9302) is SPIRAL. May be present otherwise if Frame Type (0008,9007) Value 1 of this frame is DERIVED and Acquisition Type (0018,9302) is SPIRAL. Ratio of the Table Feed per Rotation (0018,9310) to the Total Collimation Width (0018,9307). See C.8.15.3.4.1 for further explanation and some examples. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL and Acquisition Type (0018,9302) is SPIRAL. May be present otherwise if Frame Type (0008,9007) Value 1 of this frame is DERIVED and Acquisition Type (0018,9302) is SPIRAL.

The formula for Spiral Pitch Factor (0018,9311) in terms of Table Feed per Rotation (0018,9310) and Total Collimation Width (0018,9307) is: Spiral Pitch Factor = (Table Feed per Rotation (mm))/(Total Collimation Width (mm)) An example calculation of Spiral Pitch Factor (0018,9311) for a single slice spiral acquisition of an image with a Total Collimation Width of 2.5mm and a Table Feed per Rotation of 10mm is: Spiral Pitch Factor = (10 mm)/(2.5 mm) = 4.0 An example calculation of Spiral Pitch Factor (0018,9311) for a multiple slice spiral acquisition having a Total Collimation Width of 20mm and a Table Feed per Rotation of 10mm is: Spiral Pitch Factor = (10 mm)/(20 mm) = 0.5

Contains the attributes defining the CT geometry. Only a single Item shall be permitted in this sequence. Relative longitudinal position of acquisition location of this frame in mm from an implementation specific reference point. Shall be relative to the same reference point for all frames in this SOP Instance, but may be different from the reference point in other SOP Instances. Positions as the table moves into the gantry viewed from the front are more negative. Notes: 1. For contiguous slices reconstructed from multiple detectors one would expect different values for adjacent slices. 2. Lateral positioning or tilting or swiveling are not described. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise. The x, y, and z coordinates (in the patient coordinate system) in mm of the center of the region in which data were collected. See C.8.15.3.6.1. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise.

The x, y, and z coordinates (in the patient coordinate system) of the reconstruction center target point as used for reconstruction in mm. See C.8.15.3.6.1. Note: If the reconstructed image is not magnified or panned the value corresponds with the Data Collection Center (0018,9313) attribute. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise.

Contains the attributes defining the CT geometry. Only a single Item shall be permitted in this sequence. Distance in mm from source to detector center. See C.8.15.3.6.1. Note: This value is traditionally referred to as Source Image Receptor Distance (SID). Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise.

Distance in mm from source to data collection center. See C.8.15.3.6.1. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise.

Contains the attributes holding information about the reconstruction techniques used. Only a single Item shall be permitted in this sequence. Description of the algorithm used when reconstructing the image from the data acquired during the acquisition process. Defined Terms: FILTER_BACK_PROJ ITERATIVE Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise. A label describing the convolution kernel or algorithm used to reconstruct the data. A single value shall be present. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise. A label describing the group that the Convolution Kernel (0018,1210) belongs. Defined Terms: BRAIN SOFT_TISSUE LUNG BONE CONSTANT_ANGLE Required if Convolution Kernel (0018,1210) is present. May be present otherwise. The diameter in mm of the region from which data were used in creating the reconstruction of the image. Data may exist outside this region and portions of the patient may exist outside this region. See C.8.15.3.6.1. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL and Reconstruction Field of View (0018,9317) is not present. Otherwise may be present if Frame Type (0008,9007) Value 1 of this frame is DERIVED and Reconstruction Field of View (0018,9317) is not present.

The field of view width (x-dimension) followed by height (y-dimension) as used for reconstruction in mm. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL and Reconstruction Diameter (0018,1100) is not present. Otherwise may be present if Frame Type (0008,9007) Value 1 of this frame is DERIVED and Reconstruction Diameter (0018,1100) is not present. Physical distance in the patient between the center of each reconstructed pixel, specified by a numeric pair - adjacent row spacing (delimiter) adjacent column spacing in mm. See 10.7.1.3 for further explanation of the value order. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise. Angle (in degrees) over which the data from which the frame was reconstructed was collected, where 360 degrees signifies a complete revolution of the source around the gantry orbit. It is possible, in the case of over-scanning that the Reconstruction Angle is greater than 360 degrees. Shall be 0 if Acquisition Type (0018,9302) is CONSTANT_ANGLE. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise. A label describing the filter applied to the reconstructed image after the original reconstruction has been completed. Note: When Frame Type (0008,9007) Value 1 of this frame is DERIVED and Frame Type (0008,9007) Value 4 is FILTERED the type of filtration is described in Derivation Image Macro. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. Contains the attributes defining exposure information. Only a single Item shall be permitted in this sequence. Duration of exposure for this frame in milliseconds. If Acquisition Type (0018,9302) equals SPIRAL the duration of exposure shall be weighted by the Spiral Pitch Factor (0018,9311). Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise. Nominal X-Ray tube current in milliamperes. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise. The exposure expressed in milliampere seconds, for example calculated from exposure time and X-Ray tube current. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise. A label describing the type of exposure modulation used for the purpose of limiting the dose. Defined Terms: NONE Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise. A percent value of dose saving due to the use of Exposure Modulation Type (0018,9323). A negative percent value of dose savings reflects an increase of exposure. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL and Exposure Modulation Type (0018,9323) is not equal to NONE. Otherwise may be present if Frame Type (0008,9007) Value 1 of this frame is DERIVED and Exposure Modulation Type (0018,9323) is not equal to NONE. Computed Tomography Dose Index (CTDIvol), in mGy according to IEC 60601-2-44, Ed.2.1 (Clause 29.1.103.4), The Volume CTDIvol. It describes the average dose for this frame for the selected CT conditions of operation. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise. The type of phantom used for CTDI measurement according to IEC 60601-2-44. Only a single Item shall be permitted in this Sequence. Contains the attributes defining the x-ray information. Only a single Item shall be permitted in this sequence. Peak kilo voltage output of the x-ray generator used. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise. Used nominal size of the focal spot in mm. The attribute may only have one or two values, for devices with variable focal spot, small dimension followed by large dimension Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise. Type of filter(s) inserted into the X-Ray beam. Defined Terms: WEDGE BUTTERFLY MULTIPLE FLAT SHAPED NONE Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise. The X-Ray absorbing material used in the filter. May be multi-valued. Defined Terms: MOLYBDENUM ALUMINUM COPPER RHODIUM NIOBIUM EUROPIUM LEAD MIXED Note: MIXED may be used to indicate a filter type of complex composition for which listing the individual materials would be excessive or undesirable; it is not intended to mean "unknown". Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL and the value of Filter Type (0018,1160) is other than NONE. May be present otherwise. The calibration factor for the calcium mass score. These factors incorporate the effects of See C.8.2.1.1.7.

Contains the attributes involved in the transformation of stored pixel values. Only a single Item shall be permitted in this sequence. The value b in relationship between stored values (SV) and the output units. Output units = m*SV + b. m in the equation specified by Rescale Intercept (0028,1052). Specifies the output units of Rescale Slope (0028,1053) and Rescale Intercept (0028,1052). See C.11.1.1.2 for further explanation. If Frame Type (0008,9007) Value 1 of this frame is ORIGINAL and Frame Type (0008,9007) Value 3 is not LOCALIZER, the value shall be HU (Hounsfield Units).

Contains the attributes defining the data acquisition in a multiple X-Ray source system beyond the primary source. The primary X-Ray source is specified in the CT X-Ray Details Sequence. One or more items may be present. Peak kilo voltage output of the X-Ray generator used. Nominal X-Ray tube current in milliamperes. The diameter in mm of the region over which data were collected. Used nominal size of the focal spot in mm. Type of filter(s) inserted into the X-Ray beam. The X-Ray absorbing material used in the filter. Indication of the presence or absence of color information that may be used during rendering. See C.8.16.2.1.1 for a description and Enumerated Values.

Table C.8-132 PIXEL PRESENTATION ATTRIBUTE VALUES

Indication if geometric manipulations are possible with frames in the SOP Instance. See C.8.16.2.1.2 for a description and Enumerated Values.

The value of the Volumetric Properties attribute (0008,9206) allows applications doing geometric manipulations (e.g., MAX_IP or MPR or planning) to determine if the image is an appropriate candidate for an operation without having to know all the details of the generating application. Table C.8-133 specifies the Enumerated Values for the Volumetric Properties (0008,9206) attribute. Table C.8-133 VOLUMETRIC PROPERTIES ATTRIBUTE VALUES

Method used for volume calculations with frames in the SOP Instance. See C.8.16.2.1.3 for a description and Defined Terms.

The value of the Volume Based Calculation Technique attribute (0008,9207) shall be used to indicate the method used for calculating pixels based on geometry. Shall have a value of NONE when Value 1 of Image Type (0008,0008) or Value 1 of Frame Type (0008,9007) is ORIGINAL. Table C.8-134 specifies the Defined Terms for the Volume Based Calculation Technique (0008,9207) attribute. Table C.8-134 VOLUME BASED CALCULATION TECHNIQUE ATTRIBUTE VALUES

Source equipment that produced the Ophthalmic Photography Series. Enumerated Value: OP Image identification characteristics. See C.8.17.2.1.4 for specialization.

The Image Type attribute (0008,0008) (General Image Module, C.7.6.1) identifies important image characteristics in a multiple valued data element. For the Ophthalmic Photography Image IOD, Image Type is specified as a Type 1 attribute and further specialized as follows: a. Value 1 shall identify the Pixel Data Characteristics in accordance with Section C.7.6.1.1.2; Enumerated Values are: ORIGINAL and DERIVED;

A number that identifies this image. Number of samples (planes) in this image. Enumerated values: 1 or 3. See C.8.17.2.1.2 for further explanation.

Samples per Pixel (0028,0002) shall be 1 or 3. Cameras producing 2-color images are required to use a value of 3 for Samples per Pixel (0028,0002) and a value of 2 for Samples per Pixel Used (0028,0003). For 2-color images with a RGB Photometric Interpretation, the R and G channel shall be used and the B channel shall have all values set to zero. Note: In the case of Photometric Interpretations typically used for compression such as YBR_FULL_422, the encoding will be as if the RGB values were transformed to YCbCr.

The number of samples (planes) containing information. Enumerated value: 2. Required if different from Samples per Pixel (0028,0002). See section C.8.17.2.1.2 Specifies the intended interpretation of the pixel data. See section C.8.17.2.1.3 Data representation of the pixel samples. Enumerated value: 0 Indicates whether the pixel data are sent color-by-plane or color-by-pixel. Required if Samples per Pixel (0028,0002) has a value greater than 1. Enumerated value shall be 0 (color-by-pixel). Nominal physical distance at the focal plane (in the retina) between the center of each pixel, specified by a numeric pair - adjacent row spacing (delimiter) adjacent column spacing in mm. See 10.7.1.3 for further explanation of the value order. Note: These values are specified as nominal because the physical distance may vary across the field of the images and the lens correction is likely to be imperfect. Required when Acquisition Device Type Code Sequence (0022,0015) contains an item with the value (SRT, R-1021A,"Fundus Camera"). May be present otherwise. The time the image pixel data creation started. The date the image pixel data creation started. The date and time that the acquisition of data started. Note: The synchronization of this time with an external clock is specified in the synchronization Module in Acquisition Time Synchronized (0018,1800). Required if Image Type (0008,0008) Value 1 is ORIGINAL. May be present otherwise. A Sequence that identifies the Images that were used to derive this Image. Required if Image Type Value 1 is DERIVED. Zero or more items may be present in the sequence. See C.7.6.1.1.4 for further explanation.

Describes the purpose for which the reference is made, that is what role the source image or frame(s) played in the derivation of this image. Only a single Item shall be permitted in this sequence. Specifies whether an Image has undergone lossy compression. Enumerated Values: 00 = Image has NOT been subjected to lossy compression. 01 = Image has been subjected to lossy compression. See C.7.6.1.1.5

Describes the approximate lossy compression ratio(s) that have been applied to this image. See C.7.6.1.1.5 for further explanation. May be multivalued if successive lossy compression steps have been applied. Notes: 1. For example, a compression ratio of 30:1 would be described in this Attribute with a single value of 30. 2. For historical reasons, the lossy compression ratio should also be described in Derivation Description (0008,2111) Required if Lossy Image Compression (0028,2110) has a value of "01".

A label for the lossy compression method(s) that have been applied to this image. See C.7.6.1.1.5 for further explanation. May be multivalued if successive lossy compression steps have been applied; the value order shall correspond to the values of Lossy Image Compression Ratio (0028,2112). Required if Lossy Image Compression (0028,2110) has a value of "01". Note: For historical reasons, the lossy compression method should also be described in Derivation Description (0008,2111).

Specifies an identity transformation for the Presentation LUT, such that the output of all grayscale transformations defined in the IOD containing this Module are defined to be P-Values. Enumerated Values: IDENTITY - output is in P-Values. Required if Photometric Interpretation (0028,0004) is MONOCHROME2 Indicates whether a reference object (phantom) of known size is present in the image and was used for calibration. Enumerated Values: YES NO Indicates whether or not image contains sufficient burned in annotation to identify the patient and date the image was acquired. Enumerated Value: YES NO Enumerated Values: YES NO Coded value for patient movement or orientation, which is the intent, and not necessarily the result, based on what the patient is capable of. Required if the value of Patient Eye Movement Commanded (0022,0005) is YES. A single item shall be present in this sequence. Laterality of object imaged (as described in Anatomic Region Sequence (0008,2218)) examined. Enumerated Values: R = right eye L = left eye B = both left and right eye Shall be consistent with any laterality information contained in Primary Anatomic Structure Modifier Sequence (0008,2230), if present. Note: Laterality (0020,0060) is a Series level Attribute and must be the same for all Images in the Series. Since most Ophthalmic Photographic Image studies contain images of both eyes, the series level attribute will rarely be present. The position of this image on the retina (as defined by a specified nomenclature; the nomenclature is implicit in the code used). Only a single Item shall be permitted in this sequence. Type of equipment that originally acquired the data used to create the images in this Series. Enumerated Values: OPT See section C.7.3.1.1.1 for further explanation. A number that identifies this Series. Uniquely identifies the Performed Procedure Step SOP Instance to which the Series is related (e.g. a Modality or General-Purpose Performed Procedure Step SOP Instance). The Sequence shall have one Item. Required if the Modality Performed Procedure Step SOP Class or General Purpose Performed Procedure Step SOP Class is supported. Image identification characteristics. Number of samples (planes) in this image. See C.7.6.3.1.1 for further explanation. Value shall be 1.

Samples per Pixel (0028,0002) is the number of separate planes in this image. One, three, and four image planes are defined. Other numbers of image planes are allowed, but their meaning is not defined by this Standard. For monochrome (gray scale) and palette color images, the number of planes is 1. For RGB and other three vector color models, the value of this attribute is 3. For four vector color models, the value of this attribute is 4. All image planes shall have the same number of Rows (0028,0010), Columns (0028,0011), Bits Allocated (0028,0100), Bits Stored (0028,0101), High Bit (0028,0102), Pixel Representation (0028,0103), and Pixel Aspect Ratio (0028,0034). The data in each pixel may be represented as a “Composite Pixel Code”. If Samples Per Pixel is one, the Composite Pixel Code is just the “n” bit pixel sample, where “n” = Bits Allocated. If Samples Per Pixel is greater than one, Composite Pixel Code is a “k” bit concatenation of samples, where “k” = Bits Allocated multiplied by Samples Per Pixel, and with the sample representing the vector color designated first in the Photometric Interpretation name comprising the most significant bits of the Composite Pixel Code, followed in order by the samples representing the next vector colors, with the sample representing the vector color designated last in the Photometric Interpretation name comprising the least significant bits of the Composite Pixel Code. For example, for Photometric Interpretation = “RGB”, the most significant “Bits Allocated” bits contain the Red sample, the next “Bits Allocated” bits contain the Green sample, and the least significant “Bits Allocated” bits contain the Blue sample.

The date and time that the acquisition of data started. Note: The synchronization of this time with an external clock is specified in the synchronization Module in Acquisition Time synchronized (0018,1800) . The scan time in seconds used to create all frames of an Ophthalmic Tomography image. Required if Image Type (0008,0008) Value 1 is ORIGINAL. May be present otherwise. A number identifying the single continuous gathering of data over a period of time which resulted in this image. Specifies the intended interpretation of the pixel data. Enumerated Value shall be: MONOCHROME2 Data representation of pixel samples. Enumerated Value shall be 0. Number of bits allocated for each pixel sample. Each sample shall have the same number of bits allocated. Bits Allocated (0028,0100) shall be 8 or 16 Number of bits stored for each pixel sample. Each sample shall have the same number of bits stored. Bits Stored (0028,0101) shall be 8, 12 or 16 Most significant bit for pixel sample data. Each sample shall have the same high bit. High Bit (0028,0102) shall be one less than Bits Stored Specifies an identity transformation for the Presentation LUT, such that the output of all grayscale transformations defined in the IOD containing this Module are defined to be P-Values. Enumerated Values: IDENTITY - output is in P-Values. Specifies whether an Image has undergone lossy compression (at a point in its lifetime). Enumerated Values: 00 = Image has NOT been subjected to lossy compression. 01 = Image has been subjected to lossy compression. Once this tag has been set to 01 it shall not be reset. If this tag is empty, no information is explicitly available. See C.7.6.1.1.5

Describes the approximate lossy compression ratio(s) that have been applied to this image. Required when compression has been applied. See C.7.6.1.1.5 for further explanation. May be multivalued if successive lossy compression steps have been applied. Notes: 1. For example, a compression ratio of 30:1 would be described in this Attribute with a single value of 30. 2. For historical reasons, the lossy compression ratio should also be described in Derivation Description (0008,2111).

A label for the lossy compression method(s) that have been applied to this image. See C.7.6.1.1.5 for further explanation. May be multi-valued if successive lossy compression steps have been applied; the value order shall correspond to the values of Lossy Image Compression Ratio (0028,2112). Required if Lossy Image Compression (0028,2110) has a value of "01". Note: For historical reasons, the lossy compression method should also be described in Derivation Description (0008,2111).

Indicates whether or not image contains sufficient burned in annotation to identify the patient and date the image was acquired. Enumerated Value: NO Offset of the first frame in a multi-frame image of a concatenation. Value shall be 0. Identifier for one SOP Instance belonging to a concatenation. Value shall be 1. The number of SOP Instances sharing the same Concatenation UID (0020,9161). Value Shall be 1. Axial length of the eye in mm. The horizontal field of view in degrees The refractive state of the imaged eye at the time of acquisition. Zero or one Item shall be present. Zero length means the refractive state was not measured. Sphere value in diopters Cylinder value in diopters Axis value in degrees Emmetropic magnification value (dimensionless). Zero length means the emmetropic magnification was not measured. Value of intraocular pressure in mmHg. Zero length means the pressure was not measured Enumerated Values: YES NO If this tag is empty, no information is available. Information about the agent administered. Required if the value of Pupil Dilated (0022,000D) is YES. Zero or more items may be present. Note: An empty sequence indicates that an agent was used for dilation, but the name was not entered. The actual agent administered to dilate the pupil. One item shall be present. The concentration of the agent. Units of measure for the Mydriatic Agent Concentration. Required if Mydriatic Agent Concentration (0022,004E) is present. One item shall be present. The degree of the dilation in mm. Required if the value of Pupil Dilated (0022,000D) is YES. Describes the type of acquisition device. A single item shall be present in the sequence. Filters used in the light source path. Zero or more items may be present in the sequence. Nominal pass-through wavelength of light path filter in nm Pass band of light path filter in nm. This Attribute has two Values. The first is the shorter and the second the longer wavelength relative to the peak. The values are for the - 3dB nominal (1/2 of peak) pass through intensity. One of the two Values may be zero length, in which case it is a cutoff filter. Type of detector used for creating this image. Defined terms: CCD = Charge Coupled Device CMOS = Complementary Metal Oxide Semiconductor PHOTO = Photodetector INT = Interferometer Wavelength of the illuminator in nm. Required if Acquisition Device Type Code Sequence (0022,0015) contains an item with the value (A-00FBE, SRT, "Optical Coherence Tomography Scanner"). May be present otherwise. Power of the illuminator in microwatts at corneal plane. Required if Acquisition Device Type Code Sequence (0022,0015) contains an item with the value (SRT, A-00FBE,"Optical Coherence Tomography Scanner"). May be present otherwise. Bandwidth of the illuminator in nm. Required if Acquisition Device Type Code Sequence (0022,0015) contains an item with the value (A-00FBE, SRT, "Optical Coherence Tomography Scanner"). May be present otherwise. The inherent limiting resolution in microns for depth of the acquisition equipment for high contrast objects for the data gathering and reconstruction technique chosen. If variable, the value at the center of the scanning volume. Required if Acquisition Device Type Code Sequence (0022,0015) contains an item with the value (A-00FBE, SRT, "Optical Coherence Tomography Scanner"). May be present otherwise. Maximum distortion in depth direction in % of Depth Spatial Resolution. Required if Acquisition Device Type Code Sequence (0022,0015) contains an item with the value (SRT, A-00FBE,"Optical Coherence Tomography Scanner"). May be present otherwise. The inherent limiting resolution in microns of the acquisition equipment in the direction of a row. Required if Acquisition Device Type Code Sequence (0022,0015) contains an item with the value (A-00FBE, SRT, "Optical Coherence Tomography Scanner"). May be present otherwise. Maximum distortion in along-scan direction in % of Along-scan Spatial Resolution. Required if Acquisition Device Type Code Sequence (0022,0015) contains an item with the value (A-00FBE, SRT, "Optical Coherence Tomography Scanner"). May be present otherwise. The inherent limiting resolution in microns of the acquisition equipment perpendicular to the slice. Required if Acquisition Device Type Code Sequence (0022,0015) contains an item with the value (A-00FBE, SRT, "Optical Coherence Tomography Scanner"). May be present otherwise. Maximum distortion in across-scan direction in % of cross-scan Spatial Resolution. Required if Acquisition Device Type Code Sequence (0022,0015) contains an item with the value (A-00FBE, SRT, "Optical Coherence Tomography Scanner"). May be present otherwise. Specifies the column locations for this frame in terms of locations on a referenced image. One or more items shall be present. Image coordinates for the points on the referenced image that correspond to the points on this frame. See section C.8.17.10.1.1. Relative position in microns signifying the location of a Transverse image in the z-axis. Required if Ophthalmic Image Orientation (0022,0039) is TRANSVERSE. Enumerated Values: LINEAR NONLINEAR TRANSVERSE Source equipment that produced the Stereometric Series. Enumerated Value: SMR Sequence of items identifying pairs of images. There shall be one or more items in this sequence. Stereo separation angle in degrees Horizontal displacement of instrument between left and right image in mm Horizontal displacement of right image relative to left image in pixels for optimal display. Offset of right image to right means positive value. Vertical displacement of right image relative to left image in pixels for optimal display. Offset of right image downwards means positive value. Rotation of right image relative to left image in degrees for optimal display. The rotation of the right image against the left image counterclockwise is positive, rotation around the center is assumed. Left Image of the Pair. Only one Item shall be present in this Sequence. Right Image of the Pair. Only one Item shall be present in this Sequence. Type of equipment that originally acquired the data used to create the images in this Series. Enumerated Values: XA RF See section C.7.3.1.1.1 for further explanation. A number that identifies this Series. Uniquely identifies the Performed Procedure Step SOP Instance to which the Series is related (e.g. a Modality or General-Purpose Performed Procedure Step SOP Instance). Only a single Item is permitted in this sequence. Required if the Modality Performed Procedure Step SOP Class, General Purpose Performed Procedure Step SOP Class is supported. Image identification characteristics. See C.8.19.2.1.1 for specialization.

Identification of the plane used to acquire this image. Defined Terms: MONOPLANE PLANE A PLANE B Notes: 1. MONOPLANE may only be used for a single plane system 2. PLANE A and PLANE B must be used for two plane systems, independent if the acquisition is single plane or biplane. 3. The value has to be in accordance with Image Type (0008,0008) value 3. If this value is SINGLE PLANE all three Defined Term are applicable. Required if Image Type (0008,0008) Value 3 is not equal to UNDEFINED. A number identifying the single continuous gathering of data over a period of time that resulted in this image. The date and time that the acquisition of data that resulted in this image started. Note: The synchronization of this time with an external clock is specified in the Synchronization Module in Acquisition Time Synchronized (0018,1800). Number of bits allocated for each pixel sample. Each sample shall have the same number of bits allocated. Enumerated Values: 8 and 16. Number of bits stored for each pixel sample. Each sample shall have the same number of bits stored. Enumerated Values: 8 to 16. See C.8.19.2.1.2 for specialization.

Table C.8.X2-2 specifies the allowed combinations of Bits Allocated (0028,0100) and Bits Stored (0028,0101). Table C.8.19.2-2 ALLOWED COMBINATIONS OF ATTRIBUTE VALUES FOR BITS ALLOCATED AND BITS STORED

Most significant bit for pixel sample data. Each sample shall have the same high bit. Shall be one less than the value in Bits Stored (0028,0101). Number of samples (color planes) in this image shall have a value of 1. Data representation of the pixel samples. Shall have the value: 0000H = Unsigned Integer. Specifies the intended interpretation of the pixel data. Enumerated Values: MONOCHROME1 MONOCHROME2 User defined name of the protocol used to acquire this image. User defined description of the protocol used to acquire this image. Identifies any acquisition technique that was used during the acquisition of the image. Defined Terms: TOMO = Tomography CHASE = Bolus Chasing STEP = Stepping ROTA = Rotation Content Qualification Indicator Enumerated Values: PRODUCT RESEARCH SERVICE See C.8.13.2.1.1 for further explanation.

Sequence that describes the orientation of the patient with respect to gravity. See C.8.11.5.1.2 for further explanation. Only a single Item shall be permitted in this Sequence. Required if Positioner Type (0018,1508) equals CARM and C-arm Positioner Tabletop Relationship (0018,9474) equals YES. May be present otherwise.

This Attribute is not related to Patient Orientation (0020,0020) and conveys a different concept entirely.

Patient Orientation Modifier. Required if needed to fully specify the orientation of the patient with respect to gravity. Only a single Item shall be permitted in this Sequence. Sequence that describes the orientation of the patient with respect to the head of the table. See Section C.8.4.6.1.3 for further explanation. Zero or one item shall be present in the sequence. Required if Positioner Type (0018,1508) equals CARM and C-arm Positioner Tabletop Relationship (0018,9474) equals YES. May be present otherwise.

Body thickness in mm at examination location perpendicular to the table top for this series. Notes: 1. This is intended for estimation of the thickness of the patient at the tabletop, not for precise calculation of the size of the object in the X-Ray beam (see Calculated Anatomy Thickness (0018,9452) attribute). 2. For example, used to estimate the value range of the Distance Object to Table Top (0018,9403) attribute. Indicates whether or not the image contains sufficient burned in annotation to identify the patient and date the image was acquired. Enumerated Values: NO Specifies whether an Image has undergone lossy compression. Enumerated Values: 00 = Image has NOT been subjected to lossy compression. 01 = Image has been subjected to lossy compression. See C.7.6.1.1.5 for further explanation.

See C.7.6.1.1.5 for further explanation. Required if Lossy Image Compression (0028,2110) equals 01.

A label for the lossy compression method(s) that have been applied to this image. See C.7.6.1.1.5 for further explanation. May be multi valued if successive lossy compression steps have been applied; the value order shall correspond to the values of Lossy Image Compression Ratio (0028,2112). Note: For historical reasons, the lossy compression method may also be described in Derivation Description (0008,2111). Required if Lossy Image Compression (0028,2110) equals 01.

A sequence that identifies the SOP Class/Instance pairs of the corresponding plane for a Biplane acquisition device. Only a single Item shall be permitted in this Sequence. Required if Image Type (0008,0008) Value 3 is BIPLANE A or BIPLANE B. Full set of Composite SOP Instances referred to inside the Referenced Image Sequences of this SOP Instance. See C.8.13.2.1.2 for further explanation. One or more Items may be permitted in this sequence. Required if the Referenced Image Sequence (0008,1140) is present.

Full set of Composite SOP Instances referred to inside the Source Image Sequences of this SOP Instance. See C.8.13.2.1.2 for further explanation. One or more Items may be permitted in this sequence. Required if the Source Image Sequence (0008,2112) is present.

A sequence which provides reference to a set of non-image SOP Class/Instance pairs significantly related to this Image, including waveforms that may or may not be temporally synchronized with this image. One or more Items may be included in this sequence. Code describing the purpose of the reference to the SOP Instances. Only a single Item shall be permitted in this sequence. User-defined comments about the image. Indicates whether or not this image is a quality control or phantom image. Enumerated Values: YES NO If this Attribute is absent, then the image may or may not be a quality control or phantom image. This icon image is representative of the Image. Only a single Item shall be permitted in this Sequence. Specifies a predefined identity transformation for the Presentation LUT such that the output of all grayscale transformations, if any, are defined to be in P-Values. Enumerated Values: IDENTITY - output is in P-Values - shall be used if Photometric Interpretation (0028,0004) is MONOCHROME2 INVERSE - output after inversion is in P-Values - shall be used if Photometric Interpretation (0028,0004) is MONOCHROME1. Average of the peak kilo voltage outputs of the X-Ray generator used for all frames. Identify the general level of X-Ray dose exposure. Enumerated values are: SC = low dose exposure generally corresponding to fluoroscopic settings (e.g. preparation for diagnostic quality image acquisition); GR = high dose for diagnostic quality image acquisition (also called digital spot or cine); Average of the nominal X-Ray tube currents in milliamperes for all frames. Required if Exposure in mAs (0018,9332) is not present. May be present otherwise. Duration of X-Ray exposure in milliseconds. See C.8.7.2.1.1. Required if Exposure in mAs (0018,9332) is not present. May be present otherwise.

Exposure time is the cumulative time the patient received X-Ray exposure during this image (Multi-frame image acquisition). Calculation is pulse width * number of frames.

The exposure expressed in milliampereseconds, for example calculated from Exposure Time and X-Ray Tube Current. Required if either Exposure Time in ms (0018,9328) or X-Ray Tube Current in mA (0018,9330) are not present. May be present otherwise. Average width of X-Ray pulse in msec. The time in seconds needed for the complete acquisition. See C.7.6.16.2.2.1 for further explanation

Figure C.7.6.16-2 shows the relationships among the various timing parameters used.

Specifies X-Ray radiation mode. Defined Terms: CONTINUOUS PULSED Nominal focal spot size in mm used to acquire this image. The primary material in the anode of the X-Ray source. Defined Terms: TUNGSTEN MOLYBDENUM RHODIUM Type of rectification used in the X-Ray generator. Defined Terms: SINGLE PHASE THREE PHASE CONST POTENTIAL Identifies with type of X-Ray receptor is used. Enumerated Values: IMG_INTENSIFIER DIGITAL_DETECTOR Physical distance measured at the receptor plane of the detector between the centers of each pixel specified by a numeric pair - row spacing value (delimiter) column spacing value in mm. See 10.7.1.3 for further explanation of the value order. Note: These values are the actual pixel spacing distances of the stored pixel values of an image. Distance in mm between the receptor plane and the detector housing. The direction of the distance is positive from receptor plane to X-Ray source. Note: 1. A negative value is allowed in the case of an image intensifier the receptor plane can be a virtual plane located outside the detector housing depending the magnification factor of the intensifier. A negative value is not applicable for the digital detector. 2. Used to calculate the pixel size of the plane in the patient when markers are used, and they are placed on the detector housing. Defined Terms: CARM COLUMN Notes: 1. The term CARM can apply to any positioner with 2 degrees of freedom of rotation of the X-Ray beam about the Imaging Subject. 2. The term COLUMN can apply to any positioner with 1 degree of freedom of rotation of the X-Ray beam about the Imaging Subject. Describes for C-arm positioner type systems if positioner and tabletop has the same geometrical reference system. Enumerated Values: YES NO Note: The value NO is intended for mobile systems where there is no table fixed to the system Required if Positioner Type (0018,1508) equals CARM. X-Ray dose, measured in dGy*cm*cm, to which the patient was exposed for the acquisition of this image only. Notes: 1. The sum of the Image Area Dose Product of all images of a Series or a Study may not result in the actual area dose product to which the patient was exposed. 2. This may be an estimated value based on assumptions about the patient's body size and habitus. Physical diameter of the maximum active area X-Ray intensifier in mm. Note: This attribute does not specify the field of view. The attribute Field of View Dimension(s) in Float (0018,9461) is intended for this value. Shape of the active area used for acquiring this image. Enumerated Value: RECTANGLE ROUND HEXAGONAL Note: This may be different from the Field of View Shape (0018,1147), and should not be assumed to describe the stored image. Dimensions in mm of the active area used for acquiring this image. If Intensifier Active Shape (0018,9427) is: RECTANGLE: row dimension followed by column. ROUND: diameter. HEXAGONAL: diameter of the circle circumscribing the hexagon. Note: This may be different from the Field of View Dimension(s) in Float (0018,9461), and should not be assumed to describe the stored image. Dimensions of the physical detector measured in mm as a row size followed by a column size. Position of the Isocenter measured in physical detector elements as a row offset followed by a column offset from the TLHC of a rectangle circumscribing the physical detector area. Required if Isocenter Reference System Sequence (0018,9462) is present. A sequence that describes general characteristics of this frame. Only a single Item shall be permitted in this sequence. A text description of how this frame was derived. See C.8.7.1.1.5 for further explanation.

Indicates any visual processing performed on the frame prior to exchange. See Section C.8.7.1.1.3.

Code representing the device-specific processing associated with the frame (e.g. Organ Filtering code) Note: This Code is manufacturer specific but provides useful annotation information to the knowledgeable observer. Sequence containing the field of view for this frame. One or more items may be included in this sequence. Shape of the Field of View, that is the image pixels stored in Pixel Data (7FE0,0010). Enumerated Values: RECTANGLE ROUND HEXAGONAL Dimensions in mm of the Field of View, that is the image pixels stored in Pixel Data (7FE0,0010). If Field of View Shape (0018,1147) is: RECTANGLE: row dimension followed by column. ROUND: diameter. HEXAGONAL: diameter of the circle circumscribing the hexagon. Offset of the TLHC of a rectangle circumscribing the Field of View, i.e., the image pixels stored in Pixel Data (7FE0,0010) before rotation or flipping, from the TLHC of the physical detector area measured in physical detector pixels as a row offset followed by a column offset. See C.8.11.4.1.1 for further explanation. Required if X-Ray Receptor Type (0018,9420) is present and equals DIGITAL_DETECTOR.

Clockwise rotation in degrees of Field of View, i.e., the image pixels stored in Pixel Data (7FE0,0010), relative to the physical detector. Enumerated Values: 0, 90, 180, 270 See C.8.11.4.1.1 for further explanation.

Whether or not a horizontal flip has been applied to the Field of View, i.e., the image pixels stored in Pixel Data (7FE0,0010), after rotation relative to the physical detector as described in Field of View Rotation (0018,7032). Enumerated Values: NO YES See C.8.11.4.1.1 for further explanation.

Manufacturer defined description of the field of view selected during acquisition. Sequence containing the Exposure Control Sensing Region for this frame. One or more items may be included in this sequence. Shape of the Exposure Control Sensing Region. Enumerated Values: RECTANGULAR CIRCULAR POLYGONAL Required if Exposure Control Sensing Region Shape (0018,9435) is RECTANGULAR. Location of the left edge of the rectangular Exposure Control Sensing Region expressed as effective pixel column. See C.8.19.6.3.1.

The Exposure Control Sensing Region Left Vertical Edge (0018,9436), Exposure Control Sensing Region Right Vertical Edge (0018,9437), Exposure Control Sensing Region Upper Horizontal Edge (0018,9438), Exposure Control Sensing Region Lower Horizontal Edge (0018,9439) and Center of Circular Exposure Control Sensing Region (0018,9440) may have a negative value when the point defined by the attribute lies outside the left or upper border of the pixel data matrix. The top left pixel of the image has a pixel row and column value of 1.

Required if Exposure Control Sensing Region Shape (0018,9435) is RECTANGULAR. Location of the right edge of the rectangular Exposure Control Sensing Region expressed as effective pixel column. See C.8.19.6.3.1.

Required if Exposure Control Sensing Region Shape (0018,9435) is RECTANGULAR. Location of the upper edge of the rectangular Exposure Control Sensing Region expressed as effective pixel row. See C.8.19.6.3.1.

Required if Exposure Control Sensing Region Shape (0018,9435) is RECTANGULAR. Location of the lower edge of the rectangular Exposure Control Sensing Region expressed as effective pixel row. See C.8.19.6.3.1.

Required if Exposure Control Sensing Region Shape (0018,9435) is CIRCULAR. Location of the center of the circular Exposure Control Sensing Region expressed as effective pixel row and column. See C.8.19.6.3.1.

Required if Exposure Control Sensing Region Shape (0018,9435) is CIRCULAR. Radius of the circular Exposure Control Sensing Region expressed as effective number of pixels along the row direction. See C.8.19.6.3.1.

Required if Exposure Control Sensing Region Shape (0018,9435) is POLYGONAL. Multiple Values where the first set of two values are: row of the origin vertex; column of the origin vertex. Two or more pairs of values follow and are the effective pixel row and column coordinates of the other vertices of the polygon Exposure Control Sensing Region. Polygon Exposure Control Sensing Regions are implicitly closed from the last vertex to the origin vertex and all edges shall be non-intersecting except at the vertices. See C.8.19.6.3.1.

Sequence containing the pixel data properties for this frame. Only a single Item shall be permitted in this sequence. The relationship between the Pixel and the X-Ray beam intensity. See C.8.19.6.4.1.

Pixel Intensity Relationship (0028,1040) shall identify the relationship of the pixel values to the X-Ray beam intensity. Defined terms are:

The sign of the relationship between the Pixel sample values stored in Pixel Data (7FE0,0010) and the X-Ray beam intensity. Enumerated Values: 1 = Lower pixel values correspond to less X-Ray beam intensity -1 = Higher pixel values correspond to less X-Ray beam intensity See C.8.11.3.1.2 for further explanation.

Geometrical characteristics of the pixel data to indicate whether pixel spacing is uniform for all pixels or not. Enumerated Values: UNIFORM NON_UNIFORM The percentage of the maximum deviation of the pixel spacing values of images for which the geometric properties are non-uniform. Note: This attribute may be used to judge the result of measurements, 3D reconstructions, etc. Required if Geometrical Properties (0028,9444) equals NON_UNIFORM. The type or a combination of types of image processing applied to the pixel data before being stored. Defined Terms: DIGITAL_SUBTR HIGH_PASS_FILTER LOW_PASS_FILTER MULTI_BAND_FLTR FRAME_AVERAGING NONE Sequence containing the detector properties for this frame. Only a single Item shall be permitted in this sequence. Time in mSec that the detector is active during acquisition of this image. Note: This activation window overlaps the time of the X-Ray exposure as defined by Exposure Time in ms (0018,9328) and Detector Activation Offset From Exposure (0018,7016). Offset time in mSec that the detector becomes active after the X-Ray beam is turned on during acquisition of this image. May be negative. Sequence containing the calibration flag for this frame. Only a single Item shall be permitted in this sequence. Indicates whether a reference object (phantom) of known size is present in the frame and was used for calibration. Enumerated Values: YES NO Note: Device is identified using the Device module. See C.7.6.12.

Table C.7-18 describes the Attributes of devices or calibration objects (e.g., catheters, markers, baskets) that are associated with a study and/or image. Table C.7-18 DEVICE MODULE ATTRIBUTES

Sequence containing object thickness for this frame. Only a single Item shall be permitted in this sequence. The physical thickness in mm of the anatomic region of interest as specified in the Anatomic Region Sequence (0008,2218) in the direction of the center of the beam. Note: The value takes in account the position relative to object and the X-Ray source - detector axis. Sequence containing the acquisition parameters for this frame. Only a single Item shall be permitted in this sequence. Exact peak kilo voltage output of the X-Ray generator used for this frame. Exact Nominal X-Ray tube current in milliamperes applied during the Acquisition Duration (0018,9220) for this frame. A sequence that describes the geometrical position of the patient relative to the equipment. Only a single Item shall be permitted in this sequence. Distance between the anatomic region of interest of observation and table top in mm. Notes: 1.This value is always positive, the object is assumed to be above the table. 2.The value of this attribute is depending on the patient position on the tabletop (supine, left or right decubitus, etc.) Physical distance within the anatomic region of interest in the center of the beam and perpendicular to the beam between the center of each pixel, specified by a numeric pair adjacent row spacing (delimiter) adjacent column spacing in mm. See C.8.19.6.9.2. See 10.7.1.3 for further explanation of the value order. Required if Distance Object to Table Top (0018,9403) is not empty. Note: This value is provided besides the values that are the input parameters of the calibration algorithm.

The value provided for the Beam Angle (0018,9449) attribute shall correspond to the other attribute values within this module and according to the mathematic terms listed in section C.8.19.6.9.1. The terms listed will result in infinite result when used with 90-degree beam angles. It is outside the scope of this Standard to define reasonable limits for single input values in the above-mentioned terms, or to define the mathematical accuracy of applications using those terms. Note: It may be reasonable to limit automatic calculations to a narrow range of +/- 60 degrees for Beam Angle and inform users about possible deviations in the calibration result when exceeding such range limits.

The distance of the top of the patient table to the center of rotation of the source (i.e. the isocenter) in mm. A positive value indicates that the tabletop is below the isocenter. Note: All the distances are measured perpendicular to the Table Top plane. Required if Image Type (0008,0008) Value 1 is ORIGINAL, may be present otherwise. The equipment related angle in degrees of the X-Ray beam relative to the perpendicular to the tabletop plane. An angle from 0 to +90 degrees indicates that the X-Ray source is below the table. The valid range is 0 to +180 degrees. Required if Image Type (0008,0008) Value 1 is ORIGINAL, may be present otherwise. A sequence that describes the geometrical position of the positioner. Only a single Item shall be permitted in this sequence. Position of the X-Ray Image Intensifier about the patient from the RAO to LAO direction where movement from RAO to vertical is positive. See C.8.7.5.1.2. Required if Positioner Type (0018,1508) equals CARM.

Position of the X-Ray Image Intensifier about the patient from the CAU to CRA direction where movement from CAU to vertical is positive. See C.8.7.5.1.2 Required if Positioner Type (0018,1508) equals CARM.

Angle of the X-Ray beam in degree relative to an orthogonal axis to the detector plane. Positive values indicate that the tilt is towards the head of the patient. Notes: 1. The detector plane is assumed to be parallel to the table plane 2. This attribute differentiates form the attribute Column Angulation (0018,1450) by using the patient based coordinate system instead of the equipment based coordinate system. Required if Positioner Type (0018,1508) equals COLUMN. A sequence that describes the geometrical position of the table top. Only a single Item shall be permitted in this sequence. Table Top Vertical position with respect to an arbitrary chosen reference by the equipment in (mm). Table motion downwards is positive Table Top Longitudinal position with respect to an arbitrary chosen reference by the equipment in (mm). Table motion towards LAO is positive assuming that the patient is positioned supine and its head is in normal position. Table Top Lateral position with respect to an arbitrary chosen reference by the equipment in (mm). Table motion towards CRA is positive assuming that the patient is positioned supine and its head is in normal position. Rotation of the table in the horizontal plane (clockwise when looking from above the table). Angle of the head-feet axis of the table in degrees relative to the horizontal plane. Positive values indicate that the head of the table is upwards. Angle of the left-right axis of the table in degrees relative to the horizontal plane. Positive values indicate that the left of the table is upwards. A sequence that describes the collimator shape. Only a single Item shall be permitted in this sequence. Shape(s) of the collimator. Enumerated Values: RECTANGULAR CIRCULAR POLYGONAL This multi-valued Attribute shall contain at most one of each Enumerated Value. Required if Collimator Shape (0018,1700) is RECTANGULAR. Location of the left edge of the rectangular collimator expressed as effective pixel column. See C.8.7.3.1.1 and C.8.19.6.12.1.

Required if Collimator Shape (0018,1700) is RECTANGULAR. Location of the right edge of the rectangular collimator expressed as effective pixel column. See C.8.7.3.1.1 and C.8.19.6.12.1.

Required if Collimator Shape (0018,1700) is RECTANGULAR. Location of the upper edge of the rectangular collimator expressed as effective pixel row. See C.8.7.3.1.1 and C.8.19.6.12.1.

Required if Collimator Shape (0018,1700) is RECTANGULAR. Location of the lower edge of the rectangular collimator expressed as effective pixel row. See C.8.7.3.1.1 and C.8.19.6.12.1.

Required if Collimator Shape (0018,1700) is CIRCULAR. Location of the center of the circular collimator expressed as effective pixel row and column. See C.8.7.3.1.1 and C.8.19.6.12.1.

Required if Collimator Shape (0018,1700) is CIRCULAR. Radius of the circular collimator expressed as effective number of pixels along the row direction. See C.8.7.3.1.1 and C.8.19.6.12.1.

The top left pixel of the image has a pixel row and column value of 1.

A sequence that describes the Isocenter Reference Coordinate System (O, X, Y, Z). Only a single Item shall be permitted in this sequence. Position of the X-Ray center beam in the isocenter reference system in the X direction (deg). See C.8.19.6.13.1.2 for further explanation.

The positioner coordinate system (Op, Xp, Yp, Zp) is defined as follows:

Position of the X-Ray center beam in the isocenter reference system in the Z direction (deg). See C.8.19.6.13.1.2 for further explanation.

The positioner coordinate system (Op, Xp, Yp, Zp) is defined as follows:

Rotation of the X-Ray detector plane (deg). See C.8.19.6.13.1.2 for further explanation.

The positioner coordinate system (Op, Xp, Yp, Zp) is defined as follows:

X position of the Table Reference Point with respect to the Isocenter (mm). See C.8.19.6.13.1.3 for further explanation.

The table coordinate system (Ot, Xt, Yt, Zt) is defined as follows:

Y position of the Table Reference Point with respect to the Isocenter (mm). See C.8.19.6.13.1.3 for further explanation.

The table coordinate system (Ot, Xt, Yt, Zt) is defined as follows:

Z position of the Table Reference Point with respect to the Isocenter (mm). See C.8.19.6.13.1.3 for further explanation.

The table coordinate system (Ot, Xt, Yt, Zt) is defined as follows:

Rotation of the table in the horizontal plane. See C.8.19.6.13.1.3 for further explanation.

The table coordinate system (Ot, Xt, Yt, Zt) is defined as follows:

Angle of the head-feet axis of the table in degrees relative to the horizontal plane. See C.8.19.6.13.1.3 for further explanation.

The table coordinate system (Ot, Xt, Yt, Zt) is defined as follows:

Angle of the left-right axis of the table in degrees relative to the horizontal plane. See C.8.19.6.13.1.3 for further explanation.

The table coordinate system (Ot, Xt, Yt, Zt) is defined as follows:

Sequence containing the geometric properties for this frame. Only a single Item shall be permitted in this sequence. Distance from source to isocenter in mm. Distance from source to receptor plane perpendicular to the receptor plane in mm. Note: This value is traditionally referred to as Source Image Receptor Distance (SID). Describes the preferred playback sequencing for a multi-frame image. Enumerated Values: 0 = Looping (1,2...n,1,2,...n,1,2,....n,...) 1 = Sweeping (1,2,...n,n -1,...2,1,2,...n,...) Sequence that specifies the display frame rate of a selected set of frames. The Items are ordered in increasing frame number. The range of the frames may not overlap and the ranges shall be adjacent. One or more items may be included. The Frame Number of the first frame of the set of frames to be displayed in this Item. The Frame Number of the last frame of the set of frames to be displayed in this Item. A flag indicating that the range of frames in this item may be skipped. Defined Terms: DISPLAY SKIP Recommended rate at which the frames of this Item should be displayed in frames/second. Specifies the recommended viewing protocol(s). Defined terms: SUB = subtraction with mask images NAT = native viewing of image as stored Note: If an implementation does not recognize the defined term for Recommended Viewing Mode (0028,1090), reverting to native display mode is recommended. Edge enhancement filter percentage that is recommended by the pixel data creator as filter presetting for display purposes. The value of 100% corresponds to the maximum filter strength that can be applied by a specific application displaying the image. Modality Type Enumerated Value: SEG A number that identifies this Series Uniquely identifies the Performed Procedure Step SOP Instance to which the Series is related (e.g. a Modality or General-Purpose Performed Procedure Step SOP). Only a single Item is permitted in this sequence. Required if the SOP Instance was created in a workflow managed with the Modality Performed Procedure Step SOP Class or General Purpose Performed Procedure Step SOP Class. Value 1 shall be DERIVED. Value 2 shall be PRIMARY. No other values shall be present. Enumerated Values: 1 Enumerated Values: MONOCHROME2 Enumerated Values: 0 If Segmentation Type (0062,0001) is BINARY, shall be 1. Otherwise it shall be 8. See Section C.8.20.2.1.

As a consequence of the enumerated Bits Allocated and Bits Stored attribute values, single bit pixels shall be packed 8 to a byte as defined by the encoding rules in PS 3.5.

If Segmentation Type (0062,0001) is BINARY, shall be 1. Otherwise it shall be 8. See Section C.8.20.2.1.

As a consequence of the enumerated Bits Allocated and Bits Stored attribute values, single bit pixels shall be packed 8 to a byte as defined by the encoding rules in PS 3.5.

If Segmentation Type (0062,0001) is BINARY, shall be 0. Otherwise it shall be 7. See Section C.8.20.2.1.

As a consequence of the enumerated Bits Allocated and Bits Stored attribute values, single bit pixels shall be packed 8 to a byte as defined by the encoding rules in PS 3.5.

If Lossy Image Compression (0028,2110) in any of the source images is “01”, the value shall be “01” for the Segmentation instance. The process of segmentation itself is defined not to be lossy compression, even though it involves loss. If the Segmentation instance is encoded using a lossy compression transfer syntax, then the value shall be set to “01”. Notes: It is not advisable to lossy compress a Segmentation SOP Instance. In particular, a binary segmentation should not be lossy compressed.

Describes the approximate lossy compression ratio(s) that have been applied to this image. See C.7.6.1.1.5 for further explanation. May be multivalued if successive lossy compression steps have been applied. Notes: 1. For example, a compression ratio of 30:1 would be described in this Attribute with a single value of 30. 2. For historical reasons, the lossy compression ratio may also be described in Derivation Description (0008,2111). Required if present in the source images or this IOD instance has been compressed.

A label for the lossy compression method(s) that have been applied to this image. See C.7.6.1.1.5 for further explanation. May be multivalued if successive lossy compression steps have been applied; the value order shall correspond to the values of Lossy Image Compression Ratio (0028,2112). Note: For historical reasons, the lossy compression method may also be described in Derivation Description (0008,2111). Required if present in the source images or this IOD instance has been compressed. See section C.8.20.2.2.

The type of encoding used to indicate the presence of the segmented property at a pixel/voxel location. Enumerated Values are: BINARY FRACTIONAL See section C.8.20.2.3. For fractional segmentation encoding, the meaning of the fractional value. Enumerated Values are: PROBABILITY OCCUPANCY Required if Segmentation Type (0062,0001) is FRACTIONAL. See section C.8.20.2.3. Specifies the value that represents 100%. There shall be no values in Pixel Data (7FE0,0010) greater than this value. Required if Segmentation Type (0062,0001) is FRACTIONAL. Describes the segments that are contained within the data. One or more items shall be present. Identification number of the segment. The value of Segment Number (0062,0004) shall be unique within the Segmentation instance in which it is created. See C.8.20.2.4.

Segment Number (0062,0004) shall be unique within each instance, start at a value of 1, and increase monotonically by 1.

User-defined label identifying this segment. This may be the same as the Code Meaning (0008,0104) of the Segmented Property Type Code Sequence (0062,000F). User-defined description for this segment. Type of algorithm used to generate the segment. Enumerated Values are: AUTOMATIC: calculated segment SEMIAUTOMATIC: calculated segment with user assistance MANUAL: user-entered segment Name of algorithm used to generate the segment. Required if Segment Algorithm Type (0062,0008) is not MANUAL. Sequence defining the general category of this segment. This sequence shall contain a single item. Sequence defining the specific property type of this segment. This sequence shall contain a single item. A default single gray unsigned value in which it is recommended that the maximum pixel value in this segment be rendered on a monochrome display. The units are specified in P-Values from a minimum of 0000H (black) up to a maximum of FFFFH (white). Note: The maximum P-Value for this Attribute may be different from the maximum P-Value from the output of the Presentation LUT, which may be less than 16 bits in depth. A default triplet value in which it is recommended that segment be rendered on a color display. The units are specified in PCS-Values, and the value is encoded as CIELab. See C.10.7.1.1.

Attributes such as Graphic Layer Recommended Display CIELab Value (0070,0401) consist of three unsigned short values:

Identifies the characteristics of this frame. Only a single Item shall be permitted in this sequence. Uniquely identifies the segment described in the Segment Sequence (0062,0002) by reference to the Segment Number (0062,0004). Referenced Segment Number (0062,000B) shall not be multi-valued. Image identification characteristics. See C.8.21.1.1.1 for specialization.

In addition to the requirements specified in C.8.16.1 Image Type, the following additional requirements and Defined Terms are specified.

Number of bits allocated for each voxel sample. Each sample shall have the same number of bits allocated. Enumerated Values: 8 and 16. Number of bits stored for each voxel sample. Each sample shall have the same number of bits stored. Enumerated Values: 8 to16. Most significant bit for pixel sample data. Each sample shall have the same high bit. Shall be one less than the value in Bits Stored (0028,0101). Number of samples (color planes) in this image shall have a value of 1. Specifies the intended interpretation of the voxel data. Enumerated Values: MONOCHROME2 Content Qualification Indicator Enumerated Values: PRODUCT RESEARCH SERVICE See C.8.13.2.1.1 for further explanation.

Indicates whether or not the image contains sufficient burned in annotation to identify the patient and date the image was acquired. Enumerated Values: NO Specifies whether an Image has undergone lossy compression. Enumerated Values: 00 = Image has NOT been subjected to lossy compression. 01 = Image has been subjected to lossy compression. See C.7.6.1.1.5 for further explanation.

See C.7.6.1.1.5 for further explanation. Required if Lossy Image Compression (0028,2110) equals 01.

A label for the lossy compression method(s) that have been applied to this image. See C.7.6.1.1.5 for further explanation. May be multi-valued if successive lossy compression steps have been applied; the value order shall correspond to the values of Lossy Image Compression Ratio (0028,2112). Note: For historical reasons, the lossy compression method may also be described in Derivation Description (0008,2111). Required if Lossy Image Compression (0028,2110) equals 01.

Full set of Composite SOP Instances referred to inside the Referenced Image Sequences of this SOP Instance. See C.8.13.2.1.2 for further explanation. One or more Items may be permitted in this sequence. Required if the Referenced Image Sequence (0008,1140) is present.

User-defined comments about the image. Indicates whether or not this image is a quality control or phantom image. Enumerated Values: YES NO If this Attribute is absent, then the image may or may not be a quality control or phantom image. This icon image is representative of the Image. Specifies a predefined identity transformation for the Presentation LUT such that the output of all grayscale transformations, if any, are defined to be in P-Values. Enumerated Values: IDENTITY = output is in P-Values A sequence that describes characteristics of the sources that are used to create a derived SOP Instance. One or more Items may be present. Indicates any visual processing performed on the frame prior to exchange. See Section C.8.7.1.1.3. Required if present and consistent in the contributing SOP Instances.

Code representing the device-specific processing associated with the frame (e.g. Organ Filtering code) Required if present and have an equal value in the contributing SOP Instances. Identification of the plane used to acquire this image. Defined Terms: MONOPLANE PLANE A PLANE B Required if present and consistent in the contributing SOP Instances. Physical distance measured at the receptor plane of the detector between the centers of each pixel specified by a numeric pair - row spacing value (delimiter) column spacing value in mm. Required if present and consistent in the contributing SOP Instances. A sequence that describes characteristics of the sources that are used to create a derived SOP Instance. One or more Items may be present. Indicates any visual processing performed on the frame prior to exchange. See Section C.8.7.1.1.3. Required if present and consistent in the contributing SOP Instances.

Code representing the device-specific processing associated with the frame (e.g. Organ Filtering code). Required if present and have an equal value in the contributing SOP Instances. Physical distance measured at the receptor plane of the detector between the centers of each pixel specified by a numeric pair - row spacing value (delimiter) column spacing value in mm. Required if present and consistent in the contributing SOP Instances. A Sequence that identifies the set of Images that constitute this acquisition context. Required if the reconstruction is created from DICOM SOP Instances. Note: The attribute is absent in the case where the images used to create the volume are not available as SOP Instances, e.g., the volume was directly generated by acquisition system. One or more Items may be included in this Sequence. Shape of the Field of View in the referenced images. Enumerated Values: RECTANGLE ROUND HEXAGONAL Required if present and consistent in the contributing SOP Instances. Dimensions in mm of the Field of View in the referenced images. If Field of View Shape (0018,1147) is: RECTANGLE: row dimension followed by column. ROUND: diameter. HEXAGONAL: diameter of the circle circumscribing the hexagon. Required if present and consistent in the contributing SOP Instances. Offset of the TLHC of a rectangle circumscribing the Field of View in the referenced images, before rotation or flipping, from the TLHC of the physical detector area measured in physical detector pixels as a row offset followed by a column offset. See C.8.11.4.1.1 for further explanation. Required if X-Ray Receptor Type (0018,9420) is present and equals DIGITAL_DETECTOR.

Clockwise rotation in degrees of Field of View in the referenced images, relative to the physical detector. Enumerated Values: 0, 90, 180, 270 See C.8.11.4.1.1 for further explanation. Required if present and consistent in the contributing SOP Instances.

Whether or not a horizontal flip has been applied to the Field of View in the referenced images, after rotation relative to the physical detector as described in Field of View Rotation (0018,7032). Enumerated Values: NO YES See C.8.11.4.1.1 for further explanation. Required if present and consistent in the contributing SOP Instances.

Identifies the grid. May be multi-valued. Defined Terms are: FIXED FOCUSED RECIPROCATING PARALLEL CROSSED NONE Required if present and consistent in the contributing SOP Instances. Identifies the type of X-Ray receptor used. Enumerated Values: IMG_INTENSIFIER DIGITAL_DETECTOR Required if present and consistent in the contributing SOP Instances. Average of the peak kilo voltage outputs of the X-Ray generator used for all frames. Required if present and consistent in the contributing SOP Instances. Average of the nominal X-Ray tube currents in milliamperes for all frames. Required if present and consistent in the contributing SOP Instances. Duration of X-Ray exposure in milliseconds. See C.8.7.2.1.1. Required if present and consistent in the contributing SOP Instances.

Exposure time is the cumulative time the patient received X-Ray exposure during this image (Multi-frame image acquisition). Calculation is pulse width * number of frames.

The exposure expressed in milliampereseconds, for example calculated from Exposure Time and X-Ray Tube Current. Required if present and consistent in the contributing SOP Instances. Contrast or bolus agent. Required if present and consistent in the contributing SOP Instances. Sequence that identifies the contrast agent. One or more Items may be present. Required if present and consistent in the contributing SOP Instances. Start date and time of that part of an acquisition used for this acquisition context. Required if present and consistent in the contributing SOP Instances. End date and time of that part of an acquisition used for this acquisition context. Required if present and consistent in the contributing SOP Instances. Exact peak kilo voltage output of the X-Ray generator used for this projection. Required if present and consistent in the contributing SOP Instances. Exact Nominal X-Ray tube current in milliamperes applied during the Frame Acquisition Duration (0018,9220) for this projection. Required if present and consistent in the contributing SOP Instances. The actual amount of time [in milliseconds] that was used to acquire data for this projection. See C.7.6.16.2.2.1 and C.7.6.16.2.2.3 for further explanation. Required if present and consistent in the contributing SOP Instances.

Figure C.7.6.16-2 shows the relationships among the various timing parameters used.

Shape(s) of the collimator. Enumerated Values: RECTANGULAR CIRCULAR POLYGONAL This multi-valued Attribute shall contain at most one of each Enumerated Value. Required if present and consistent in the contributing SOP Instances. Required if Collimator Shape (0018,1700) is RECTANGULAR. Location of the left edge of the rectangular collimator with respect to pixels in the image given as column. See C.8.7.3.1.1.

Required if Collimator Shape (0018,1700) is RECTANGULAR. Location of the right edge of the rectangular collimator with respect to pixels in the image given as column. See C.8.7.3.1.1.

Required if Collimator Shape (0018,1700) is RECTANGULAR. Location of the upper edge of the rectangular collimator with respect to pixels in the image given as row. See C.8.7.3.1.1.

Required if Collimator Shape (0018,1700) is RECTANGULAR. Location of the lower edge of the rectangular collimator with respect to pixels in the image given as row. See C.8.7.3.1.1.

Required if Collimator Shape (0018,1700) is CIRCULAR. Location of the center of the circular collimator with respect to pixels in the image given as row and column. See C.8.7.3.1.1.

Required if Collimator Shape (0018,1700) is CIRCULAR. Radius of the circular collimator with respect to pixels in the image given as a number of pixels along the row direction. See C.8.7.3.1.1.

Required if Collimator Shape (0018,1700) is POLYGONAL. Multiple Values where the first set of two values are: row of the origin vertex; column of the origin vertex. Two or more pairs of values follow and are the row and column coordinates of the other vertices of the polygon collimator. Polygon collimators are implicitly closed from the last vertex to the origin vertex and all edges shall be non-intersecting except at the vertices. Each item represents an acquisition context related to one or more reconstructions. The values of the Acquisition Index (0020,9518) attribute may be used as index to Items in this sequence. One or more Items may be present. Dimensions of the physical detector measured in mm as a row size followed by a column size. Required if present and consistent in the contributing SOP Instances. Position of the Isocenter measured in physical detector elements as a row offset followed by a column offset from the TLHC of a rectangle circumscribing the physical detector area. Required if Isocenter Reference System Sequence (0018,9462) is present. Required if present and consistent in the contributing SOP Instances. Distance from source to receptor plane perpendicular to the receptor plane in mm or distance in mm from source to detector center on the chest wall line See C.8.11.7.1.1. Required if present and consistent in the contributing SOP Instances. Note: This value is traditionally referred to as Source Image Receptor Distance (SID).

Distance from source to isocenter in mm. Required if present and consistent in the contributing SOP Instances. Nominal focal spot size in mm used to acquire this image. Required if present and consistent in the contributing SOP Instances. Type of filter(s) inserted into the X-Ray beam (e.g. wedges). Defined Terms: STRIP WEDGE BUTTERFLY MULTIPLE NONE Required if present and consistent in the contributing SOP Instances. The X-Ray absorbing material used in the filter. May be multi-valued. Defined Terms: MOLYBDENUM ALUMINUM COPPER RHODIUM NIOBIUM EUROPIUM LEAD Required if present and consistent in the contributing SOP Instances. The minimum thickness in mm of the X-Ray absorbing material used in the filters. May be multi-valued, with values corresponding to the respective values in Filter Material (0018,7050). Required if present and consistent in the contributing SOP Instances. The maximum thickness in mm of the X-Ray absorbing material used in the filters. May be multi-valued, with values corresponding to the respective values in Filter Material (0018,7050). Required if present and consistent in the contributing SOP Instances. Total amount of rotation of the primary positioner in degrees. Required if present and consistent in the contributing SOP Instances. Start position of the primary positioner in degrees. See C.8.7.5.1.2. Required if present and consistent in the contributing SOP Instances.

Nominal increment of the primary positioner angle in degrees. Positive values indicate moving from RAO to LAO position through the anterior. See C.8.7.5.1.2. Required if present and consistent in the contributing SOP Instances.

Total amount of rotation of the secondary positioner in degrees. Required if present and consistent in the contributing SOP Instances. Start position of the secondary positioner in degrees. See C.8.7.5.1.2. Required if present and consistent in the contributing SOP Instances.

Nominal increment of the secondary positioner angle in degrees. Positive values indicate moving from CAU to CRA through the anterior. See C.8.7.5.1.2. Required if present and consistent in the contributing SOP Instances.

Sequence containing detailed acquisition context of each individual projection used in this acquisition context. Zero or more items may be present. Required if present and consistent in the contributing SOP Instances. Position of the X-Ray center beam for this projection in the isocenter reference system in the X direction (deg). See C.8.19.6.13.1.2 for further explanation. Required if present and consistent in the contributing SOP Instances.

The positioner coordinate system (Op, Xp, Yp, Zp) is defined as follows:

Position of the X-Ray center beam for this projection in the isocenter reference system in the Z direction (deg). See C.8.19.6.13.1.2 for further explanation. Required if present and consistent in the contributing SOP Instances.

The positioner coordinate system (Op, Xp, Yp, Zp) is defined as follows:

Rotation of the X-Ray detector plane for this projection (deg). See C.8.19.6.13.1.2 for further explanation. Required if present and consistent in the contributing SOP Instances.

The positioner coordinate system (Op, Xp, Yp, Zp) is defined as follows:

Each item represents a acquisition context related to a set of frames of SOP Instance defined by this IOD, The values of the Acquisition Index (0020,9518) attribute may be used as index to Items in this sequence. One or more Items may be present. Sequence containing detailed acquisition context of each individual projection used in this acquisition context. Zero or more items may be present. Required if present and consistent in the contributing SOP Instances. A sequence of Items each describing the characteristics of one 3D reconstruction included in this SOP instance. One or more items may be present. Free text description of the purpose of the reconstruction, e.g., mask volume. Name of the application that created the reconstruction. Version of the application that created the reconstruction. Name of the manufacturer of the application that created the reconstruction. Type of algorithm used to create the reconstruction. Defined Terms: FILTER_BACK_PROJ ITERATIVE Description of the algorithm used to create the reconstruction. The Item number(s) of the X-Ray 3D Acquisition Sequence (0018,9507) that describes the acquisition context(s) contributing to this reconstruction. A sequence that describes general characteristics of this frame. Only a single Item shall be permitted in this sequence. Type of Frame. A multi-valued attribute analogous to the Image Type (0008,0008). Enumerated Values and Defined Terms are the same as those for the four values of the Image Type (0008,0008) attribute, except that the value MIXED is not allowed. See C.8.16.1 and C.8.13.3.1.1.

The Item number of the X-Ray 3D Reconstruction Sequence (0018,9530) that describes the characteristics of the 3D Reconstruction to which this frame is part of. Number of Rows in Overlay. Number of Columns in Overlay. Indicates whether this overlay represents a region of interest or other graphics. Enumerated Values: G = Graphics R = ROI. Location of first overlay point with respect to pixels in the image, given as row\column. The upper left pixel of the image has the coordinate 1\1. Column values greater than 1 indicate the overlay plane origin is to the right of the image origin. Row values greater than 1 indicate the overlay plane origin is below the image origin. Values less than 1 indicate the overlay plane origin is above or to the left of the image origin. Note: Values of 0\0 indicate that the overlay pixels start 1 row above and one column to the left of the image pixels. Number of Bits Allocated in the Overlay. The value of this Attribute shall be 1. Note: Formerly the standard described embedding the overlay data in the Image Pixel Data (7FE0,0010), in which case the value of this Attribute was required to be the same as Bits Allocated (0028,0100). This usage has been retired. See PS 3.3 2004. The value of this Attribute shall be 0. Note: Formerly the standard described embedding the overlay data in the Image Pixel Data (7FE0,0010), in which case the value of this Attribute specified the bit in which the overlay was stored. This usage has been retired. See PS 3.3 2004. Overlay pixel data. The order of pixels sent for each overlay is left to right, top to bottom, i.e., the upper left pixel is sent first followed by the remainder of the first row , followed by the first pixel of the 2nd row, then the remainder of the 2nd row and so on. Overlay data shall be contained in this Attribute . See C.9.2.1.1 for further explanation.

There are two specific types of overlays. The type is specified in this Attribute. A Region of Interest (ROI) is a specific use of an Overlay. The overlay bits corresponding to all the pixels included in the ROI shall be set to 1. All other bits are set to 0. This is used to specify an area of the image of particular interest. A Graphics overlay may express reference marks, graphic annotation, or bit mapped text, etc. A Graphics overlay may be used to mark the boundary of a ROI. If this is the case and the ROI statistical parameters are used, they will only refer to the pixels under the boundaries, not those in the included regions. The overlay bits corresponding to all the pixels included in the Graphics shall be set to 1. All other bits are set to 0.

User-defined comments about the overlay. Defined term which identifies the intended purpose of the Overlay Type. See C.9.2.1.3 for further explanation.

Two Defined Terms are specified: USER - User created graphic annotation (e.g. operator) AUTOMATED - Machine or algorithm generated graphic annotation, such as output of a Computer Assisted Diagnosis algorithm. Note: Additional or alternative Defined Terms may be specified in modality specific Modules, such as in the Ultrasound Image Module, C.8.5.6.1.11.

A user defined text string which may be used to label or name this overlay. Number of pixels in ROI area. See C.9.2.1.2 for further explanation.

These Attributes contain the statistical parameters of the ROI. The values of these parameters are for the overlay pixel values set to 1.

ROI Mean. See C.9.2.1.2 for further explanation.

These Attributes contain the statistical parameters of the ROI. The values of these parameters are for the overlay pixel values set to 1.

ROI standard deviation. See C.9.2.1.2 for further explanation.

These Attributes contain the statistical parameters of the ROI. The values of these parameters are for the overlay pixel values set to 1.

Number of Frames in Overlay. Required if Overlay data contains multiple frames. Frame number of Multi-frame Image to which this overlay applies; frames are numbered from 1. A sequence of Items each of which describes the displayed area selection for a group of images or frames. Sufficient Items shall be present to describe every image and frame listed in the Presentation State Relationship Module. One or more Items shall be present. Sequence of Items where each Item provides reference to a selected set of Image SOP Class/SOP Instance pairs that are defined in the Presentation State Relationship Module. One or more Items shall be present. Requiredif the displayed area selection in this Item does not apply to all the images and frames listed in the Presentation State Relationship Module. The top left (after spatial transformation) pixel in the referenced image to be displayed, given as column\row. Column is the horizontal (before spatial transformation) offset (X) and row is the vertical (before spatial transformation) offset (Y) relative to the origin of the pixel data before spatial transformation, which is 1\1. See Figure C.10.4-1. The bottom right (after spatial transformation) pixel in the referenced image to be displayed, given as column\row. Column is the horizontal (before spatial transformation) offset (X) and row is the vertical (before spatial transformation) offset (Y) relative to the origin of the pixel data before spatial transformation, which is 1\1. See Figure C.10.4-1. Manner of selection of display size. Enumerated Values: SCALE TO FIT TRUE SIZE MAGNIFY See C.10.4 for further explanation. Physical distance between the center of each pixel in the referenced image (before spatial transformation), specified by a numeric pair - adjacent row spacing (delimiter) adjacent column spacing in mm. See 10.7.1.3 for further explanation of the value order. Notes: 1. This value may be different from Pixel Spacing (0028,0030) or Imager Pixel Spacing (0018,1164) specified in the referenced image, which are ignored, since some form of calibration may have been performed (for example by reference to an object of known size in the image). 2. If the row and column spacing are different, then the pixel aspect ratio of the image is not 1:1. Required if Presentation Size Mode (0070,0100) is TRUE SIZE, in which case the values will correspond to the physical distance between the center of each pixel on the display device. May be present if Presentation Size Mode (0070,0100) is SCALE TO FIT or MAGNIFY, in which case the values are used to compute the aspect ratio of the image pixels. Ratio of the vertical size and the horizontal size of the pixels in the referenced image, to be used to display the referenced image, specified by a pair of integer values where the first value is the vertical pixel size and the second value is the horizontal pixel size. See C.7.6.3.1.7. Required if Presentation Pixel Spacing (0070,0101) is not present. Notes: 1. This value may be different from the aspect ratio specified by Pixel Aspect Ratio (0028,0034) in the referenced image, or implied by the values of Pixel Spacing (0028,0030) or Imager Pixel Spacing (0018,1164) specified in the referenced image, which are ignored. 2. This value must be specified even if the aspect ratio is 1:1.

The pixel aspect ratio is the ratio of the vertical size and horizontal size of the pixels in the image specified by a pair of integer values where the first value is the vertical pixel size, and the second value is the horizontal pixel size. To illustrate, consider the following example pixel size: Pixel Aspect Ratio = Vertical Size \ Horizontal Size = 0.30 mm \0.25 mm. Thus the Pixel Aspect Ratio could be represented as the multivalued integer string "6\5", "60\50", or any equivalent integer ratio.

Ratio of displayed pixels to source pixels, specified in one dimension. Required if Presentation Size Mode (0070,0100) is MAGNIFY. Notes: 1. A value of 1.0 would imply that one pixel in the referenced image would be displayed as one pixel on the display (i.e. it would not be interpolated if the aspect ratio of the image pixels is 1:1). 2. A value of 2.0 would imply that one pixel in the referenced image would be displayed as 4 pixels on the display (i.e. up-sampled by a factor of 2 in each of the row and column directions). 3. A value of 0.5 would imply that 4 pixels in the referenced image would be displayed as 1 pixel on the display (i.e. down-sampled by a factor of 2 in each of the row and column directions). 4. If the source pixels have an aspect ratio of other than 1:1, then they are assumed to have been interpolated to a display pixel aspect ratio of 1:1 prior to magnification. A sequence of Items each of which represents a group of annotations composed of graphics or text or both. One or more Items shall be present. Sequence of Items where each Item provides reference to a selected set of Image SOP Class/SOP Instance pairs that are defined in the Presentation State Relationship Module. One or more Items shall be present. Required if graphic annotations in this Item do not apply to all the images and frames listed in the Presentation State Relationship Module. The layer defined in the Graphic Layer Module C.10.7 in which the graphics or text is to be rendered. Sequence that describes a text annotation. One or more Items may be present. Either one or both of Text Object Sequence (0070,0008) or Graphic Object Sequence (0070,0009) are required . Units of measure for the axes of the text bounding box. Defines whether or not the annotation is Image or Displayed Area relative. Both dimensions shall have the same units. Enumerated Values: PIXEL = Image relative position specified with sub-pixel resolution such that the origin at the Top Left Hand Corner (TLHC) of the TLHC pixel is 0.0\0.0, the Bottom Right Hand Corner (BRHC) of the TLHC pixel is 1.0\1.0, and the BRHC of the BRHC pixel is Columns\Rows (see figure C.10.5-1). The values must be within the range 0\0 to Columns\Rows. DISPLAY = Fraction of Specified Displayed Area where 0.0\0.0 is the TLHC and 1.0\1.0 is the BRHC. The values must be within the range 0.0 to 1.0. Required if Bounding Box Top Left Hand Corner (0070,0010) or Bounding Box Bottom Right Hand Corner (0070,0011) is present. Units of measure for the axes of the text anchor point annotation. Enumerated Values for Anchor Point Annotation Units (0070,0004) are the same as for Bounding Box Annotation Units (0070,0003). Required if Anchor Point (0070,0014) is present. Text data which is unformatted and whose manner of display within the defined bounding box or relative to the specified anchor point is implementation dependent. See C.10.5.1.1. The text value may contain spaces, as well as multiple lines separated by either LF, CR, CR LF or LF CR, but otherwise no format control characters (such as horizontal or vertical tab and form feed) shall be present, even if permitted by the Value Representation of ST. The text shall be interpreted as specified by Specific Character Set (0008,0005) if present in the SOP Common Module. Note: The text may contain single or multi-byte characters and use code extension techniques as described in PS 3.5 if permitted by the values of Specific Character Set (0008,0005).

The text shall be displayed if any part of the bounding box or anchor point is within the Specified Display Area. The text need not be confined to within the bounding box, but shall be rendered in a direction from the Top Left Hand Corner (TLHC) of the bounding box to the Bottom Right Hand Corner (BRHC) of the bounding box, even if these coordinates have been specified in an image relative space and then transformed (rotated, flipped or scaled). Notes: 1. An implementation may render text outside the confines of the bounding box if necessary to display all the specified text. 2. Alternatively, an implementation may choose to render the text in a scrolling box, or a link to another fixed or popup window as appropriate. Whether the contents of the bounding box completely opacify the underlying image or whether the box is “transparent” is undefined. Notes: 1. For example, an implementation may choose an “exclusive or” style opacification to be sure that the text is discernible over light and dark portions of the image. 2. Commonly, the region of the bounding box around the text will be rendered “transparently”, i.e. the image will be visible, though some implementations may choose to opacify the bounding box behind the text to improve its readability. An alternative to specifying a bounding box, is to specify an Anchor Point (0070,0014), i.e. some point in an image or Specified Displayed Area that is related to the text. The semantics of this relationship, and the manner of positioning or linking the text to this point, are unspecified. Notes: 1. For example, a description of a feature may be linked to a point in the image, and when that image is displayed, if it is magnified and panned, the rendered text (and any arrow or line drawn in response to Anchor Point Visibility (0070,0015)) might be repositioned as appropriate so as not to be cropped out of the Specified Displayed Area. 2. As another example, the text could be rendered in a pop-up window when a hypertext link flagged on the displayed image at the location of the Anchor Point (0070,0014) is selected. 3. The bounding box and anchor point need not be defined with the same axis units, i.e. one can be image pixel relative, and the other displayed area relative. The size, font and rotation of the individual rendered text characters are unspecified.

Location of the Top Left Hand Corner (TLHC) of the bounding box in which Unformatted Text Value (0070,0006) is to be displayed, in Bounding Box Annotation Units (0070,0003), given as column\row. Column is the horizontal offset and row is the vertical offset. Required if Anchor Point (0070,0014) is not present. Location of the Bottom Right Hand Corner (BRHC) of the bounding box in which Unformatted Text Value (0070,0006) is to be displayed, in Bounding Box Annotation Units (0070,0003), given as column\row. Column is the horizontal offset and row is the vertical offset. Required if Anchor Point (0070,0014) is not present. Location of the text relative to the vertical edges of the bounding box. Enumerated Values: LEFT = closest to left edge RIGHT = closest to right edge CENTER = centered Required if Bounding Box Top Left Hand Corner (0070,0010) is present. Location of a point in the image or Specified Displayed Area to which the Unformatted Text Value (0070,0006) is related, in Anchor Point Annotation Units (0070,0004), given as column\row. Column is the horizontal offset and row is the vertical offset. Required if Bounding Box Top Left Hand Corner (0070,0010) and Bounding Box Bottom Right Hand Corner (0070,0011) are not present. May be present even if a bounding box is specified (i.e. Bounding Box Top Left Hand Corner (0070,0010) and Bounding Box Bottom Right Hand Corner (0070,0011) are present). Flag to indicate whether or not a visible indication (such as a line or arrow) of the relationship between the text and the anchor point is to be displayed. Enumerated Values: Y = yes N = no Required if Anchor Point (0070,0014) is present. Sequence that describes a graphic annotation. One or more Items may be present. Either one or both of Text Object Sequence (0070,0008) or Graphic Object Sequence (0070,0009) are required. Units of measure for the axes of the graphic annotation. Enumerated Values for Graphic Annotation Units (0070,0005) are the same as for Bounding Box Annotation Units (0070,0003). Enumerated Value: 2 Number of data points in this graphic. Coordinates that specify this graphic annotation. See C.10.5.1.2 for further explanation.

Graphic Data (0070,0022) contains the points in the graphic annotation, each dimension for the first point, followed by dimensions for second point, etc. For a two dimensional curve: X1, Y1, X2, Y2, etc. The first (X) dimension corresponds to the image or Specified Displayed Area column (horizontal offset), and the second (Y) dimension corresponds to the image or Specified Displayed Area row (vertical offset). The Value Representation of all components of the N-tuple shall be the same. The image or Specified Displayed Area relative drawing space is defined in Graphic Annotation Units (0070,0005). If Graphic Type (0070,0023) is POINT, then two values (one point) shall be specified and the single point specified is to be drawn. If Graphic Type (0070,0023) is POLYLINE, then the points are to be interpreted as an n-tuple list of end points between which straight lines are to be drawn. If Graphic Type (0070,0023) is INTERPOLATED, then the points are to be interpreted as an n-tuple list of end points between which some form of implementation dependent curved lines are to be drawn. The rendered line shall pass through all the specified points. If Graphic Type (0070,0023) is CIRCLE, then exactly two points shall be present; the first point is to be interpreted as the center and the second point as a point on the circumference of a circle, some form of implementation dependent representation of which is to be drawn. If Graphic Type (0070,0023) is ELLIPSE, then exactly four points shall be present; the first two points are to be interpreted as the endpoints of the major axis and the second two points as the endpoints of the minor axis of an ellipse, some form of implementation dependent representation of which is to be drawn. The notion of “open” or “closed” has no inherent meaning in the context of an arbitrary graphic, other than in the condition for the presence of Graphic Filled (0070,0024). The graphic has no semantic notion of an associated observation such as a region of interest, except that which the unformatted text in the same Item may describe. The choice of pixel value used to represent the graphic on a display is defined in the Graphic Layer Module C.10.7. Figure C.10.5-1 Sub-pixel Addressing Units in PIXEL Space

The shape of graphic that is to be drawn. See C.10.5.1.2. Enumerated Values: POINT POLYLINE INTERPOLATED CIRCLE ELLIPSE

Whether or not the closed graphics element is displayed as filled (in some unspecified manner that shall be distinguishable from an outline) or as an outline. See C.10.5.1.2. Enumerated Values: Y = yes N = no Required if Graphic Data (0070,0022) is "closed", that is Graphic Type (0070,0023) is CIRCLE or ELLIPSE, or Graphic Type (0070,0023) is POLYLINE or INTERPOLATED and the first data point is the same as the last data point.

How far to rotate the image clockwise in degrees, before any Image Horizontal Flip (0070,0041) is applied. Enumerated Values: 0, 90,180,270 Notes: Negative values are not permitted since the Value Representation is unsigned. Whether or not to flip the image horizontally after any Image Rotation has been applied such that the left side of the image becomes the right side. Enumerated Values: Y = yes, N = no Note: No vertical flip is specified since the same result can be achieved by a combination of a 180 degree rotation and a horizontal flip. A sequence of Items each of which represents a single layer in which overlays, curves, graphics or text may be rendered. One or more Items shall be present. An Item is required for each layer referenced from the Graphic Annotation Module or the Overlay Activation Module. A string which identifies the layer. Note: This identifier may be used by other Attributes within the same presentation state instance to reference this layer. There is no requirement for the same identifiers to be used in different presentation states, and there is no mechanism for referencing layers in other presentation states. That is, a UID is not required. An integer indicating the order in which it is recommended that the layer be rendered, if the display is capable of distinguishing. Lower numbered layers are to be rendered first. A default single gray unsigned value in which it is recommended that the layer be rendered on a monochrome display. The units are specified in P-Values from a minimum of 0000H (black) up to a maximum of FFFFH (white). Note: The maximum P-Value for this Attribute may be different from the maximum P-Value from the output of the Presentation LUT, which may be less than 16 bits in depth. A default color triplet value in which it is recommended that the layer be rendered on a color display. The units are specified in PCS-Values, and the value is encoded as CIELab. See C.10.7.1.1.

Attributes such as Graphic Layer Recommended Display CIELab Value (0070,0401) consist of three unsigned short values:

A free text description of the contents of this layer. A number that identifies this Waveform. The date the Waveform data was created. The time the Waveform data was created. The date and time that the acquisition of data that resulted in this waveform started; the reference timestamp for the Multiplex Group Time Offset (0018,1068) for a waveform multiplex group Note: The synchronization of this time with an external clock is specified in the Synchronization Module in Acquisition Time Synchronized (0018,1800). A sequence which provides reference to a set of SOP Class/Instance pairs significantly related to this Waveform. One or more Items may be included in this sequence. Code describing the purpose of the reference to the Instance(s). Only a single Item shall be permitted in this sequence. Sequence of one or more Items, each representing one waveform multiplex group. Ordering of Items in this Sequence is significant for external reference to specific multiplex groups. Offset time in milliseconds from a reference time (see C.10.9.1.1). Required if Acquisition Time Synchronized (0018,1800) value is Y; may be present otherwise. Offset time in milliseconds from a synchronization trigger to the first sample of a waveform multiplex group. May be positive or negative. Required if waveform acquisition is synchronized to a trigger. Sample number whose time corresponds to a synchronization trigger (see C.10.9.1.2). See C.10.9.1.3. Enumerated values: ORIGINAL DERIVED

Waveform Originality (003A,0004) shall have the value ORIGINAL if the Waveform Data samples are the original or source data, and shall have the value DERIVED if the Waveform Data samples have been derived in some manner from the sample data of other waveforms. Notes : 1. The Waveform Originality (003A,0004) attribute is comparable to the Image Type (0008,0008) attribute value 1 (see C.7.6.1.1.2). Within a single Multiplex Group, all channels shall have the same Originality value. 2. Waveform data which has been transcoded from a non-DICOM format may have Waveform Originality value ORIGINAL if the samples are unchanged from the originally acquired waveform samples.

Number of channels for this multiplex group. Number of samples per channel in this multiplex group. Frequency in Hz Label for multiplex group Sequence of one or more Items, with one Item per channel (see C.10.9.1.4). Ordering of Items in this Sequence is significant for reference to specific channels. Equipment physical channel number used for acquisition. Text label for channel which may be used for display purposes One or more values for the status of this channel within this SOP Instance. Defined terms: OK TEST DATA DISCONNECTED QUESTIONABLE INVALID UNCALIBRATED UNZEROED Precise location of a change in status may be noted in an Annotation. A coded descriptor of the waveform channel source (metric, anatomical position, function, and technique). Only a single Item shall be permitted in this sequence. (See C.10.9.1.4.1)

Channel Source Sequence (003A,0208) identifies the metric (quality being measured, e.g., voltage or pressure), the anatomical position of the sensor or probe, the function of the channel (e.g., measurement or stimulus), and any particulars of technique which affect those parameters (e.g., pull-back across multiple anatomic sites, or differential input from two distinct sites). If the full semantics of the source is not carried in a single coded entry (e.g., if it specifies the location but not the metric), additional qualifiers are identified in Channel Source Modifiers Sequence (003A,0209) coded entries. When a single sensor channel is used to collect a waveform from two (or more) anatomic sites, e.g., in hemodynamic pull-back procedures, multiple Channel Source Modifier items will identify the sequence of sites, if not encoded in the semantics of the Channel Source Coded Entry. Transition times from one site to another may be indicated with an Annotation, or pull-back rate may be indicated with an Acquisition Context Sequence Item (see Section C.7.6.14). The Baseline (default) Context IDs are defined by IOD in accordance with Section A.34. Restrictions in the IOD may also determine the pattern of specification of the waveform source, i.e., which item is to be encoded in the Channel Source sequence, and the order in which Channel Source Modifier items are to be encoded. Unless otherwise specified, pattern of specification of the waveform source shall be:

Sequence of one or more Items which further qualify the Waveform Source. Required if Channel Source Sequence (003A,0208) does not fully specify the semantics of the source. Ordering of Items in this Sequence may be semantically significant. A sequence which provides reference to a DICOM waveform from which this channel was derived. One or more Items may be included in this Sequence. Identifies the waveform multiplex group and channel within the referenced SOP Instance. Pair of values (M,C). Additional description of waveform channel derivation Nominal numeric value of unit quantity of sample. Required if samples represent defined (not arbitrary) units. A coded descriptor of the Units of measure for the Channel Sensitivity. Only a single Item shall be permitted in this sequence. (see C.10.9.1.4.2) Required if Channel Sensitivity (003A,0210) is present. Multiplier to be applied to encoded sample values to match units specified in Channel Sensitivity (003A,0210) (e.g., based on calibration data) (see C.10.9.1.4.2) Required if Channel Sensitivity (003A,0210) is present. Offset of encoded sample value 0 from actual 0 using the units defined in the Channel Sensitivity Units Sequence (003A,0211). Required if Channel Sensitivity (003A,0210) is present. Offset of first sample of channel from waveform multiplex group start time, in seconds (see C.10.9.1.4.3) Required if Channel Sample Skew is not present. Offset of first sample of channel from waveform multiplex group start time, in samples (see C.10.9.1.4.3) Required if Channel Time Skew is not present. Additional offset of first sample of channel to be used in aligning multiple channels for presentation or analysis, in seconds (see C.10.9.1.4.3) Number of significant bits within the waveform samples (see C.10.9.1.4.4) Nominal 3dB point of lower frequency of pass band; in Hz Nominal 3dB point of upper frequency of pass band; in Hz Center frequency of notch filter(s); in Hz Nominal 3dB bandwidth of notch filter(s); in Hz Minimum valid sample value as limited by the acquisition equipment (see C.10.9.1.4.5) Maximum valid sample value as limited by the acquisition equipment (see C.10.9.1.4.5) Size of each waveform data sample within the Waveform Data; see section C.10.9.1.5 Data representation of the waveform data points. See C.10.9.1.5.

Waveform Bits Allocated (5400,1004) specifies the number of bits allocated for each sample, and Waveform Sample Interpretation (5400,1006) specifies the data representation of each waveform sample. Waveform Bits Allocated shall be a multiple of 8. These data elements are related, and their defined terms are specified in Table C.10-10. Table C.10-10 Waveform Bits Allocated and Waveform Sample Interpretation Notes: 1. The set of valid values from within this table may be constrained by definition of the IOD (see Section A.34). 2. mu-law and A-law encoding is without the alternate bit inversion used for PCM transmission through the telephone network. This representation also applies to the Channel Minimum and Maximum Data Values, and Waveform Padding Value.

Value of waveform samples inserted in channels when input is absent or invalid. Required if acquisition equipment inserts padding. See C.10.9.1.6.

Equipment which produces digitized waveform curves may encode a specific value when the source is disconnected or otherwise invalid. This value is encoded like the Waveform Data attribute with one sample only. The Waveform Padding Value need not be within the range specified by the Channel Minimum and Maximum Data Values.

Encoded data samples - channel multiplexed See section C.10.9.1.7 The recommended time-based waveform data display scale in units of mm/s (see C.10.9.1.8). A color triplet value recommended for rendering the waveform display background on a color display. The units are specified in PCS-Values, and the value is encoded as CIELab. See C.10.7.1.1.

Attributes such as Graphic Layer Recommended Display CIELab Value (0070,0401) consist of three unsigned short values:

Sequence of Items, each Item describing a Presentation Group of one or more waveform channels to be displayed together. Note: A Presentation Group is conventionally denoted a "display page", and a waveform object may be rendered using several Presentation Groups under user display control. One or more Items may be present. A number that identifies the Presentation Group. Sequence of Items, each Item describing a channel to be displayed in the Presentation Group. One or more Items shall be present. Identifier of the displayed channel, specified as a pair of values (M,C) where the first value is the ordinal of the sequence item of the Waveform Sequence (5400,0100) attribute (i.e., the Multiplex Group Number), and the second value is the ordinal of the sequence item of the Channel Definition Sequence (003A,0200) attribute (i.e., the Waveform Channel Number) within the multiplex group. Note: In the context of a Channel Display Sequence (003A,0242) Item, only a single channel shall be referenced. The offset in seconds from the beginning of the channel waveform data to the first sample to be used for presentation. Value may be negative. A color triplet value recommended for rendering the channel on a color display. The units are specified in PCS-Values, and the value is encoded as CIELab. See C.10.7.1.1.

Attributes such as Graphic Layer Recommended Display CIELab Value (0070,0401) consist of three unsigned short values:

Position of the Channel within the Presentation Group display area (see C.10.9.1.9). Specifies display area shading between the displayed waveform channel and another line. The nature of the shading (e.g., solid, or cross-hatching) is implementation dependent. Enumerated Values: NONE - no shading BASELINE- shading between the waveform and the channel display baseline (sample value 0 equivalent location) ABSOLUTE - shading between the waveform and the channel real world actual value 0 (i.e., taking into account the Channel Baseline (003A,0213) value) DIFFERENCE - shading between the waveform and a second waveform in the Presentation Group at the same Channel Position that also has Display Shading Flag (003A,0246) value DIFFERENCE. Fraction of the Presentation Group vertical display dimension assigned to the unit quantity (least significant bit) of the Channel samples (see C.10.9.1.10). Required if Absolute Channel Display Scale (003A,0248) is not present, may be present otherwise. Nominal vertical display height in mm assigned to the unit quantity (least significant bit) of the Channel samples (see C.10.9.1.10). Required if Fractional Channel Display Scale (003A,0247) is not present, may be present otherwise. Sequence of Annotation Items; one or more items shall be present Text Observation Value (annotation). Mutually exclusive with Concept Name Code Sequence (0040,A043) Code representing the fully specified name of the NUMERIC measurement or CODED concept. This sequence shall contain exactly one item. Mutually exclusive with Text Value (0070,0006). A sequence of items modifying or specializing the Concept Name. One or more Items may be included in this Sequence. Required if Concept Name Code Sequence (0040,A043) is sent and the value does not fully describe the semantics of the measurement or concept. A sequence that conveys the categorical coded nominal value. This sequence shall contain exactly one item. A sequence of items modifying or specializing the Concept. One or more Items may be included in this Sequence. Required if Concept Code Sequence (0040,A168) is sent and the value does not fully describe the semantics of the concept value. Numeric measurement value or values. Units of measurement. Coded entry sequence with one item only. List of channels in waveform to which annotation applies. See C.10.10.1.1

Referenced Waveform Channels (0040,A0B0) is a multi-value attribute which lists the channels to which an annotation of a waveform applies. Each channel is specified as a pair of values (M,C), where the first value is the ordinal of the sequence item of the Waveform Sequence (5400,0100) attribute (i.e., the Multiplex Group Number), and the second value is the ordinal of the sequence item of the Channel Definition Sequence (003A,0200) attribute (i.e., the Waveform Channel Number) within the multiplex group. If the specified channel number is 0, the annotation applies to all channels in the multiplex group. Note: As an example, an annotation which applies to the entire first multiplex group and channels 2 and 3 of the third multiplex group would have Referenced Channels value 0001 0000 0003 0002 0003 0003.

See C.10.10.1.2 for Enumerated Values. Required if Annotation does not apply to entire Referenced Waveform Channels; shall not be present if Annotation applies to entire temporal extent of referenced channels.

The Temporal Range Type attribute (0040,A130) defines the type of temporal extent of the annotated region of interest. A temporal point (or instant of time) may be defined by a waveform sample offset (for a single waveform multiplex group only), time offset, or absolute time. The following terms are Enumerated Values for Temporal Range Type: POINT = a single temporal point MULTIPOINT = multiple temporal points SEGMENT = a range between two temporal points MULTISEGMENT = multiple segments, each denoted by two temporal points BEGIN = a range beginning at one temporal point, and extending beyond the end of the acquired data END = a range beginning before the start of the acquired data, and extending to (and including) the identified temporal point

List of samples within a multiplex group specifying temporal points for annotation. Position of first sample is 1. Required if Temporal Range Type (0040,A130) is present, and if Referenced Time Offsets (0040,A138) and Referenced DateTime (0040,A13A) are not present. See C.10.10.1.3

Referenced Sample Positions (0040,A132) may be used only if Referenced Waveform Channels (0040,A0B0) refers to channels within a single multiplex group. The sample position is by channel, and applies to all channels specified in Referenced Channels (0040,A0B0).

Specifies temporal points for annotation by number of seconds after start of data. Required if Temporal Range Type (0040,A130) is present, and if Referenced Sample Positions (0040,A132) and Referenced DateTime (0040,A13A) are not present. Specifies temporal points for annotation by absolute time. Required if Temporal Range Type (0040,A130) is present, and if Referenced Sample Positions (0040,A132) and Referenced Time Offsets (0040,A138) are not present. Number identifying associated annotations (see C.10.10.1.4). Defines a sequence of Modality LUTs. Only one Item may be present. Shall not be present if Rescale Intercept (0028,1052) is present. Specifies the format of the LUT Data in this Sequence. See C.11.1.1 for further explanation. Required if the Modality LUT Sequence (0028,3000) is sent.

Free form text explanation of the meaning of the LUT. Specifies the output values of this Modality LUT. See C.11.1.1.2 for further explanation. Required if the Modality LUT Sequence (0028,3000) is sent.

LUT Data in this Sequence. Required if the Modality LUT Sequence (0028,3000) is sent. The value b in relationship between stored values (SV) and the output units specified in Rescale Type (0028,1054). Output units = m*SV + b. Required if Modality LUT Sequence (0028,3000) is not present. Shall not be present otherwise. m in the equation specified by Rescale Intercept (0028,1052). Required if Rescale Intercept is present. Specifies the output units of Rescale Slope (0028,1053) and Rescale Intercept (0028,1052). See C.11.1.1.2 for further explanation. Required if Rescale Intercept is present.

Defines a sequence of VOI LUTs. One or more Items shall be present. Required if Window Center (0028,1050) is not present. May be present otherwise. Specifies the format of the LUT Data in this Sequence. See C.11.2.1.1 for further explanation.

The three values of the LUT Descriptor (0028,3002) describe the format of the LUT Data in the corresponding Data Element (0028,3006). The first value is the number of entries in the lookup table. When the number of table entries is equal to 216 then this value shall be 0. The second value is the first input value mapped. The Value Representation of the second value (US or SS) depends on the source of the input to the VOI LUT, and shall be: - the same as specified by Pixel Representation (0028,0103), if there is no Modality LUT or Rescale Slope and Intercept specified; - SS if the possible output range after application of the Rescale Slope and Intercept may be signed; Note: This is always the case for the CT Image IOD in which the Rescale Type is specified to be Hounsfield Units, which are always signed. - US otherwise. This input value is mapped to the first entry in the LUT. All input values less than the first value mapped are also mapped to the first entry in the LUT Data. An input value one greater than the first value mapped is mapped to the second entry in the LUT Data. Subsequent input values are mapped to the subsequent entries in the LUT Data up to an input value equal to number of entries + first value mapped - 1 which is mapped to the last entry in the LUT Data. Input values greater than or equal to number of entries + first value mapped are also mapped to the last entry in the LUT Data. The third value specifies the number of bits for each entry in the LUT Data. If the VOI LUT is included in an Image IOD, the third value of LUT Descriptor (0028,3002) shall be 8 or 16 bits, unless otherwise specialized. If the VOI LUT is included in a Presentation State IOD, the third value of LUT Descriptor (0028,3002) shall be between 8 and 16 inclusive. The LUT Data shall be stored in a format equivalent to 8 bits allocated when the number of bits for each entry is 8, and 16 bits allocated when the number of bits for each entry is 16, where in both cases the high bit is equal to bits stored - 1, and where bits stored is the third value. Notes: 1. Since the LUT Descriptor (0028,3002) Attribute is multi-valued, in an Explicit VR Transfer Syntax, only one value representation (US or SS) may be specified, even though the first and third values are always by definition interpreted as unsigned. The explicit VR actually used is dictated by the VR needed to represent the second value. 2. Some implementations have encoded 8 bit entries with 16 bits allocated, padding the high bits; this can be detected by comparing the number of entries specified in the LUT Descriptor with the actual value length of the LUT Data entry. The value length in bytes should equal the number of entries if bits allocated is 8, and be twice as long if bits allocated is 16. The LUT Data contains the LUT entry values. The output range is from 0 to 2n-1 where n is the third value of LUT Descriptor. This range is always unsigned.

Free form text explanation of the meaning of the LUT. LUT Data in this Sequence. Window Center for display. See C.11.2.1.2 for further explanation. Required if VOI LUT Sequence (0028,3010) is not present. May be present otherwise.

Window Width for display. See C.11.2.1.2 for further explanation. Required if Window Center (0028,1050) is sent.

Free form explanation of the meaning of the Window Center and Width. Multiple values correspond to multiple Window Center and Width values. Describes a VOI LUT function to apply to the values of Window Center (0028,1050) and Window Width (0028,1051). See C.11.2.1.3 for further explanation. Defined terms: LINEAR SIGMOID When this attribute is not present, the interpretation of the values of Window Center (0028,1050) and Window Width (0028,1051) is linear as in C.11.2.1.2.

Defines a sequence of Presentation LUTs. Only a single item shall be included in this sequence. Specifies the format of the LUT Data in this Sequence. Required if Presentation LUT Sequence (2050,0010) is sent. See C.11.4.1 for further explanation.

The three values of the LUT Descriptor (0028,3002) describe the format of the data in LUT Data (0028,3006). The first value is the number of entries in the lookup table. When the number of table entries is equal to 216 then this value shall be 0. The number of entries shall be equal to the number of possible values in the input. (For 8 bit input will be 256 entries, for 12 bit input it will be 4096 entries) The second value is the first input value mapped, and shall always be 0. The Value Representation of the second value is always US. This input value is mapped to the first entry in the LUT. Subsequent input values are mapped to the subsequent entries in the LUT Data up to an input value equal to number of entries + first value mapped - 1 which is mapped to the last entry in the LUT Data. There are no input values greater than number of entries – 1. The third value specifies the number of bits for each entry in the LUT Data. It shall be between 10 and 16 inclusive. The LUT Data shall be stored in a format equivalent to 16 bits allocated where the high bit is equal to bits stored - 1, where bits stored is the third value. Note: Since the LUT Descriptor (0028,3002) Attribute is multi-valued, in an Explicit VR Transfer Syntax, only one value representation (US or SS) may be specified. Since all three values are always by definition interpreted as unsigned, the explicit VR actually used will always be US. LUT Data (0028,3006) contains the LUT entry values, which are P-Values. The output range is from 0 to 2n-1 where n is the third value of LUT Descriptor. This range is always unsigned. This range specifies the output range of the P-Values.

Free form text explanation of the meaning of the LUT. LUT Data in this Sequence. Specifies pre-defined Presentation LUT shapes. Enumerated Values : IDENTITY = input to the Presentation LUT is in P-Values, no further translation is necessary. LIN OD = input to Presentation LUT is in linear optical density over the range of Min Density (2010,0120) and Max Density (2010,1030). Note: LIN OD is only defined for hardcopy devices and is not applicable to softcopy devices. Defines a sequence of Histograms. One or more Items may be included in this Sequence. The number of "bins" (entries) in the histogram. The stored pixel value corresponding to the lowest pixel value counted in the first bin. All image pixel values less than this value are not included in the histogram. Note: The Value Representation of this Attribute is determined by the value of Pixel Representation (0028,0103). The stored pixel value corresponding to the highest pixel value counted in the last bin. All image pixel values greater than this value are not included in the histogram. Note: The Value Representation of this Attribute is determined by the value of Pixel Representation (0028,0103). The number of consecutive stored pixel values included in a bin. All bins shall be of equal width. Free form text explanation of the meaning of the LUT. Histogram Data encoded as 32 bit unsigned counts of the number of pixel values in each bin. Defines a sequence of Presentation LUTs. Only a single item shall be included in this sequence. Required if Presentation LUT Shape (2050,0020) is absent. Specifies the format of the LUT Data in this Sequence. See C.11.6.1.1 for further explanation.

The three values of the LUT Descriptor (0028,3002) describe the format of the LUT Data in the corresponding Data Element (0028,3006). The first value is the number of entries in the lookup table. When the number of table entries is equal to 216 then this value shall be 0. The second value is the first implicitly scaled input value mapped, and shall always be 0. The Value Representation of the second value is always US. This implicitly scaled input value is mapped to the first entry in the LUT. There are no implicitly scaled input values less than the first value mapped. An implicitly scaled input value one greater than the first value mapped is mapped to the second entry in the LUT Data. Subsequent implicitly scaled input values are mapped to the subsequent entries in the LUT Data up to an implicitly scaled input value equal to number of entries + first value mapped - 1 which is mapped to the last entry in the LUT Data. There are no implicitly scaled input values greater than number of entries + first value mapped. The third value specifies the number of bits for each entry in the LUT Data. The third value of the LUT Descriptor (0028,3002) shall be between 8 and 16 inclusive. The LUT Data shall be stored in a format equivalent to 8 bits allocated when the number of bits for each entry is 8, and 16 bits allocated when the number of bits for each entry is 16, where the high bit is equal to bits stored - 1, and where bits stored is the third value. Notes: 1. Since the LUT Descriptor (0028,3002) Attribute is multi-valued, in an Explicit VR Transfer Syntax, only one value representation (US or SS) may be specified. Since all three values are always by definition interpreted as unsigned, the explicit VR actually used will always be US. 2. Some implementations have encoded 8 bit entries with 16 bits allocated, padding the high bits; this can be detected by comparing the number of entries specified in the LUT Descriptor with the actual value length of the LUT Data entry. The value length in bytes should equal the number of entries if bits allocated is 8, and be twice as long if bits allocated is 16. The LUT Data contains the LUT entry values, which are P-Values. The output range is from 0 to 2n-1 where n is the third value of LUT Descriptor. This range is always unsigned. This range specifies the output range of the P-Values.

Free form text explanation of the meaning of the LUT. LUT Data in this Sequence. Specifies predefined Presentation LUT transformation. Required if Presentation LUT Sequence (2050,0010) is absent. Enumerated Values: IDENTITY - no further translation necessary, input values are P-Values INVERSE - output values after inversion are P-Values See C.11.6.1.2.

A value of INVERSE shall mean the same as a value of IDENTITY, except that the minimum output value shall convey the meaning of the maximum available luminance, and the maximum value shall convey the minimum available luminance. In other words: P-Value = maximum value - output value

The layer (defined in Graphic Layer (0070,0002) of the Graphic Layer Module C.10.7) in which the Overlay described in group 60xx shall be displayed. If no layer is specified (zero length) then the overlay shall not be displayed. Required if Group 60xx is present in the referenced image(s) or the Presentation State instance containing this Module. Defines a sequence of VOI LUTs or Window Centers and Widths and to which images and frames they apply. No more than one VOI LUT Sequence containing a single Item or one pair of Window Center/Width values shall be specified for each image or frame. One or more Items shall be present. Sequence of Items where each Item provides reference to a selected set of Image SOP Class/SOP Instance pairs that are defined in the Presentation State Relationship Module, to which this VOI LUT or Window Center and Width applies. One or more Items shall be present. Required if the VOI LUT transformation in this Item does not apply to all the images and frames listed in the Presentation State Relationship Module. Type of equipment that originally acquired the data. Enumerated Value: PR = Presentation State See C.7.3.1.1.1.

Date on which this presentation was created. Note: This date may be different from the date that the DICOM SOP Instance was created, since the presentation state information contained may have been recorded earlier. Time at which this presentation was created. Note: This time may be different from the time that the DICOM SOP Instance was created, since the presentation state information contained may have been recorded earlier. Sequence of Items where each Item includes the Attributes of one Series to which the Presentation applies. One or more Items shall be present. Unique identifier of a Series that is part of the Study defined by the Study Instance UID (0020,000D) in the enclosing dataset. Note: The Study Instance UID (0020,000D) will be that of the presentation state itself, unless the macro is invoked from the Blending Sequence (0070,0402) in the Presentation State Blending Module, in which case it will be explicitly specified. Sequence of Items where each Item provides reference to a selected set of Image SOP Class/SOP Instance pairs to which the Presentation applies that are part of the Study defined by Study Instance UID (0020,000D) and the Series defined by Series Instance UID (0020,000E). One or more Items shall be present. The referenced SOP Class shall be the same for all Images in any Item of this Referenced Series Sequence (0008,1115). A single grayscale unsigned value used to replace those parts of the image occluded by the shutter, when rendered on a monochrome display. The units are specified in P-Values. Required if the Display Shutter Module or Bitmap Display Shutter Module is present. Note: The requirement in this module is type 1C which overrides the type 3 in the Display Shutter Module. A color triplet value used to replace those parts of the image occluded by the shutter, when rendered on a color display. The units are specified in PCS-Values, and the value is encoded as CIELab. See C.10.7.1.1. Required if the Display Shutter Module or Bitmap Display Shutter Module is present and the SOP Class is other than Grayscale Softcopy Presentation State Storage. Note: The requirement in this module is type 1C, which overrides the type 3 in the Display Shutter and Bitmap Display Shutter Modules.

Attributes such as Graphic Layer Recommended Display CIELab Value (0070,0401) consist of three unsigned short values:

Required if Mask Module is present. Only one Item shall be present. Applicable Frame Range (0028,6102) shall not be included in the Sequence Item. See C.7.6.10 for a complete definition of the Attributes in the Items of this Sequence other than Mask Operation(0028,6101) and Applicable Frame Range (0028,6102). Notes: 1. This Sequence is replicated here in order to specify one Item, additional conditions on Mask Operation (0028,6101) and to forbid Applicable Frame Range (0028,6102). 2. The role of Applicable Frame Range (0028,6102) is replaced by Referenced Frame Number (0008,1160).

Table C.7-16 specifies the Attributes that describe mask operations for a Multi-frame image. Table C.7-16 MASK MODULE ATTRIBUTES Note: Frame numbers begin at 1.

Type of mask operation to be performed Enumerated Values: AVG_SUB TID See C.7.6.10.1 for further explanation. Note: The requirement in this module is for Enumerated Values which override the requirements of the Mask Module.

Specified the number of contrast frames to average together before performing the mask operation. Required if Mask Frame Numbers (0028,6110) specifies more than one frame (i.e. is multi-valued). Note: The requirement in this module is conditional and overrides the optional requirements of the Mask Module. Specifies the recommended viewing protocol(s). Enumerated Value: SUB = for subtraction with mask images Required if Mask Subtraction Sequence (0028,6100) is present. Note: The requirement in this module is type 1C and an Enumerated Value is specified which override the requirements of the Mask Module. A Sequence of exactly two Items, one identifying and describing transformations upon a set of underlying grayscale images, and the other identifying and describing transformations upon a set of superimposed grayscale images. See C.11.14.1.1.

The Blending Sequence (0070,0402) Attribute is used to identify two sets of images, one to be superimposed upon the other. The sets of images and any subset of the frames therein in the case of multi-frame images are identified by Study, Series, SOP Instance and Frame Number. This module specifies no explicit relationship (such as pairing or ordering) between the sets of images and frames defined in the first item for the underlying images, and the second item for the superimposed images. This module does not define how the images are spatially related, and what re-sampling, if any, needs to be performed before the images are blended for rendering. Note: The images in the two sets may share the same Frame of Reference, in which case the rendering application can spatially relate the two sets of images based on their Image Position (Patient) (0020,0032) and Image Orientation (Patient) (0020,0037) Attributes. Alternatively, a Spatial Registration SOP Instance may exist that relates either two different Frames of Reference, or two sets of images identified by UID and frame. Whilst the two sets of images may already be spatially co-registered and oriented in the same plane, or even be sampled at the same in-plane and between-plane resolution, this will frequently not be the case. See PS 3.4 for behavioral requirements that apply to Storage SOP Classes using this Module.

Whether or not the contents of the Item represent the superimposed or underlying image set. Enumerated Values: SUPERIMPOSED UNDERLYING Unique identifier for the Study that contains the images, which may differ from the Study in which the presentation state is contained. Defines a sequence of VOI LUTs or Window Centers and Widths and to which images and frames they apply. No more than one VOI LUT Sequence containing a single Item or one pair of Window Center/Width values shall be specified for each image or frame. One or more Items shall be present. Required if a VOI LUT is to be applied to referenced image(s). Sequence of Items identifying images that are defined in the enclosing Item of the Blending Sequence (0070,0402), to which this VOI LUT or Window Center and Width applies. One or more Items shall be present. Required if the VOI LUT transformation in this Item does not apply to all the images and frames in the enclosing Item of the Blending Sequence (0070,0402). A value from 0.0 to 1.0 indicating the relative opacity of the pixels of the superimposed image, where 1.0 means that pixels of the superimposed image completely replace the pixels of the underlying image, and 0.0 means that the pixels of the underlying image completely replace the pixels of the superimposed image. See PS 3.4 for a detailed description of the blending operation. A reference to Spatial Registration Instances that may be used to register the underlying and superimposed images. Zero or more Items may be present. Note: A Spatial Registration Instance may identify registration between frames of reference, or between explicitly identified images. In the latter case, the list of images referenced by the Presentation State, not the list of images referenced by the Spatial Registration Instance, are to be blended. An ICC Profile encoding the transformation of device-dependent color stored pixel values into PCS-Values. Uniquely identifies the SOP Class. See C.12.1.1.1 for further explanation. See also PS 3.4.

The SOP Class UID and SOP Instance UID Attributes are defined for all DICOM IODs. However, they are only encoded in Composite IODs with the Type equal to 1. See C.1.2.3. When encoded they shall be equal to their respective Attributes in the DIMSE Services and the File Meta Information header (see PS 3.10 Media Storage).

Uniquely identifies the SOP Instance. See C.12.1.1.1 for further explanation. See also PS 3.4.

Character Set that expands or replaces the Basic Graphic Set. Required if an expanded or replacement character set is used. See C.12.1.1.2 for Defined Terms.

Specific Character Set (0008,0005) identifies the Character Set that expands or replaces the Basic Graphic Set (ISO 646) for values of Data Elements that have Value Representation of SH, LO, ST, PN, LT or UT. See PS 3.5. If the Attribute Specific Character Set (0008,0005) is not present or has only a single value, Code Extension techniques are not used. Defined terms for the Attribute Specific Character Set (0008,0005), when single valued, are derived from the International Registration Number as per ISO 2375 (e.g., ISO_IR 100 for Latin alphabet No. 1). See Table C.12-2. Table C.12-2 DEFINED TERMS FOR SINGLE-BYTE CHARACTER SETS WITHOUT CODE EXTENSIONS Note: To use the single-byte code table of JIS X0201, the value of attribute Specific Character Set (0008,0005), value 1 should be ISO_IR 13. This means that ISO-IR 13 is designated as the G1 code element which is invoked in the GR area. It should be understood that, in addition, ISO-IR 14 is designated as the G0 code element and this is invoked in the GL area. If the attribute Specific Character Set (0008,0005) has more than one value, Code Extension techniques are used and Escape Sequences may be encountered in all character sets. Requirements for the use of Code Extension techniques are specified in PS 3.5. In order to indicate the presence of Code Extension, the Defined Terms for the repertoires have the prefix “ISO 2022”, e.g., ISO 2022 IR 100 for the Latin Alphabet No. 1. See Table 12-3 and Table 12-4. Table 12-3 describes single-byte character sets for value 1 to value n of the attribute Specific Character Set (0008,0005), and Table 12-4 describes multi-byte character sets for value 2 to value n of the attribute Specific Character Set (0008,0005). Note: A prefix other than “ISO 2022” may be needed in the future if other Code Extension techniques are adopted. Table C.12-3 DEFINED TERMS FOR SINGLE-BYTE CHARACTER SETS WITH CODE EXTENSIONS Note: If the attribute Specific Character Set (0008,0005) has more than one value and value 1 is empty, it is assumed that value 1 is ISO 2022 IR 6. Table C.12-4 DEFINED TERMS FOR MULTI-BYTE CHARACTER SETS WITH CODE EXTENSIONS There are multi-byte character sets that prohibit the use of Code Extension Techniques. The Unicode character set used in ISO 10646, when encoded in UTF-8, and the GB18030 character set, encoded per the rules of GB18030, both prohibit the use of Code Extension Techniques. These character sets may only be specified as value 1 in the Specific Character Set (0008,0005) attribute and there shall only be one value. The minimal length UTF-8 encoding shall always be used for ISO 10646. Notes: 1. The ISO standards for 10646 now prohibit the use of anything but the minimum length encoding for UTF-8. UTF-8 permits multiple different encodings, but when used to encode Unicode characters in accordance with ISO 10646-1 and 10646-2 (with extensions) only the minimal encodings are legal. 2. The representation for the characters in the DICOM Default Character Repertoire is the same single byte value for the Default Character Repertoire, ISO 10646 in UTF-8, and GB18030. It is also the 7-bit US-ASCII encoding. Table C.12-5 DEFINED TERMS FOR MULTI-BYTE CHARACTER SETS WITHOUT CODE EXTENSIONS

Date the SOP Instance was created. Time the SOP Instance was created. Uniquely identifies device which created the SOP Instance. Uniquely identifies a Related General SOP Class for the SOP Class of this Instance. See PS 3.4. The SOP Class in which the Instance was originally encoded, but which has been replaced during a fall-back conversion to the current Related General SOP Class. See PS 3.4. Sequence of items that map values of Coding Scheme Designator (0008,0102) to an external coding system registration, or to a private or local coding scheme. One or more items may be present in the sequence. The value of a Coding Scheme Designator, used in this SOP Instance, which is being mapped. The name of the external registry where further definition of the identified coding scheme may be obtained. Required if coding scheme is registered. Defined term: HL7 The coding scheme UID identifier. Required if coding scheme is identified by an ISO 8824 object identifier compatible with the UI VR. The coding scheme identifier as defined in an external registry. Required if coding scheme is registered and Coding Scheme UID (0008,010C) is not present. The coding scheme full common name The coding scheme version associated with the Coding Scheme Designator (0008,0102). Name of the organization responsible for the Coding Scheme. May include organizational contact information. Contains the offset from UTC to the timezone for all DA and TM Attributes present in this SOP Instance, and for all DT Attributes present in this SOP Instance that do not contain an explicitly encoded timezone offset. Encoded as an ASCII string in the format "&ZZXX". The components of this string, from left to right, are & = "+" or "-", and ZZ = Hours and XX = Minutes of offset. Leading space characters shall not be present. The offset for UTC shall be +0000; -0000 shall not be used. Notes: 1. This encoding is the same as described in PS 3.5 for the offset component of the DT Value Representation. 2. This Attribute does not apply to values with a DT Value Representation, that contains an explicitly encoded timezone offset. 3. The corrected time may cross a 24 hour boundary. For example, if Local Time = 1.00 a.m. and Offset = +0200, then UTC = 11.00 p.m. (23.00) the day before. 4. The "+" sign may not be omitted. Time earlier than UTC is expressed as a negative offset. Note: For example: UTC = 5.00 a.m. Local Time = 3.00 a.m. Offset = -0200 The local timezone offset is undefined if this Attribute is absent. Sequence of Items containing descriptive attributes of related equipment which has contributed to the acquisition, creation or modification of the composite instance. One or more Items may be included in this Sequence. See C.12.1.1.5 for further explanation.

Contributing Equipment Sequence (0018,A001) allows equipment to be described which has contributed towards the creation of the composite instance. The general class of contribution is denoted via a coded entry within the Purpose of Reference Code Sequence (0040,A170). Notes: 1. For example, a post-processing application creating DERIVED images from ORIGINAL images would place its own identification within the Equipment Module and identify the original acquisition equipment as an Item within the Contributing Equipment Sequence (0018,A001). Here, the value of the Purpose of Reference Code Sequence (0040,A170) within the Item would be (109101, DCM, ”Acquisition Equipment"). Image display applications wishing to annotate images with information related to the acquisition environment would prefer to extract such details from the Contributing Equipment Sequence rather than the Equipment Module. 2. For example, an image fusion application would place its own identification within the Equipment Module and identify each of the original acquisition equipment as separate Items within the Contributing Equipment Sequence (0018,A001). Here, the value of the Purpose of Reference Code Sequence (0040,A170) within each Item would be (109101, DCM, ”Acquisition Equipment"). 3. For example, a post-processing application creating DERIVED images from other DERIVED images would place its own identification within the Equipment Module and add the source equipment as an additional Item within the Contributing Equipment Sequence (0018,A001). Here, the value of the Purpose of Reference Code Sequence (0040,A170) within the Item would be (109102, DCM, ”Processing Equipment"). 4. For example, a gateway device that coerces attributes of existing composite instances (without creating new composite instances) would retain information about the creating equipment within the Equipment Module and provide its own identification as an Item within the Contributing Equipment Sequence (0018,A001). Here, the value of the Purpose of Reference Code Sequence (0040,A170) within the Item would be (109103, DCM, ”Modifying Equipment").

Describes the purpose for which the related equipment is being reference. Only a single Item shall be permitted in this sequence. See C.12.1.1.5 for further explanation.

Manufacturer of the equipment that contributed to the composite instance. Institution where the equipment that contributed to the composite instance is located. Address of the institution where the equipment that contributed to the composite instance is located. User defined name identifying the machine that contributed to the composite instance. Department in the institution where the equipment that contributed to the composite instance is located. Manufacturer's model name of the equipment that contributed to the composite instance. Manufacturer's serial number of the equipment that contributed to the composite instance. Manufacturer's designation of the software version of the equipment that contributed to the composite instance. The inherent limiting resolution in mm of the acquisition equipment for high contrast objects for the data gathering and reconstruction technique chosen. If variable across the images of the series, the value at the image center. Date when the image acquisition device calibration was last changed in any way. Multiple entries may be used for additional calibrations at other times. See C.7.5.1.1.1 for further explanation.

Date of Last Calibration (0018,1200) and Time of Last Calibration (0018,1201) are used to convey the date and time of calibration. The Attribute Date of Last Calibration (0018,1200) may be supported alone, however, Time of Last Calibration (0018,1201) Attribute has no meaning unless Attribute Date of Last Calibration (0018,1200) is also supported. The order for each Attribute shall be from the oldest date/time to the most recent date/time. When the Attributes are both supported they shall be provided as pairs.

Time when the image acquisition device calibration was last changed in any way. Multiple entries may be used. See C.7.5.1.1.1 for further explanation.

The Date & Time when the equipment contributed to the composite instance. Description of the contribution the equipment made to the composite instance. A number that identifies this Composite object instance. A flag that indicates the storage status of the SOP Instance. Not Specified (NS) implies that this SOP Instance has no special storage status, and hence no special actions need be taken. Original (OR) implies that this is the primary SOP instance for the purpose of storage, but that it has not yet been authorized for diagnostic use. Authorized Original (AO) implies that this is the primary SOP instance for the purpose of storage, which has been authorized for diagnostic use. Any copies of an Authorized Original should be given the status of Authorized Copy. Authorized Copy (AC) implies that this is a copy of an Authorized Original SOP Instance. Enumerated Values: NS, OR, AO, AC Note: Proper use of these flags is specified in Security Profiles. Implementations that do not conform to such Security Profiles may not necessarily handle these flags properly. The date and time when the SOP Instance Status (0100,0410) was set to AO. Any comments associated with the setting of the SOP Instance Status (0100,0410) to AO. The certification number issued to the Application Entity that set the SOP Instance Status (0100,0410) to AO. Sequence of Items containing encrypted DICOM data. One or more Items shall be present. Required if application level confidentiality is needed and certain recipients are allowed to decrypt all or portions of the Encrypted Attributes Data Set. See C.12.1.1.4.1.

Each Item of the Encrypted Attributes Sequence (0400,0500) contains an encrypted DICOM dataset containing a single instance of the Encrypted Attributes Data Set (Table C.12-7). It also contains encrypted content-encryption keys for one or more recipients. The encoding is based on the Enveloped-data Content Type of the Cryptographic Message Syntax defined in RFC 2630. It allows to encrypt the embedded Data Set for an arbitrary number of recipients using any of the three key management techniques supported by RFC 2630:

Transfer Syntax used to encode the encrypted content. Only Transfer Syntaxes that explicitly include the VR and use Little Endian encoding shall be used. Encrypted data. See C.12.1.1.4.2.

The Encrypted Content (0400,0520) Attribute contains an Enveloped-data content type of the cryptographic message syntax defined in RFC 2630. The encrypted content of the Enveloped-data content type is an instance of the Encrypted Attributes Data Set as shown in Table C.12-7 (i.e., it is a Sequence with a single Item), encoded with the Transfer Syntax specified by the Encrypted Content Transfer Syntax UID (0400,0510) Attribute. Figure C.12-2 shows an example of how the Encrypted Content is encoded. The exact use of this Data Set is defined in the Attribute Confidentiality Profiles in PS 3.15. Since the de-identified SOP Instance is a significantly altered version of the original Data Set, it is a new SOP Instance, with a SOP Instance UID that differs from the original Data Set. Note: 1. Content encryption may require that the content (the DICOM Data Set) be padded to a multiple of some block size. This shall be performed according to the Content-encryption Process defined in RFC-2630. 2. Any standard or private Transfer Syntax may be specified in Encrypted Content Transfer Syntax UID (0400,0510) unless encoding is performed in accordance with an Attribute Confidentiality Profile that specifies additional restrictions. In general, an application entity decoding the Encrypted Attributes Sequence may not assume any particular Transfer Syntax or set of Transfer Syntaxes to be used with Encrypted Content Transfer Syntax UID (0400,0510). 3. For certain applications it might be necessary to “blacken” (remove) identifying information that is burned in to the image pixel data. The Encrypted Attributes Data Set does not specify a means of restoring the original image information without the complete image pixel data being encoded inside the Modified Attributes Sequence (0400,0550). If access to the original, unmodified pixel data is required and the image pixel data cannot be replicated inside the Modified Attributes Sequence (0400,0550) due to resource considerations, the SOP Instance UID may be used to locate the original SOP Instance from which the de-identified version was derived. 4. There is no guarantee that the original SOP Instance can be reconstructed from the data in Encrypted Content. If access to the original data is required, the (de-encrypted) UIDs may be used to locate the original SOP Instance from which the de-identified version was derived. Table C.12-7 ENCRYPTED ATTRIBUTES DATA SET ATTRIBUTES

Sequence of Items containing all attributes that were removed or replaced by other values in the main dataset. One or more Items may be permitted in this sequence. The source that provided the SOP Instance prior to the removal or replacement of the values. For example, this might be the Institution from which imported SOP Instances were received. Date and time the attributes were removed and/or replaced. Identification of the system which removed and/or replaced the attributes. Reason for the attribute modification. Defined terms are: COERCE = Replace values of attributes such as Patient Name, ID, Accession Number, for example, during import of media from an external institution, or reconciliation against a master patient index. CORRECT = Replace incorrect values, such as Patient Name or ID, for example, when incorrect worklist item was chosen or operator input error. Sequence containing a single item that contains all the Attributes, with their previous values, that were modified or removed from the main data set. Sequence of items defining mapping and/or access mechanism for HL7 Structured Documents referenced from the current SOP Instance. One or more Items may be included in this sequence. See C.12.1.1.6. Required if HL7 Structured Documents are referenced within the Instance.

The HL7 Structured Document Reference Sequence (0040,A390) identifies instances of Structured Documents defined under an HL7 standard. The HL7 standards that define such documents include the Clinical Document Architecture (CDA) and Structured Product Labeling (SPL) standards. References to HL7 Structured Documents from within DICOM SOP Instances shall be encoded with a SOP Class UID and SOP Instance UID pair. The Abstract Syntax of an HL7 Structured Document is defined by its Hierarchical Message Description; the Object Identifier of the Hierarchical Message Description shall be used as the SOP Class UID for the Structured Document reference. Notes: 1. The Hierarchical Message Description Object Identifiers are specified in the HL7 OID Registry (http://hl7.org/oid). The HL7 OIDs for these types of documents are: CDA Release 1 2.16.840.1.113883.1.7.1 CDA Release 2 2.16.840.1.113883.1.7.2 SPL Release 1 2.16.840.1.113883.1.7.3 2. The Hierarchical Message Description Object Identifiers do not imply a network or media storage service, as do SOP Class UIDs. However, they do identify the Abstract Syntax, similar to SOP Class UIDs. The HL7 Structured Document instances are natively identified by an attribute using the Instance Identifier (II) Data Type, as defined in HL7 v3 Data Types - Abstract Specification. A UID as defined by the DICOM UI Value Representation is a valid identifier under the II Data Type; however, an II attribute is not always encodable as a UID. Therefore a UID shall be constructed for use within the DICOM Data Set that can be mapped to the native instance identifier encoded as an HL7 II Data Type. This mapping is performed through the combination of the local Referenced SOP Instance UID (0008,1155) and the HL7 Instance Identifier (0040,E001) attributes in the HL7 Structured Document Reference Sequence (0040,A390). Notes: 1. An HL7 II is not encodable as a UID if it exceeds 64 characters, or if it includes an extension. See HL7 v3 DT R1. 2. Even though an II may contain just a UID, applications should take care to use the II specified in HL7 Instance Identifier (0040,E001) to access the Structured Document. If the instance identifier used natively within the referenced document is encodable using the UI VR, i.e., it is an ISO 8824 OID up to 64 characters without an extension, it is recommended to be used as the Referenced SOP Instance UID within the current Instance. 3. The Referenced SOP Instance UID used to reference a particular HL7 Structured Document is not necessarily the same in all DICOM Instances. For example, two SR Documents may internally use different SOP Instance UIDs to reference the same HL7 Structured Document, but they will each contain a mapping to the same HL7 Instance Identifier as the external identifier. 4. The HL7 Instance Identifier is encoded in attribute (0040,E001) as a serialization of the UID and Extension (if any) separated by a caret character. This is the same format adopted in the IHE Cross-Enterprise Document Sharing (XDS) profile (see http://www.ihe.net). 5. See Figure C.12-3. Figure C.12-3 HL7 Structured Document References

Unique identifier for the class of HL7 Structured Document. Unique identifier for the HL7 Structured Document as used in DICOM instance references. Instance Identifier of the referenced HL7 Structured Document, encoded as a UID (OID or UUID), concatenated with a caret ("^") and Extension value (if Extension is present in Instance Identifier). Retrieval access path to HL7 Structured Document. Includes fully specified scheme, authority, path, and query in accordance with RFC 2396 A sequence of one or more items that describe the parameters used to calculate a MAC for use in Digital Signatures. A number, unique within this SOP Instance, used to identify this MAC Parameters Sequence (4FFE,0001) item from an Item of the Digital Signatures Sequence (FFFA,FFFA). The Transfer Syntax UID used to encode the values of the Data Elements included in the MAC calculation. Only Transfer Syntaxes that explicitly include the VR and use Little Endian encoding shall be used. Notes: Certain Transfer Syntaxes, particularly those that are used with compressed data, allow the fragmentation of the pixel data to change. If such fragmentation changes, Digital Signatures generated with such Transfer Syntaxes could become invalid. The algorithm used in generating the MAC to be encrypted to form the Digital Signature. Defined Terms: RIPEMD160 MD5 SHA1 . Note: Digital Signature Security Profiles (see PS 3.15) may require the use of a restricted subset of these terms. A list of Data Element Tags in the order they appear in the Data Set which identify the Data Elements used in creating the MAC for the Digital Signature. See Section C.12.1.1.3.1.1.

The Data Elements Signed Attribute shall list the Tags of the Data Elements that are included in the MAC calculation. The Tags listed shall reference Data Elements at the same level as the Mac Parameters Sequence (4FFE,0001) Data Element in which the Data Elements Signed Attribute appears. Tags included in Data Elements Signed shall be listed in the order in which they appear within the Data Set. The following Data Elements shall not be included either implicitly or explicitly in the list of Tags in Data Elements Signed, nor included as part of the MAC calculation:

Sequence holding Digital Signatures. One or more items may be included in this sequence. A number used to identify which MAC Parameters Sequence item was used in the calculation of this Digital Signature. A UID that can be used to uniquely reference this signature. The date and time the Digital Signature was created. The time shall include an offset (i.e., time zone indication) from Coordinated Universal Time. Note: This is not a certified timestamp, and hence is not completely verifiable. An application can compare this date and time with those of other signatures and the validity date of the certificate to gain confidence in the veracity of this date and time. The type of certificate used in (0400,0115). Defined Term: X509_1993_SIG Note: Digital Signature Security Profiles (see PS 3.15) may require the use of a restricted subset of these terms. A certificate that holds the identity of the entity producing this Digital Signature, that entity's public key or key identifier, and the algorithm and associated parameters with which that public key is to be used. Algorithms allowed are specified in Digital Signature Security Profiles (see PS 3.15). Notes: 1. As technology advances, additional encryption algorithms may be allowed in future versions. Implementations should take this possibility into account. 2. When symmetric encryption is used, the certificate merely identifies which key was used by which entity, but not the actual key itself. Some other means (e.g., a trusted third party) must be used to obtain the key. The MAC generated as described in Section C.12.1.1.3.1.1 and encrypted using the algorithm, parameters, and private key associated with the Certificate of the Signer (0400,0115). See Section C.12.1.1.3.1.2.

To generate the MAC, Data Elements referenced either explicitly or implicitly by the Tags in the Data Elements Signed list shall be encoded using the Transfer Syntax identified by the MAC Calculation Transfer Syntax UID (0400,0010) of the MAC Parameters Sequence item where the Data Elements Signed Attribute appears. Data shall be formed into a byte stream and presented to the MAC Algorithm for computation of the MAC according to the following rules: For all Data Elements except those with a VR of SQ or with a VR of OB with an undefined length, all Data Element fields, including the Tag, the VR, the reserved field (if any), the Value Length, and the Value, shall be placed into the byte stream in the order encountered. For Data Elements with a VR of SQ or with a VR of OB with an undefined length, the Tag, the VR, and the reserved field are placed into the byte stream. The Value Length shall not be included. This is followed by each Item Tag in the order encountered, without including the Value Length, followed by the contents of the Value for that item. In the case of an Item within a Data Element whose VR is SQ, these rules are applied recursively to all of the Data Elements within the Value of that Item. After all the Items have been incorporate into the byte stream, a Sequence Delimitation Item Tag (FFFE,E0DD) shall be added to the byte stream presented to the MAC Algorithm, regardless of whether or not it was originally present. Note: Since the Value Length of Data Elements with a VR of SQ can be either explicit or undefined, the Value Lengths of such Data Elements are left out of the MAC calculation. Similarly, the Value Length of Data Elements with a VR of OB with an undefined length are also left out so that they are handled consistently. If such Data Elements do come with undefined lengths, including the Item Tags that separate the Items or fragments insures that Data Elements cannot be moved between Items or Fragments without compromising the Digital Signature. For those Data Elements with explicit lengths, if the length of an item changes, the added or removed portions would also impact the MAC calculation, so it is not necessary to include explicit lengths in the MAC calculation. It is possible that including the Value Lengths could make cryptoanalysis easier. After the fields of all the Data Elements in the Data Elements Signed list have been placed into the byte stream presented to the MAC Algorithm according to the above rules, all of the Data Elements within the Digital Signatures Sequence item except the Certificate of Signer (0400,0115), Signature (0400,0120), Certified Timestamp Type (0400,0305), and Certified Timestamp (0400,0310) shall also be encoded according to the above rules, and presented to the MAC algorithm (i.e., the Attributes of the Digital Signature Sequence Item for this particular Digital Signature are also implicitly included in the list of Data Elements Signed, except as noted above). The resulting MAC code after processing this byte stream by the MAC Algorithm is then encrypted as specified in the Certificate of Signer and placed in the Value of the Signature Data Element. Notes: 1. The Transfer Syntax used in the MAC calculation may differ from the Transfer Syntax used to exchange the Data Set. 2. Digital Signatures require explicit VR in order to calculate the MAC. An Application Entity which receives a Data Set with an implicit VR Transfer Syntax may not be able to verify Digital Signatures that include Private Data Elements or Data Elements unknown to that Application Entity.This also true of any Data Elements whose VR is UN. Without knowledge of the Value Representation, the receiving Application Entity would be unable to perform proper byte swapping or be able to properly parse sequences in order to generate a MAC. 3. If more than one entity signs, each Digital Signature would appear in its own Digital Signatures Sequence item. The Digital Signatures may or may not share the same MAC Parameters Sequence item. 4. The notion of a notary public (i.e., someone who verifies the identity of the signer) for Digital Signatures is partially filled by the authority that issued the Certificate of Signer.

The type of certified timestamp used in the Certified Timestamp (0400,0310) Attribute. Required if Certified Timestamp (0400,0310) is present. Defined Terms: CMS_TSP - Internet X.509 Public Key Infrastructure Time Stamp Protocol Note: Digital Signature Security Profiles (see PS 3.15) may require the use of a restricted subset of these terms. A certified timestamp of the Digital Signature (0400,0120) Attribute Value, which shall be obtained when the Digital Signature is created. See Section C.12.1.1.3.1.3.

To generate a certified timestamp, the Value of the Signature (0400,0120) Attribute is sent to a third party, as specified by the protocol referred to by the Certified Timestamp Type (0400,0305) Attribute. The third party then generates and returns a certified timestamp in the form specified by that protocol. The certified timestamp returned by the third party is encoded as a stream of bytes in the Certified Timestamp Attribute. Note: The timestamp protocol may be specified by a Profile in PS 3.15.

The purpose of this Digital Signature. Only a single Item shall be permitted in this sequence. Sequence of Items containing all Attributes that were removed or replaced by "dummy values" in the main dataset during de-identification of the SOP instance. Upon reversal of the de-identification process, the Attributes are copied back into the main dataset, replacing any dummy values that might have been created. Only a single Item shall be present. Sequence of items each identifying a Study other than the Study of which this Instance is a part, which Studies contain Instances that are referenced elsewhere in this Instance. One or more Items shall be present. Required if this Instance references Instances in other Studies. Unique identifier of the Study containing the referenced Instances. Number of copies to be printed for each film of the film session. Specifies the priority of the print job. Enumerated Values: HIGH MED LOW Type of medium on which the print job will be printed. Defined Terms: PAPER CLEAR FILM BLUE FILM MAMMO CLEAR FILM MAMMO BLUE FILM Film destination. Defined Terms: MAGAZINE = the exposed film is stored in film magazine PROCESSOR = the exposed film is developed in film processor BIN_i = the exposed film is deposited in a sorter bin where "I" represents the bin number. Film sorter BINs shall be numbered sequentially starting from one and no maxiumu is placed on the number of BINs. The encoding of the BIN number shall not contain leading zeros. Human readable label that identifies the film session Amount of memory allocated for the film session. Value is expressed in KB Identification of the owner of the film session A Sequence which provides references to a set of Film Box SOP Class/Instance pairs. Zero or more Items may be included in this Sequence. Type of image display format. Enumerated Values: STANDARD\C,R : film contains equal size rectangular image boxes with R rows of image boxes and C columns of image boxes; C and R are integers. ROW\R1,R2,R3, etc. : film contains rows with equal size rectangular image boxes with R1 image boxes in the first row, R2 image boxes in second row, R3 image boxes in third row, etc.; R1, R2, R3, etc. are integers. COL\C1,C2,C3, etc.: film contains columns with equal size rectangular image boxes with C1 image boxes in the first column, C2 image boxes in second column, C3 image boxes in third column, etc.; C1, C2, C3, etc. are integers. SLIDE : film contains 35mm slides; the number of slides for a particular film size is configuration dependent. SUPERSLIDE : film contains 40mm slides; the number of slides for a particular film size is configuration dependent. CUSTOM\i : film contains a customized ordering of rectangular image boxes; i identifies the image display format; the definition of the image display formats is defined in the Conformance Statement; i is an integer Identification of annotation display format. The definition of the annotation display formats and the annotation box position sequence are defined in the Conformance Statement Film orientation. Enumerated Values: PORTRAIT = vertical film position LANDSCAPE = horizontal film position Film size identification. Defined Terms: 8INX10IN 8_5INX11IN 10INX12IN 10INX14IN 11INX14IN 11INX17IN 14INX14IN 14INX17IN 24CMX24CM 24CMX30CM A4 A3 Note: 10INX14IN corresponds with 25.7CMX36.4CM A4 corresponds with 210 x 297 millimeters A3 corresponds with 297 x 420 millimeters Interpolation type by which the printer magnifies or decimates the image in order to fit the image in the image box on film. Defined Terms: REPLICATE BILINEAR CUBIC NONE Further specifies the type of the interpolation function. Values are defined in Conformance Statement. Only valid for Magnification Type (2010,0060) = CUBIC Density of the film areas surrounding and between images on the film. Defined Terms: BLACK WHITE i where i represents the desired density in hundredths of OD (e.g. 150 corresponds with 1.5 OD) Density of the image box area on the film that contains no image. Defined Terms: BLACK WHITE i where i represents the desired density in hundredths of OD (e.g. 150 corresponds with 1.5 OD) Minimum density of the images on the film, expressed in hundredths of OD. If Min Density is lower than minimum printer density than Min Density is set to minimum printer density. Maximum density of the images on the film, expressed in hundredths of OD. If Max Density is higher than maximum printer density than Max Density is set to maximum printer density. Specifies whether a trim box shall be printed surrounding each image on the film. Enumerated Values: YES NO Character string that contains either the ID of the printer configuration table that contains a set of values for implementation specific print parameters (e.g. perception LUT related parameters) or one or more configuration data values, encoded as characters. If there are multiple configuration data values encoded in the string, they shall be separated by backslashes. The definition of values shall be contained in the SCP's Conformance Statement. Defined Terms: CS000-CS999: Implementation specific curve type. Note: It is recommended that for SCPs, CS000 represent the lowest contrast and CS999 the highest contrast levels available. Luminance of lightbox illuminating a piece of transmissive film, or for the case of reflective media, luminance obtainable from diffuse reflection of the illumination present. Expressed as L0, in candelas per square meter (cd/m2). For transmissive film, luminance contribution due to reflected ambient light. Expressed as La, in candelas per square meter (cd/m2). Specifies the resolution at which images in this Film Box are to be printed. Defined Terms: STANDARD = approximately 4k x 5k printable pixels on a 14 x 17 inch film HIGH = Approximately twice the resolution of STANDARD. An ICC Profile encoding the transformation of device-dependent color stored pixel values into PCS-Values. See C.11.15. Note. This is an Input Device Profile that describes the characteristics of the pixel data in the film box, not an Output Device Profile that might describe the characteristics of the Print SCP.

Table C.11.15-1 contains Attributes that identify and describe an ICC Profile. Table C.11.15-1 ICC PROFILE MODULE ATTRIBUTES

A sequence which provides references to a Film Session SOP Class/Instance pairs. Only a single Item shall be permitted in this Sequence. A sequence which provides references to a set of Image Box SOP Class/Instance pairs. One or more Items may be included in this Sequence. A Sequence which provides references to a set of Basic Annotation Box SOP Class/Instance pairs. Zero or more Items may be included in this Sequence. A sequence which provides references to a Presentation LUT related SOP Class/Instance pairs. Only a single Item shall be included in this sequence. The position of the image on the film, based on Image Display Format (2010,0010). See C.13.5.1 for specification.

The position of the image on the film; the encoding of the image position sequence is based on the selected Image Display Format (2010,0010). The image position sequence shall be increasing order beginning with the value 1. Image Box Position (2020,0010) is defined as follows: - STANDARD display format: image box sequence shall be major row order (from left-to-right and from top-to-bottom); top left image position shall be equal to 1. - ROW display format: image box sequence shall be major row order (from left-to-right and from top-to-bottom); top left image position shall be set to 1. - COL display format: image box sequence shall be major column order (from top-to-bottom and from left-to-right); top left image position shall be equal to 1. - SLIDE display format: image box sequence shall be major row order (from left-to-right and from top-to-bottom); top left image position shall be set to 1. - SUPERSLIDE display format: image box sequence shall be major row order (from left-to-right and from top-to-bottom); top left image position shall be set to 1. - CUSTOM STANDARD display format: image box sequence shall be defined in the Conformance Statement; top left image position shall be set to 1.

Specifies whether minimum pixel values (after VOI LUT transformation) are to printed black or white. Enumerated Values: NORMAL = pixels shall be printed as specified by the Photometric Interpretation (0028,0004) REVERSE = pixels shall be printed with the opposite polarity as specified by the Photometric Interpretation (0028,0004) If Polarity (2020,0020) is not specified by the SCU, the SCP shall print with NORMAL polarity. Description is the same as in Table C.13-3. Overrides the Magnification Type specified for the Film Box Description is the same as in Table C.13-3. Overrides the Smoothing Type specified for the Film Box See Table C.13-3 for description of Configuration Information. Width (x-dimension) in mm of the image to be printed. This value overrides the size that corresponds with optimal filling of the Image Box. Specifies whether image pixels are to be decimated or cropped if the image rows or columns is greater than the available printable pixels in an Image Box. Decimation means that a magnification factor <1 is applied to the image. The method of decimation shall be that specified by Magnification Type (2010,0060) or the SCP default if not specified Cropping means that some image rows and/or columns are deleted before printing Enumerated Values: DECIMATE = a magnification factor <1 to be applied to the image. CROP = some image rows and/or columns are to be deleted before printing. The specific algorithm for cropping shall be described in the SCP Conformance Statement. FAIL = the SCP shall not crop or decimate A sequence which provides the content of the grayscale image pixel data to be printed. This is a specialization of the Image Pixel Module defined in C.7.6.3 of this part. It is encoded as a sequence of Attributes of the Image Pixel Module. Zero or one Item may be included in this Sequence. See PS 3.4 for further description. See C.7.6.3 for description of Image Pixel Module. Enumerated Value: 1

Table C.7-11a describes the Image Pixel Module. Table C.7-11a IMAGE PIXEL MODULE ATTRIBUTES Table C.7-11b specifies the common attributes that describe the pixel data of the image. Table C.7-11b IMAGE PIXEL MACRO ATTRIBUTES

See C.7.6.3 for description of Image Pixel Module. Enumerated Values: MONOCHROME1 MONOCHROME2

See C.7.6.3 for description of Image Pixel Module

See C.7.6.3 for description of Image Pixel Module. Enumerated Values: 8 (if Bits Stored = 8) 16 (if Bits Stored = 12)

See C.7.6.3 for description of Image Pixel Module. Enumerated Values: 8 12

See C.7.6.3 for description of Image Pixel Module. Enumerated Values: 7 (if BITS STORED = 8) 11 (if BITS STORED = 12)

See C.7.6.3 for description of Image Pixel Module. Enumerated Value: 0 (unsigned integer)

See C.7.6.3 for description of Image Pixel Module

A sequence which provides the content of the color image pixel data to be printed. It is a specialization of the Image Pixel Module defined in C.7.6.3 of this part. It is encoded as a sequence of Attributes of the Image Pixel Module. Zero or one Item may be included in this Sequence. See PS 3.4 for further description. See C.7.6.3 for description of Image Pixel Module. Enumerated Value: 3

See C.7.6.3 for description of Image Pixel Module. Enumerated Value: RGB

See C.7.6.3 for description of Image Pixel Module. Enumerated Value: 1 (frame interleave)

See C.7.6.3 for description of Image Pixel Module.

See C.7.6.3 for description of Image Pixel Module. Enumerated Value: 8

See C.7.6.3 for description of Image Pixel Module. Enumerated Value: 7

See C.7.6.3 for description of Image Pixel Module. Enumerated Value: 0000H (unsigned integer)

See C.7.6.3 for description of Image Pixel Module

The position of the annotation box in the parent film box. Annotation position sequence depends on the selected Annotation Display Format ID (2010,0030) Text string Execution status of print job. Enumerated Values: PENDING PRINTING DONE FAILURE Additional information about Execution Status (2100,0020). Defined Terms when the Execution Status is DONE or PRINTING: NORMAL Defined Terms when the Execution Status is FAILURE: INVALID PAGE DES = The specified page layout cannot be printed or other page description errors have been detected. INSUFFIC MEMORY = There is not enough memory available to complete this job. See Section C.13.9.1 for additional Defined Terms when the Execution Status is PENDING or FAILURE.

Additional Defined Terms for Printer Status Info (2110,0020) and Execution Status Info (2100,0030) are:

Date of print job creation. Time of print job creation. Priority of print job (see C.13.1 for further explanation). User defined name identifying the printer. DICOM Application Entity Title that issued the print operation. Printer device status. Enumerated Values: NORMAL WARNING FAILURE Additional information about Printer Status (2110,0010). Defined Terms when the Printer Status is equal to NORMAL: NORMAL See Section C.13.9.1 for Defined Terms when the Printer Status is equal to WARNING or FAILURE.

Additional Defined Terms for Printer Status Info (2110,0020) and Execution Status Info (2100,0030) are:

User defined name identifying the printer. Manufacturer of the printer. Manufacturer's model number of the printer. Manufacturer's serial number of the printer. Manufacturer's designation of software version of the printer. Date when the printer was last calibrated. Time when the printer was last calibrated. Contains printer configuration information for a single Application Entity title. See Print Management Service Class Structure in PS 3.4. The sequence shall contain one item for each physical printer/Meta SOP Class combination supported by the Application Entity title. The Meta-SOP Class and a list of optional SOP Classes supported. It shall contain one Meta SOP Class UID and 0-n optional SOP Class UIDs. Maximum number of kilobytes of memory that can be allocated for a Film Session. The value shall be 0 if Memory Allocation (2000,0060) is not supported. The maximum number of bits for each pixel that can be stored in printer memory. The number of bits used by the print engine for internal LUT calculation and printing of each pixel. A sequence which specifies the combinations of Medium Type and Film Size IDs available in the printer at this time and the Min and Max Densities supported by these media. The Item Number with the value of 1 is the printer default. There is no significance to other item numbers. One item for each Medium Type and Film Size ID installed shall be included. A number that labels this item. Each item in the sequence shall have a unique number. See C.13.1

Table C.13-1 BASIC FILM SESSION PRESENTATION MODULE ATTRIBUTES

See C.13.3